INSTRUCTORS MANUAL for Healthy Foundations in Early Childhood Settings. 6th Edition by Pimento Barba by digitaldownload87

UNIT

Health Promotion

CONTENTS

CLASSROOM ACTIVITIES AND DISCUSSIONS..........................................................................3 Critical Thinking...................................................................................................................................... 8 First (refer to text page 11) ........................................................................................................................ 8 Second (refer to text page 26) ................................................................................................................... 9 Third (refer to text page 36) .................................................................................................................... 11 Fourth (refer to text page 39) .................................................................................................................. 11 Fifth (refer to text page 41) ..................................................................................................................... 11 Assess Your Learning ............................................................................................................................ 12 Resource Materials for Teaching........................................................................................................... 14

ANCILLARY MATERIALS ........................................................................................................15 Health Promotion: Getting Started Checklist ........................................................................................ 15 Medicare’s History: In Brief .................................................................................................................. 16 Some Practical Steps in Network Building for Educators ....................................................................... 16

ASSIGNMENT IDEAS .............................................................................................................18 TEST QUESTIONS ..................................................................................................................26 Terms from across Unit 1 ...................................................................................................................... 26 What Is Health? .................................................................................................................................... 28 Social Determinants of Health .............................................................................................................. 28 Canada’s Health Care System ............................................................................................................... 29 Changing Attitudes toward Health Care ................................................................................................ 31 Prevention and Health Promotion ........................................................................................................ 32 1-1

Health Promotion in Early Childhood Learning and Care Programs ....................................................... 34 Health Promotion Action Plan .............................................................................................................. 37 Networking with the Community ......................................................................................................... 39

HERE’S THE ANSWER—WHAT’S THE QUESTION? ...............................................................40

1-2

Classroom Activities and Discussions Here’s the Answer—What’s the Question? (see handout, page 1-36) Divide students into four groups and have each group develop ideas for the three components of health promotion: In a high-density area of the city, hundreds of families are living in several apartment buildings side by side down the street. The park is five blocks away and it doesn’t have any playground equipment for children. •

individual problem solving and self-reliance (suggestions: parent and children walk to the park after supper and brings balls, etc., to use; enroll children in physically active programs before or after school; family moves)

•

community action (suggestions: two or three families alternate taking all the children to the park or other facilities; tenants approach the landlord to renovate an empty apartment into an indoor play space and/or develop the rooftop; tenants from the various buildings approach the parks and recreation department, city hall, or a community service club to install playground equipment in the park)

•

societal change (suggestions: architects recognize the importance of incorporating physical space outdoors, and perhaps indoors, for children and adults, into the design of apartment buildings; municipal zoning bylaws require a certain amount of park/playground space be allocated to apartment buildings by the number of units or neighbourhood density)

Other topics/issues students could integrate into the health promotion action plan: health promotion; smoking; drinking and driving; TV advertising to children; speeding; increasing adults’ physical activity; violence in society; products over packaging; or any number of environmental issues. For example: You are a family daycare provider with five children under your care. All the children live in your neighbourhood, which has smokestacks from two local factories. Three of the five children have been diagnosed with asthma over the past year. You are concerned about the impact of the environment on their health and want to do something about it. You are aware that four of the issues of greatest concern to children’s health are air pollution, lead, pesticides, and PVCs. Public health agency’s organizational structure: The agency should be able to provide you with a list of various health personnel (with or without names) working in the agency’s office, and the types of services available to programs, parents, children, and families in the community. This information will be useful not only for programs networking with public health on specific issues, but also for referring parents to health services.

1-3

Invite a public health nurse, public health inspector, or nutritionist to come in and describe his or her role with programs in his or her area. Online posts to identify components of the health promotion action plan: Print posts (or view online) related to health issues that are currently appearing in the media. In their discussion of the issue (e.g., pesticides, food engineering, smoking, dangling curtain cords that have resulted in a child’s strangulation, etc.), most articles will include different components of action. The vast majority will at least discuss individual action and societal action (e.g., when a major food manufacturer recalls unsafe meat or the danger of small magnets that can be ingested). A number of media articles identify what consumers should be alerted to in regards to the meats they may have already purchased, and possible symptoms (individual problem solving). Most of these articles include the government’s reaction to this serious and widespread health occurrence, and what legislative changes need to happen to prevent recurrence (societal change). In addition to individual and societal action, there may be some discussion of the community action components of health promotion action; if not, it is interesting to brainstorm possibilities. Using current media information helps students to integrate their understanding of health promotion into “real” life and a way of thinking and acting. Identifying significant social determinants of health in early childhood learning and care (ECLC) programs: •

Download Putting Health Promotion into Action: A Resource for Early Learning and Child Care Settings by Best Start Resource Centre (2006) from https://www.beststart.org/resources/hlthy_chld_dev/pdf/hpaction.pdf

•

Provide each small group with a program description. Each group will identify the most significant social determinants that their assigned program is promoting and provide rationale for their choices.

Poverty—resources: •

See Resource Materials for Teaching, page 1-14.

•

Campaign 2000 produces a yearly report card on child poverty.

Health policies: Bring in (or ask students to bring in) examples of health policies from various ECLC programs (if you believe that the agency name should be anonymous, bring in the health policies with the names removed). In small groups, students work with two or three examples, evaluating the following:

1-4

•

What seems to be the most obvious purpose(s) of these policies?

•

Are the policies family-positive and do they promote family-centred partnerships, or are they written in a way that sounds inflexible?

It may be interesting to compare the same policies and procedures from different programs. You may be able to incorporate a timely local or national health issue into this discussion and its impact on policies (e.g., West Nile, unsafe water supply). Consider if program policy changes were a result based on fact rather than an overreaction to the issue and unrealistic perception of risk (e.g., overuse of gloves for diaper changes, the use of products claiming antibacterial properties). Health Promotion Action Plan Strategies: How Can We Do the Best for Our Children? 10 minutes: Write a specific example, including relevant information such as targeted age group, whether family members are involved, level of community or government if applicable, etc. Member 1: Individual Problem Solving and Self-Reliance _____________________________________________________________________ _____________________________________________________________________ Member 2: Community Action _____________________________________________________________________ _____________________________________________________________________ Member 3: Societal Change _____________________________________________________________________ _____________________________________________________________________ Cultural diversity: •

In small groups, students can share some health practices that they experienced growing up.

•

Were these experiences based on particular health beliefs and practices, and where did they originate?

•

Some questions that could stimulate this discussion include the following: o How were colds treated? o How were tummyaches treated?

1-5

o Were there particular illnesses that people were embarrassed to talk about? o What were practices that you did at home that were intended to keep you healthy (e.g., not going outside with wet hair)? o What were some beliefs that your grandparents or parents held about keeping healthy, and do you follow these now that you are an adult? Health promotion is the process of enabling people to increase control over and to improve their health. Health promoters include those who work to promote health regardless of professional designation, including people, organizations, and groups from various sectors. After reading this unit, do you recognize the role educators have as health promoters? Health promotion has been discussed in general terms in this unit. The upcoming units focus on specific content areas: occupational health, preventing illness, managing illness, nutrition, safety, healthy active living, preventing child maltreatment, and supporting children’s development. Before you delve into these units, identify at least one specific way educators can be health promoters in each of these areas. After you complete these units, revisit your response to this question and compare it with what you have learned throughout the course. Suggestions: Educators play an important role in the promotion of the children’s healthy development and contribute to the health of the children and their families. Here are a few examples: Units Occupational Health Illness Prevention Illness Management Nutrition Healthy Active Living Safety Promotion Preventing Child Maltreatment Supporting Children’s Development

Examples of the Role of Health Promoter Modelling good lifting practices, which benefits self and coworkers Teaching children how and when to wash hands Communicating your program’s exclusion criteria with parents to ensure the recovery of their child and limit transmission to others Creating a positive eating environment Active involvement and supervision in children’s outdoor play Director and staff stay current on issues around environmental health and safety; regularly monitor the centre for possible environmental hazards Ensuring that behaviour guidance is child-positive and promotes children’s well-being Creating a curriculum that supports the development of children’s learning about self: feelings, rights, and responsibilities

The community centre that houses your ECLC program is offering a community kitchen on Saturday afternoons. All families are welcome. The children will be cared for by paid 1-6

staff while the adults will cook together and bring home enough food for two evening family meals. Use the handout Health Promotion: Getting Started Checklist (page 1-14) as a guide to identify the determinants of health being addressed, and provide an example for how each of the features and values of a health promotion philosophy can be met in this scenario (refer to High-Quality Early Childhood Learning and Care Programs, text page 41). Suggestions: Here are a few examples: In What Areas Are We Taking Action? Determinants of Health Income and Social Status Social Support Networks Personal Health Practices and Coping Skills

How? Having the opportunity to make two meals for each week reduces their weekly food budget. The community kitchen provides opportunities for families to connect and offers mutual support. The community kitchen offers opportunities to increase knowledge of nutrition, understand the Nutrition Facts table on packaging, and gain cooking skills.

Features of Health Promotion Taking Participatory Approaches The community kitchen’s program requires and recognizes each person’s contribution in menu planning, introducing others to favourite recipes and unique fruit and vegetables. Values of Health Promotion Inclusion The community kitchen’s policy ensures that everyone has equal access to the program and necessary resources.

Referring to The Federal and Provincial/Territorial Collaboration to Deliver Medicare (refer to text page 13), have class discussions, either in large or small groups. The discussions can help students clarify their understanding of which roles and responsibilities the levels of government hold: •

In small groups, give students a scrambled list of the roles and responsibilities identified in the text, and ask them to place them under either a provincial or federal role/responsibility.

•

Can they identify specific examples of each of the National Principles of Medicare (five) “in action”?

•

Can they give examples of the two levels of government working together to ensure that the National Principles of Medicare are met by Canadians?

•

Discussion of the workings of transfer payments in your province or territory.

1-7

•

Discussion of how the roles/responsibilities of the municipal government relate to the delivery of health care.

Discussion about Table 1.2: The Elements of Quality Early Childhood Learning and Care (refer to text page 43). Discussion about Figure 1.3: Groups and Individuals Who Interact with ECLC Programs (refer to text page 55). Can students identify specific examples in their community?

Critical Thinking First (refer to text page 11) Referring to the preceding discussion on the multipronged population health approach and the example of a community’s polluted water, let’s take a look at the ongoing discussion around another issue: harmonizing Canada’s immunization schedule. As you may or may not know, the provincial and territorial governments have responsibility for determining which routine immunizations will be recommended and funded. This results in a patchwork of routine schedules for infants and children, with possible serious health consequences. One example is the hepatitis B vaccine, where provinces and territorial programs vary widely in age of immunization. Some require it to begin at birth, whereas others have it available routinely as late as Grade 7. One major consideration that puts children in Canada at risk for inadequate immunization coverage is the reality that many families move from one province to another annually. Inconsistent immunization schedules result in infants and children missing doses, putting them unnecessarily at risk for certain contagious illnesses (Canadian Paediatric Society, 2018). Consider the following points to develop a population health strategy to harmonize the delivery of vaccines in Canada, which would address inequity and safety problems for children: •

Invest Upstream We have a national immunization schedule, yet the provinces and territories create their own and determine which vaccines are covered by their health plan (see The Federal and Provincial/Territorial Roles and Responsibilities, text page 13).

•

Base Decisions on Evidence Science has demonstrated the effectiveness and safety of immunizing children and adults (see Immunization, text page 139). There are parents who choose not to immunize their children. There continue to be claims that immunizations are responsible for causing autism, yet science has proved that this is not true. Would these unfounded claims impact the lobbying effort to harmonize immunization and ensure that as many children’s immunizations as possible are upto-date?

•

Apply Multiple Strategies to Act on the Determinants of Health If we were to snap our fingers and all the provinces and territories implemented the national immunization schedule tomorrow, the work still wouldn’t be done. What else would need to be done to support this program? (Examples include reducing the cost of

1-8

vaccines, educating health care providers and the public on the national schedule, and catching up children’s immunizations.) •

Collaborate across Levels and Sectors The National Advisory Committee on Immunization (NACI) consists of a wide range of governmental, public health, and medical representatives. Aside from health care, who else in Canada may join the lobby nationally and locally to move to a harmonized program?

•

Employ Mechanisms to Engage Citizens Ultimately, families are responsible for ensuring that their children are immunized. How does your strategy bring families into supporting the harmonization? Does the “one size fits all” approach work when developing educational material for families? If not, what factors do the writers need to keep in the forefront when developing material? (Some examples might be using social media or sending out reminders that a child is due for a vaccine using an automated phone and/or email system.)

•

Increased Accountability for Health Outcomes What kind of research and feedback do you think needs to be shared with public health professionals and families as a harmonized program is rolled out and into the future? Suggestions: You may find these resources helpful for the discussion on immunization: •

Canadian Paediatric Society: https://www.cps.ca/en/documents/position/harmonized-immunizationschedule-Canada

•

National Advisory Committee on Immunization, Government of Canada: https://www.canada.ca/en/public-health/services/immunization/nationaladvisory-committee-on-immunization-naci.html

Second (refer to text page 26) Serena, a young woman who spends most of her time on social media, sneaks away at work whenever possible and can’t wait for her next break time to check who has responded to her latest tweet or posted on Instagram. As coworkers stop talking to her, and friends only contact her on social media, Serena begins to realize that she has an addiction that has actually resulted in loneliness and isolation, rather than social wellbeing. Serena’s best friend, as well as her siblings, have told her that she doesn’t look or listen to anyone; she just stares at her phone. Her boss just gave Serena a final notice in writing that she will be fired if she doesn’t focus on her work. Give an example of a prevention strategy within a health promotion framework. Which of the social determinants of health could be affected by Serena’s addiction to social media? Suggestions: Serena must recognize the personal impact that her addiction to social media is having on a healthy life. Copyright © 2019 by Nelson Education Ltd.

1-9

She needs to find ways to get support that will help reduce or fully stop this practice that is not only detrimental to her mental and social well-being but also may soon lead to a precarious (unstable) work-life situation. She is in serious danger of losing her job and her social support (family and friends). An example of a prevention goal is to completely stop sending tweets and posting on Instagram, using strategies that will help her focus on much more positive aspects of her life: •

Apologize to her closest friends and family members who are concerned about Serena’s well-being, and negotiate ways she can return to a more positive social life with them without the use of social media. For example, family may ask for Serena’s focus at the dinner table or other get-together opportunities where use of social media is off limits. Friends and coworkers may come up with suggestions to help Serena enjoy other activities, such as a walk with a work partner during the lunch hour or with a friend after dinner. There are many other ways that friends and family may be able to support Serena’s needs to stop her addiction, which will also help to improve her mental and social well-being.

•

Ensure that her work ethic improves, including a focus on the responsibilities she has while in the workplace, so that she will not be fired.

When Serena’s goal to end her social media addiction is achieved, she will be on the way to improving her health. As is evident from Serena’s situation, the following social determinants of health could be detrimentally affected if her addiction to social media does not stop: •

Income and social status

•

Social support networks

•

Personal health practices and coping skills

See other suggestions to deal with social media addictions at

1-10

•

“Addicted to Social Media?” in Psychology Today by M. D. Griffiths (May 7, 2018) from https://www.psychologytoday.com/ca/blog/inexcess/201805/addicted-social-media

•

“6 Questions Help Reveal If You’re Addicted to Social Media” in The Washington Post by M. Griffiths & D. Kuss (April 25, 2018) from https://www.washingtonpost.com/news/theworldpost/wp/2018/04/25/socialmedia-addiction/?noredirect=on&utm_term=.808cbd5af28b

Third (refer to text page 36) For the education and literacy determinant of health, particularly health literacy, give an example of how an early childhood learning and care program can support newcomer families in promoting their health. Refer to the Canadian Paediatric Society’s Caring for Kids New to Canada website. Suggestions: In Section Four: Training & Resources (p. 41) of Putting Health Promotion into Action: A Resource for Early Learning and Child Care Settings by Best Start Resource Centre (2013), Early Learning Canada, which supports education and literacy, is summarized. Download from https://www.beststart.org/resources/hlthy_chld_dev/BSRC_HP_Action_June2013.pdf Fourth (refer to text page 39) Your program’s philosophy places a high value on helping children develop independence. However, one family in the program places a high value on interdependence (i.e., a long-term commitment to depending on one another, remaining close to family). How do the staff and parents compromise in the best interest of the child? Suggestions: Depending on the age of the child, different issues may arise. For example: Interdependence infants adult always holds toddlers adult always feeds preschoolers adult dresses child

Independence child encouraged to have more time on the floor child feeds self child tries to dress self

As long as the educators care for the well-being of the child and respect the child’s place in the family, most issues can be negotiated. For an infant—assure the parent that, although the infant won’t be held all the time due to their 1:3 ratio and because of the program’s philosophy, infants will be responded to and will never be left to cry. When an infant is not being held, an effort will be made to provide security and culturally relevant artifacts whenever possible. Younger infants are placed in a swing for short periods, familiar music from the child’s first language is played during floor time, and so on. If conflicts arise, try to negotiate—flexibility is an important role of the program. Fifth (refer to text page 41) Your main responsibility as an educator is to focus on each child’s healthy development and communicate updates with the child’s family on a regular basis. However, you may find that it is challenging for families, especially newcomer families, to focus on these discussions when they are facing immediate issues and problems. Refer to the most applicable social determinants of health to ECLC programs (see text page 27) to identify two relevant determinants that may be at the forefront of family concerns after arriving in Canada. Think of at least one positive, respectful way to support parents in becoming Copyright © 2019 by Nelson Education Ltd.

1-11

more ready to discuss their child’s development with staff (see Growing Up in a New Land: A Guide for Newcomer Parents in the Resource Materials on the Nelson site). Suggestions: Although any of the social determinants of health may be of relevance to newcomer families to Canada, likely the following would be of most concern: •

Income and Social Status

•

Education and Literacy

•

Culture

•

Social Support Networks

For positive, respectful ways to support parents in becoming more ready to discuss their child’s development with educators, we suggest referring to What’s Good for Children: A Multiethnic View (refer to text page 40). In addition, the Best Start Resource Centre has resources that are supportive to 1. Newcomer families with young children, such as Growing Up in a New Land: A Guide for Newcomer Parents: https://www.beststart.org/resources/hlthy_chld_dev/Growing_up_Parents_EN _online_Final.pdf 2. Staff in agencies working with newcomer families, such as Growing Up in a New Land: Strategies for Working with Newcomer Families: https://www.beststart.org/resources/hlthy_chld_dev/growin_up/growing_up_n ew_land_June2013.pdf Note: Although resources in these PDFs mostly include Ontario-based options, these can be substituted with those from your province/territory.

Assess Your Learning Evaluate your options in each situation. 1. Your doctor hands you a prescription. When you ask him what it’s for and whether there are any side effects, he replies, “Don’t worry about it. Just take these pills and you’ll feel better.” Suggestions: The doctor’s comment is a clue that he has a paternalistic view of the physician–patient relationship rather than a partnership; if you don’t feel intimidated and feel comfortable enough, you could respond by saying that you don’t take medication without understanding what it is for, what it can do, and potential side effects; if he doesn’t take the time to answer your questions, ask him who can (i.e., pharmacists); consider changing physicians to one with a patient-centred philosophy; in a community with only one doctor, continue to ask questions, ask the receptionist to book you enough time to talk with the doctor 1-12

during appointments, inform yourself with books, and speak with your community’s public health nurse. Over time, perhaps you and other like-minded patients will change the doctor’s attitude. 2. Classes have been cancelled for the day to allow students to attend a child care rally at the legislature. You are tempted to skip it because you have to study for a test. Suggestions: When you consider the short- and long-term consequences, it should become clear that attending the rally is a better choice. Examples: •

You have the opportunity to see the political process at work and find out where the MLAs stand on the ECLC issue, as their decisions will affect your professional future.

•

You will experience first-hand the passion that ECLC advocates bring to the political process and the emotions among all the participants.

•

By cancelling classes for the day, the ECLC instructors are making a powerful statement, viewing students’ attendance as a valuable experience, an experience equal to going to class.

•

If you skip it and study, you may improve your mark, but in the grand scheme of things, is this the priority? You will have time to study before and after the rally.

•

You will be able to participate in the class discussion about the rally.

3. A parent is angry at pickup time because his daughter’s sleeves are damp from water play, even though she was wearing a smock. He believes that this is how someone gets a cold. He asks that his daughter never play at the water table again. Suggestions: Although you know that this is a commonly held myth, the parent is obviously concerned about his child. Acknowledge the parent’s feelings: “I can see that you’re angry about your daughter’s wet sleeves, but she really loves water play.” Negotiate options, such as her changing into a short-sleeved top before water play, or having another top in the cubby to change into if what she is wearing gets wet. If a number of parents hold this myth and others around illness, it would be beneficial to have the public health nurse or an infectious disease expert come in to speak at a parents’ night; be sure to access material written in the parents’ first language. 4. One of the parents of a child in the infant room says she doesn’t know what to do because she gets different messages at every turn. The information in her magazines and what she finds on the Internet differs from what her husband’s family tells her, and that differs from what the educators say and do in the ECLC program. Suggestions: Educators listen to the mother’s concern about mixed messages; mutual respect makes ongoing communication more effective; when parents Copyright © 2019 by Nelson Education Ltd.

1-13

believe they are being heard, they are more open to problem solving; this process can reduce confusion and mixed messages; it may be helpful to recommend resources and keep in mind cultural values and practices. 5. A safety issue arises at the centre. None of the staff can think of a viable response, and you suggest that consulting with another centre may provide options. The director insists, “We can work this out ourselves,” and does not want outside interference. Suggestions: You are placed in an awkward position since you look to the director for guidance yet she or he mistakenly believes that programs should operate completely independently; perhaps this comes from a lack of self-confidence, or concern that staff are usurping the director’s authority, or other directors will think the individual is not an effective director; when concerned about the safety of the children or staff, do your best to communicate the urgency of the situation to the director—for example, “I know you’ve really tried to come up with a solution, but if an injury occurs because of this hazard, the program could be held legally responsible. We must consult with someone else who has experience in this issue”; talk with someone from the program’s board; as a last resort, contact the consultant from the provincial/territorial child care licensing agency.

Resource Materials for Teaching National Collaborating Centre for Determinants of Health’s Resource Library: http://nccdh.ca/resources/library/ Let’s Start a Conversation about Health … and Not Talk about Health Care at All is a video on the social determinants of health that have been adapted to meet the needs of different public health regions in Ontario. The links to the various health regions’ videos are on the website along with a link to their user guide: To download the user guide, visit https://www.youtube.com/watch?v=QboVEEJPNX0 Ontario Health Promotion Resource System. Health Promotion Foundations Course. This series of interactive modules introduces the field of health promotion in Canada. Definitions, concepts, milestones, models, theories, strategies, and more are covered in this self-directed course. Completion certificates are available for each module. To learn more about this free course and how to complete it, visit https://www.publichealthontario.ca/en/LearningAndDevelopment/OnlineLearning/Health Promotion/Pages/default.aspx “Social Determinants of Children’s Health in Canada: Analysis and Implications,” International Journal of Child, Youth and Family Studies (2014) by Dennis Raphael. To view the article, visit http://scholar.google.ca/scholar_url?hl=en&q=http://journals.uvic.ca/index.php/ijcyfs/arti cle/download/12899/3988&sa=X&scisig=AAGBfm3t2hcShQhWaN57NcrF8icHJ7q8g&oi=scholaralrt

1-14

Ancillary Materials Health Promotion: Getting Started Checklist This checklist may help you determine where your program currently practises health promotion and where it might be possible to include or address health promotion more. Use the checklist as a launching point to identify if your program is aware of the determinants of health and the features and values of health promotion. It may help you see what you are already doing and in what areas you may need to take more action. In the last column, you can briefly note what next steps you can take.

Health Promotion

Are We Aware of the Determinants of Health and the Features and Values of Health Promotion? DETERMINANTS OF HEALTH

In What Area Are We Taking Action?

In What Areas Do We Need Strengthening?

What Are the Next Steps to Consider?

Income & Social Status Social Support Networks Employment & Working Conditions Education & Literacy Social Environments Physical Environments Personal Health Practices & Coping Skills Healthy Child Development Biology & Genetic Endowment Health Services Gender Culture FEATURES OF HEALTH PROMOTION Taking a Holistic View of Health Taking Participatory Approaches Building on Strengths Addressing the Determinants of Health Using Multiple, Copyright © 2019 by Nelson Education Ltd.

1-15

Complementary Approaches VALUES OF HEALTH PROMOTION Empowerment Respect Inclusion Social Justice & Equality Source: Best Start: Ontario’s Maternal, Newborn and Early Child Development Resource Centre. (n.d.). Putting Health Promotion into Action: A Resource for Early Learning and Child Care Settings, pp. 46–47. https://www.beststart.org/resources/hlthy_chld_dev/pdf/hpaction.pdf

Medicare’s History: In Brief The Evolution of Canada’s Medicare System 1867

The British North America Act (BNA) proclaimed Canada’s Confederation, which granted provinces jurisdiction over hospitals. Most hospitals were run by voluntary, charitable, or municipal organizations. Those who could afford to pay for services (fee-forservice) did so.

1935–1945

The federal government made two attempts at establishing a national health insurance program, but both attempts failed because the provinces viewed the program as an intrusion on their jurisdiction.

1947

Saskatchewan Premier Tommy Douglas introduced the first hospitalization plan in Canada, for all Saskatchewan residents. British Columbia, Alberta, and Newfoundland and Labrador soon followed with similar plans.

1957–1967

With the passage of the federal Hospital Insurance and Diagnostic Services Act (HIDS) and the Medical Care Act (medicare), respectively, the provinces recognized the advantage of a cost-sharing agreement with the federal government.

1972

All the provinces had now entered into this provincial–federal agreement. Health care for the territories and First Nations and Inuit communities is primarily the responsibility of the federal government. Transfer payments are made to each province, but each plan must comply with the national principles of medicare.

1984

The Canada Health Act abolished extra billing and user charges to ensure that all Canadians had equal access to necessary medical services.

Some Practical Steps in Network Building for Educators To Improve the Status of Early Childhood Learning and Care as a Profession 1-16

Actively participate in your local, provincial, or national early childhood education associations. Improve your own knowledge and skills through continuing education. Lobby for better working conditions and salaries. Demand better resource services. Support improved standards and insist that resources be made available to implement them.

1-17

To Build a Local Network Exchange information with •

parents

•

members of your board of directors or • parent advisory committee • coworkers • public health nurses • physicians •

• • •

•

other health professionals social workers cultural centre representatives suppliers of goods and services politicians teachers

Seek help and advice from a wide variety of sources, such as universities, colleges, religious institutions, and bureaucrats. Make contact with local schools attended by older children and siblings of younger children. Open your centre to students in health care, social service, and education who express an interest in learning about ECLC. Offer your expertise to community groups. Present workshops at early childhood education and other meetings. Share information with other educators and interested professionals. Have open houses at centres. Write articles for local newspapers and professional journals. Invite a broad range of people to sit on your board of directors or parent advisory committee.

Assignment Ideas 1. Contact your public health department:

1-18

•

Determine available publications and DVDs/videos, and in what language(s).

•

Ask for the name of your medical officer of health.

•

Inquire about the range of health services provided to programs in your area.

2. What is the range of health care delivery services available (i.e., community-based health centres; physicians who practise complementary medicine) in your community? 3. Divide students into six groups and assign each with one grouping from Figure 1.3 (refer to text page 55) to develop specific examples of those interacting with organizations associated with your ECLC program. Return and share with the class. 4. Health policies: Using copies of policies from ECLC programs (anonymously), have students answer some or all of the following questions (refer to Early Childhood Learning and Care Program Policies, text page 43): •

Does it contribute to quality ECLC?

•

Does it outline good practice for educators?

•

Is the rationale clearly explained?

•

Does it define lines of communication and confidentiality?

•

Is it up-to-date with health and ECLC research?

•

Could it be revised in any way? If so, make the specific changes and explain how you have improved (i.e., strengthened, clarified, added rationale, updated).

•

How would the staff and parents be advised of the change in policy?

5. Debate: “CPS position on Natural Health Products” STUDENTS READ ARTICLE : https://www.cps.ca/en/documents/position/naturalhealth-products (Note: Link available in NELSONstudy, Resource Materials (Unit 1): Printed Matter and Online Resources ) “The use of complementary and alternative medicine (CAM) in Canada has grown exponentially in recent years” – opening sentence in POSITION STATEMENT (Canadian Paediatric Society): “Children and natural health products: What a clinician should know” Copyright © 2019 by Nelson Education Ltd.

1-19

IN CLASS, EITHER FULL CLASS DISCUSSION, OR SMALL GROUPS OF 6 STUDENTS, WITH EITHER 2 DISCUSSING ON EACH SIDE (positive, negative, neutral) OR 3 DISCUSSING ON EITHER POSITIVE OR NEGATIVE SIDE (with some discussion from instructor re: neutral) AN INTRODUCTION TO STUDENTS SHOULD INCLUDE A REMINDER THAT THEY ARE NOT DOCTORS NOR NURSES; THE PURPOSE OF THIS ASSIGNMENT IS TO BRING AWARENESS THAT MANY FAMILIES MAY USE COMPLEMENTARY AND ALTERNATIVE MEDICINE INSTEAD OF OR IN ADDITION TO THEIR FAMILY DOCTOR’S PRESCRIPTIONS OR ADVICE. Educators need to have a nonjudgmental attitude- and avoid lack of sensitivity or concern for the family’s perspective. Additional resource: https://www.caringforkids.cps.ca/handouts/natural_health_products_and_children If instructor wants written work from each group: Blank table with 2 or 3 columns and at least 3 rows with examples of why positive, negative (or neutral), to be handed in with students’ names at the end of the discussion. Positive side

1-20

Negative side

Unsure ( or ‘neutral’)

6. Example:

Positive side

Negative side

Unsure (or ‘neutral’)

Natural Health Products

There is considerable

Findings confirm what

have been used for

variation in the purity and

paediatricians have always

generations. These practices

potency of products, and

known: children are not

thrive within the

contamination is a major

small adults. Children are a

multicultural milieu of North

concern (e.g., heavy metal

special population by virtue

America. Each cultural

poisoning from traditional

of their small size, immature

1-21

heritage is quite aware of

Chinese medicines has been

physiology and ongoing

which plants are poisonous

reported several times)

growth and development

and how to prepare them in a nontoxic manner. Moreover, these cultures have given us many drugs that are currently used (eg, reserpine, digoxin, vincristine) No doubt that these practices will lead to continued discoveries.

7. Health promotion action plan: You may want to combine this major assignment with the English department, which has a couple of advantages: •

Students complete this one assignment for both courses.

•

The ECE and English instructors are able to work collaboratively to give the students more comprehensive feedback.

This assignment provides students with the opportunity to think about a health issue in a way that makes it evident that most health concerns are multifaceted, and to explore the different parties’ perspectives and interests. We would suggest having students complete this assignment near the end of the course, which provides them with the opportunity to revisit the action plan found at the end of all units before they begin this assignment. There are many ways to adapt this assignment, including expanding the topic areas. We have chosen environmental and occupational health and safety topics because we haven’t been able to devote as much classroom time as we would like to these areas. However, there are endless possibilities. Students can make their selection from the list of topics you provide when the assignment is introduced. If students prefer to select a topic not listed, it is advisable to have them seek your approval before they begin to ensure its relevance. Environmental Health and Safety Topics 1-22

People in Canada are becoming increasingly aware of environmental health and safety from a personal perspective, at the community level, and globally. Identify one environmental health and safety issue that may impact upon the health of children, parents, and program staff, and explore how many perspectives this one issue may have. Here are a few examples: •

organic foods

•

hormones in meat and food additives

•

pesticides

•

climate change

•

product packaging

•

safe drinking water/bottled water

•

garbage disposal/waste management (e.g., diapers)

•

lead poisoning

•

air pollution

•

radon levels

Note: the discussion on Environmental Contaminants in Unit 7: Safety Promotion (refer to text page 444) and the Canadian Partnership for Children’s Health and Environment: http://www.healthyenvironmentforkids.ca/ Occupational Health Topics Our workplaces’ physical attributes contribute to our well-being either positively or negatively. The way in which work responsibilities are organized and the style of management, along with the skills and abilities of employees, can have a significant impact on our health. Identify one health issue that is common in ECLC programs and directly affects staff and may indirectly affect the children and families: • • • • • •

physical injuries use of cleaning and sanitizing products infections (e.g., respiratory, gastrointestinal, blood-borne) physical environment educators who are pregnant premenstrual syndrome

• • • • • •

issues for male educators stressors of working with different age groups turnover job advancement salaries access to post-diploma education

1-23

One: Submit a preliminary plan to both instructors, which is due two or three weeks after the assignment is introduced to students. (This ensures that you know that the student is on the right track and you can provide each with your feedback before completing the assignment.) As well, you can allocate a portion of the final mark to this component. This plan includes: •

the key questions about the issue/topic the student has selected. At least one of these questions must deal directly with early childhood education. (Provide students with the following list of general questions, which will help them think about their specific issue.) For example: Questions to think about as you select your issue, conduct your research, and develop the assignment: o How is this issue a problem for you as well as for children, parents, and staff in the program? Put yourself in each of the players’ shoes. o What is currently being done, if anything? If something is being done, how effective is it? What possible alternatives exist, and how will that help? To gain insight and the various viewpoints of each of the players, ask yourself who benefits from each alternative. o How is this issue dealt with from the perspectives of prevention, management, and the promotion of appropriate attitudes and policies by the community, the program you are referring to, the various levels of government, institutions, and society at large? o What, if anything, could the other possible players do? o What approach(es) to health is/are being taken: a medical approach, a behavioural approach, or a socio-environmental approach? o Could this issue be incorporated into health curriculum for children? If so, choose either preschoolers or school-agers and describe.

Two: An annotated bibliography. Include at least 10 sources/references that you will use during the research of this assignment (e.g., academic journals, magazine and newspaper articles, online posts, books, TV programs, DVDs/videos, names of organizations, interviews with key informants, or surveys that you may want to conduct). (Provide students with an example of the style for citations, the bibliography, and direct quotes and explain how to avoid plagiarism. If you are collaborating with the English instructor, ideally both she or he and you can discuss this information with the students and provide them with a handout.) Three: The final assignment: 1-24

a) will be 1200 to 2000 words in length and typed or neatly written (doublespaced) b) will clearly and concretely identify the issue/topic c) will refer to the list of questions you submitted in the preliminary plan d) for each of the three components of the health promotion action plan, will indicate specific suggestions for action e) will include a complete bibliography (add any additional resources used after the preliminary plan was submitted) f) will be submitted to your ECE instructor, and another copy of the assignment to your English instructor 8. Report on a health story in the news. From a newspaper, magazine, or online post, each student selects a story covering a current health issue (at least 600 words in length). You could stipulate that the issue be related to children, but often students more fully understand the components of the Health Promotion Action Plan when using examples that are personally relevant. The following is a suggested grading scheme: Complete the following questions in a report format and bibliography: a) Summarize the article in 200 words or fewer, identifying the health promotion issue and the players. (graded on clarity and relevance to health promotion) Marks: 0, 1, 2, 3 b) Identify and briefly describe two components of the health promotion action plan (i.e., individual, community action, societal change) discussed in the article in 200 words or fewer for each level. (graded on correct identification and clarity of description) Marks: 0, 1, 2, 3, 4 c) For the health promotion action plan component that was not identified in the article, make a specific suggestion for action in 200 words or fewer. (graded on relevance of action to issue and creativity) Marks: 0, 1, 2, 3 9. Social determinants of health: •

Students are instructed to select one of the five social determinants most applicable to ECLC settings (refer to text page 27).

1-25

•

Give a 100- to 200-word introduction describing the determinant.

•

Relate it to one of their practicum placements (approximately 500 words).

10. Cultural diversity: The goal of this group assignment is to have students become familiar with the culturally relevant resources that are available in their community on a variety of health issues. This can include public health information, communitybased health clinics, agencies that serve particular ethnocultures, government services, and immigration services. Have each group of students research and document the materials available, how they are accessed, languages they are available in, and resources that they find on their assigned topic (e.g., infection control, dental health, immunization, nutrition, physical activity, short-term illness, asthma, allergies, etc.).

Test Questions Terms from across Unit 1 For each statement (1–14), fill in the blank with the most correct term from the following list (A–S): A. complementary (or traditional) health practitioner B. cultural safety C. culture D. developmental health E. health F. health policies G. health promotion

H. health promotion action plan I. interprofessional collaboration

N. prevention O. primary health care system P. public health system

J. national principles of medicare

Q. quality of life

K. natural health products

R. social capital

L. networking

S. social determinants

M. population health

1. _____ refers to the degree to which an individual enjoys the important dimensions of her or his life, including the fulfillment of physical and emotional needs, social belonging, and the realization of goals, hopes, and aspirations. (Q. quality of life) 2. _____ is the extent to which an individual or group is able, on the one hand, to realize aspirations and satisfy needs, and, on the other hand, to change or cope with the environment. (E. health) 3. _____ is the process of enabling people to increase control over and to improve their health. (G. health promotion) 4. _____ A wealth of evidence supports the view that the social, economic, and physical environmental circumstances of individuals and groups are equally or more important to our health status than medical care and personal health 1-26

behaviour (S. social determinants) 5. _____ gives professionals the opportunity to learn with, from, and about each other, building mutual respect as well as shared knowledge and decision making in the best interests of patients. (I. interprofessional collaboration) 6. _____ publicly administered, comprehensiveness, universality, accessibility, and portability. (J. national principles of medicare) 7. _____ involves identifying the factors that cause a condition and then reducing or eliminating them. (N. prevention) 8. _____ approach aims to improve the health of the entire population and to reduce health inequities among population groups. (M. population health) 9. _____ refers to the outcome of interactions in which individuals experience their cultural identity and way of being as having been respected or, at least, not challenged or harmed. (B. cultural safety) 10. _____ are now the most popular form of complementary health care in North America. (K. natural health products) 11. _____ When they are well written, their rationale is clearly understood, and the stated procedures obviously promote the well-being of children, staff, and families. (F. health policies) 12. _____ essentially includes conventional medical services available to people who want to maintain their health and seek cures for illness. (O. primary health care system) 13. _____ establishes a set of strategies that can be divided into three components: individual problem solving and self-reliance, community action, and societal change. (H. health promotion action plan) 14. _____ is a term that means the power of socially cohesive communities that benefit all children and families, as communities support healthy practices by making a healthy choice the easy choice. (R. social capital)

1-27

What Is Health? Objective: To identify the World Health Organization’s definition of health. (LO 1) •

(T or F) When a person isn’t sick, he or she is healthy.

•

Health is the interrelationship among our physical, __________, and __________ well-being. (answer: emotional; social)

•

Our __________ and ___________ well-being will have a positive or negative impact on our emotional well-being. (answer: physical; social)

•

In your own words, define health according to the World Health Organization (WHO). (answer: health is seen in the broader context for either an individual or group; health permits us to maximize our potential; our health status encompasses our physical, emotional, and social well-being and that these are interconnected)

•

World Health Organization’s definition of health includes a. health is the objective for living b. the extent to which we are able to realize our goals and satisfy our needs c. our ability to change or cope with change d. both b and c e. a, b, and c

Social Determinants of Health Objectives: To list the 12 social determinants of health, as defined by the Government of Canada. (LO 1) To define the term “population health.” (LO 1) To list the features of a population health approach. (LO 1) •

Identify 3 of the 12 social determinants of health and explain how each of these can impact an individual’s health. (answer: refer to text page 5)

•

Define population health.

1-28

•

List three (3) features of a population health approach. (answer: refer to text page 8– 11)

•

(T or F) Canada has one of the highest standards of living in the world; therefore, we are fortunate that very few children live in poverty here.

•

Which of the following is not likely to be considered a social determinant of health? a. freedom from discrimination b. eating habits c. access to an adequate income d. life skills

•

Housing insecurity includes the following: a. living in unsafe housing b. having neighbours who make a lot of noise c. the need to spend half or more of an individual’s or family’s income d. a, b, and c e. a and c

•

Provide an example of how being a victim of discrimination can affect one’s health. (answer: examples—lack of suitable student housing; a senior citizen may not be given priority for an organ transplant; an individual with a low income has limited access to adequate health care and services, possibly due to others blaming the victim, causes low self-esteem; a child who is heavier than peers is always the last picked for a team, which will have a negative effect on his self-esteem and interest/motivation for physical activity)

Canada’s Health Care System Objectives: To list and define the national principles of medicare. (LO 3) To differentiate between the roles and responsibilities of the federal and provincial/territorial governments on the delivery of health care. (LO 5) To differentiate between the roles of the primary and public health care systems. (LO 5)

1-29

•

(T or F) Our public health care system focuses primarily on the health of individuals.

•

(T or F) One of the roles of educators is to network with the local public health agency.

•

The national principles of medicare are a. universality, completeness, portability, publicly administered, accessibility b. universality, comprehensive, portability, publicly administered, accessibility c. universality, comprehensive, portability, privately administered, accessibility d. universality, comprehensive, portability, publicly administered, availability

•

List the national principles of medicare. (answer: universality, comprehensive, portability, publicly administered, accessibility)

•

A physician known as the __________ __________of health is responsible for public health in a geographic region. (answer: medical officer)

•

List the components of Canada’s health care system. (answer: primary health care and public health)

•

The following is true with reference to Canada’s health care system: a. One of the roles of staff is to network with the local public health agency. b. Each public health department serves a specific geographic area. c. The goal of the public health system is to improve the health status of Canadians. d. both a and b e. a, b, and c

•

For the following roles and responsibilities to deliver health care within Canada, identify whether it is applicable provincially (P) or federally (F): _____ Funds and/or delivers primary and supplementary services to certain groups of people, such as First Nations people living on reserves, Inuit, and active members of the Canadian Forces (F) _____ Provides an independent workers’ compensation agency (P) _____ Provides support for health promotion and health research (F)

1-30

_____ Provides reasonable access to hospital and doctors’ services; expected to meet national principles set out under the Canada Health Care Act (P) _____ Sets and administers the national principles of the Canada Health Care Act, which establishes criteria and conditions for health insurance plans in order to send full cash transfers in support of health (F) _____ Regulates and protects health (e.g., regulation of pharmaceuticals, food, and medical devices), consumer safety, disease surveillance and prevention (F)

Changing Attitudes toward Health Care Objectives: To discuss a holistic view of health and its effect on Canada’s changing health care system. (LO 1) To describe how complementary health practitioners contribute to a collaborative approach to health care. (LO 1) To define the term “interprofessional collaboration.” (LO 1) To define the term “natural health products.” (LO 1) To describe the role that the federal government has in regulating natural health products. (LO 1) •

(T or F) As of the end of 2013, midwives are licensed to practise in every province/territory in Canada.

•

Use the example of midwifery or community health centres to illustrate the emerging collaborative approach in Canada’s health care system.

•

Conventional medical care primarily focuses on _______________________. (answer: refer to text page 17)

•

Which health care system costs more: a curative (conventional medicine) approach or a health promotion approach, and why? (answer: the curative approach costs more both financially and personally: o financial costs due to medical tests, treatments, medications, and surgical and non-surgical procedures; hospital admissions; days lost away from work due to hospital stays and recovery; doesn’t routinely utilize the expertise of other health professionals, which costs less than physicians; acute illnesses that can result in long-term medical conditions

1-31

o personal costs due to loss of income, especially if ineligible for sick-leave benefits, hospital insurance that covers additional expenses beyond those covered by medicare, or disability insurance, or if self-employed; personal, social, and emotional consequences of being ill; disruption in family life) •

Circle all of the following that are considered to be natural health products (NHP), according to Health Canada’s NHP regulations: (answer: a, c, and d) a. homeopathic medicines b. antibiotics c. herb- and plant-based remedies d. vitamins and minerals e. over-the-counter pain medications

•

Ipsos Reid’s 2010 survey reported on Canadians’ attitudes toward natural health products (NHP). Which of the following are true? a. Three in four used NHPs, and a third used them every day. b. Canadians need more information on the safety, side effects, and regulations about NHPs. c. Many Canadians are confused about what NHPs are. d. a, b, and c e. a and b only

Prevention and Health Promotion Objectives: To define prevention. (LO 1, 3) To describe how prevention fits into the health promotion approach. (LO 1) To define health promotion according to the World Health Organization. (LO 1, 3) To define mental health promotion according to the Government of Canada. (LO 1, 3) •

1-32

(T or F) Disease prevention is the primary goal of health promotion.

•

(T or F) Health promotion is the process of enabling people to increase control over their health.

•

(T or F) Individuals have complete control over their own health status.

•

The ______________________ defines positive mental health as “the capacity of each and all of us to feel, think, act in ways that enhance our ability to enjoy life and deal with challenges we face.” (answer: Public Health Agency of Canada [PHAC])

•

Which of the following is/are a prevention strategy(ies)? a. wearing a bike helmet when riding b. parents using appropriate car seats/seatbelts for their children c. eating nutritious, well-balanced meals d. all of the above e. a and c only

•

Mental health: a. is a positive sense of physical and spiritual well-being b. is the capacity of each of us to feel, think, act in ways that enhance our ability to enjoy life and deal with challenges we face c. issues have decreased substantially for persons of all ages d. b only e. all of the above

•

Define “health promotion” according to the World Health Organization. (answer: refer to text page 23)

•

What is the difference between disease prevention and health promotion? (answer: refer to text page 22)

•

Explain how strict legislation around smoking in public can have a positive impact on individual health. (answer: benefits for the smokers: limits when and where they can smoke, which is an enforced deterrent with the potential to reduce the effects of nicotine on the individual’s lungs and any underlying long-term medical conditions such as heart disease, asthma, emphysema; benefits for the nonsmokers: improved air quality, better able to avoid second-hand and third-hand smoke, reinforces the public health message that supports scientific research linking smoking and cancer, good modelling for children)

1-33

Health Promotion in Early Childhood Learning and Care Programs Objectives: To list and describe the five determinants of health most applicable to ECLC programs. (LO 2) To identify at least one strategy to promote health in the ECLC setting for each of the five determinants. (LO 2) To list the elements of quality in an ECLC program. (LO 2, 4) To list the purposes of program policies in an ECLC program. (LO 6) To discuss student and educator strategies to advocate for high-quality ECLC programs. (LO 2, 3, 4) •

(T or F) When educators and parents disagree on program policies, in the best interests of the children, educators will suggest to parents to find a new program for their child.

•

Shankoff (2010), a renowned researcher in early childhood development, acknowledges that a. solid evidence emphasizes that positive, early experiences strengthen brain formation in young children b. the later we wait to invest in children at greatest risk, the more challenging for them to have best developmental outcomes c. both a and b d. none of the above

•

List and describe the five (5) determinants of health most applicable to ECLC programs. (answer: refer to text page 27)

•

Identify at least one (1) strategy to promote health in the ECLC setting for each of the five determinants. (answer: refer to text page 27)

•

Circle each of the following social determinants of health that are included in the five (5) more applicable to ECLC programs: (answer: a, d, and e) a. social support networks b. biology and genetics

1-34

c. health services and social services d. culture e. healthy child development •

Discuss three (3) ways that poverty can have a negative effect on children’s health. (answer: examples—refer to the discussion that picks up on text page 32)

•

Comparison of child poverty across industrialized countries shows that ____________ _____________ is a key driver to reduce child poverty. (answer: government action)

•

Developmental health combines which two (2) fields of study in recognizing the impact that early childhood experiences have on lifelong health? ______________ and ______________ (answer: population health; developmental psychology)

•

Match the following term that most closely relates to each statement below: (answer: b, a, d, e, and c) a. healthy child development b. education and literacy c. income and social status d. social support networks e. culture In an early childhood program, parents who are not sufficiently fluent in the same language as the educators may not understand when they are asked to bring in their child’s immunization record. Early learning, behaviour, and health are markers for brain development. Educators can encourage mutual support and connect families with services and support. How people view health and illness, and approaches to healing, may be influenced by their ethnicity. A standard of living that fosters well-being is achieved when adults work at meaningful jobs, have access to affordable housing, and have high-quality early childhood education for their children.

•

Identify each statement as true or false about the status of health for Indigenous people:

1-35

a. (T or F) Indigenous people in Canada have contributed a rich heritage to the country but have not shared fully in its social and economic development. b. (T or F) To meet the challenge of administering and controlling their own health care, Indigenous communities do not need investment from the federal government to build infrastructure. c. (T or F) Indigenous people have the poorest health status of all Canadians. d. (T or F) Much support is needed from initiatives that draw on traditional knowledge and culture to develop culturally relevant approaches to problems such as substance abuse and family violence. e. (T or F) The provincial/territorial government holds the primary responsibility to support Indigenous communities in addressing the health gap. •

In Canada, health literacy is defined as “the ability to _________________, _________________, _________________, and _________________ information as a way to promote, maintain, and improve health in a variety of settings across the life course.” (answer: access, comprehend, evaluate, communicate)

•

Educators and all other professionals working with children and families new to Canada need to take steps to communicate by o providing information that is appropriate and _________________. (answer: easy to use) o using straightforward language and _________________ messages and body language. (answer: culturally appropriate) o recognizing that familiarizing themselves with _________________ system can be complicated for new immigrant families. (answer: Canada’s health care) o ensuring through various ways that _________________is being understood by both parties. (answer: communication)

•

To enable educators to implement policies and procedures outlined in their policy manuals, they must understand the _________________ behind specific policies. (answer: rationale or who, what, when, where, and why)

•

What is the relationship between quality ECLC and the well-being of children? (answer: has positive lifelong health effects; supports the physical, emotional, social, and intellectual well-being and the growth and development of children)

•

A policy manual is a. an informational tool used primarily to “sell” your program to the community

1-36

b. a living document, evolving with the changing needs of the program c. a legal document that outlines the program philosophy, goals, and objectives d. all of the above e. b and c only •

Purposes of program policies include _________________. (answer: refer to text page 43)

•

Beyond the licensing requirements, what are four (4) other purposes of program policies? (answer: conducting staff orientation, in-service training, and job performance appraisals; extracting the most relevant policies to be developed into parent handbooks; defining lines of communication and confidentiality; containing administrative and health forms; containing information sheets, handouts, and routines that can be used for posters [e.g., diapering]; identifying names and associations with which the program networks; staying current with research)

•

How can your ECE training contribute to providing a high-quality ECLC program? (answer: provides knowledge and skills; allows you to provide care above the minimum provincial/territorial child care regulations; helps you recognize the importance of quality ECLC in promoting children’s health; provides increased awareness in professional advocacy role)

Health Promotion Action Plan Objectives: To identify the three components of a health promotion action plan and describe how they can be implemented. (LO 3) To list three reasons why a health promotion action approach contributes to ECLC programs. (LO 2, 3) To discuss student and educator strategies to advocate for high-quality ECLC programs. (LO 3, 5) •

Select the action-plan component (A, B, or C) that best matches each example. A) individual problem solving and self-reliance B) community action C) societal change Alcoholics Anonymous (answer: B) She enrolls in a “Cooking in a Rush” course (answer: A) A group protesting the location of a landfill site (answer: B)

1-37

He recycles, reuses, reduces, and composts at home (answer A) You join a national group lobbying for stricter legislation against family violence (answer: C) Families living near a busy intersection have the town council install a fourway Stop sign (answer: B) Your provincial/territorial government has passed a law to ban smoking in vehicles where there are children/youth under 16 (answer: C) A few families decide to pool their resources and improve their nutrition by shopping and cooking together on Saturday, making enough meals for the week (answer: B) A municipal law is passed disallowing vehicles from idling for long periods of time (answer: C) You wear safety equipment to roller-blade (answer: A) •

Wearing a helmet while bike riding even though it is not a law is an example of a. individual problem solving and self-reliance b. community action c. societal change d. none of the above

•

In a high-density area of the city, hundreds of families are living in several apartment buildings side by side down the street. The park is five blocks away and it doesn’t have any playground equipment for children. Looking at the issue around the importance of physical activity for children and adults, use your imagination to develop scenarios for each of the following: o individual problem solving and self-reliance (answer: examples—parent and children walk to the park after supper and brings balls, etc., to use; enroll children in physically active programs before or after school; family moves) o community action (answer: examples—two families alternate taking all the children to the park or other facilities; tenants approach the landlord to renovate an empty apartment into a play space and/or develop the rooftop; tenants from the various buildings approach the parks and recreation department or city hall to install a playground in the park) o societal change (answer: examples—architects recognize the importance of incorporating into the design of apartment buildings physical space outdoors, and perhaps indoors, for children and adults; municipal zoning bylaws require a

1-38

certain amount of park/playground space be allocated to apartments by the number of units or neighbourhood density) •

Identify three (3) reasons why a health promotion approach can have a positive impact on ECLC programs. (answer: refer to text page 53)

Networking with the Community Objectives: To list ways that educators and ECLC programs benefit from networking with the community. (LO 5) To describe strategies to handle “mixed messages” that families and educators are faced with around health issues. (LO 5, 6) •

(T or F) Your early childhood education equips you to effectively respond to and deal with every family issue that arises in your program.

•

(T or F) Health-related messages from public sources directed at families and educators are always clear and consistent.

•

(T or F) Interprofessional collaboration is learning with, from, and about each other.

•

Choose a current health-related issue with at least two (2) different messages directed at families.

1-39

HERE’S THE ANSWER—WHAT’S THE QUESTION? Here’s the answer. primary health and public health medical officer of health and public health nurses and inspectors process that enables people to increase control over and improve their health the capacity of each and all of us to feel, think, act in ways that enhance our ability to enjoy life and deal with the challenges we face refers to the degree to which an individual enjoys the important dimensions of her or his life the first two interactions whereby individuals experience their identity and way of being as respected or, at least, not challenged or harmed identifies the factors that cause a medical condition/illness and tries to reduce or eliminate them individual problem solving and self-reliance; community action; societal change extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment they have been excluded from the conventional medical model in Canada but have been part of a tradition in other parts of Canada the study of why some groups of people are healthier than others publicly administered; comprehensiveness; universality; accessibility; portability provide a minimum standard of care to children program staff liaise with community and social agencies in order to contribute to the well-being of children and their families

1-40

What’s the question? What are the components of Canada’s health care system? Who, from the community, is ultimately responsible for the health of children and educators in early childhood learning and care programs? What is health promotion? What is positive mental health?

What is quality of life? What is cultural safety?

What is the principle behind disease prevention? What are the three components of the health promotion action plan? What is health? Who are complementary health practitioners? What is population health? What are the national principles of medicare? What do child care regulations require of programs? What is networking?

conduct staff orientation, training, and appraisals; inform parent handbooks; define the lines of communication; contain forms and information sheets healthy child development; education and literacy; social support networks; income and social status; culture the most popular form of complementary health care in North America professionals are learning with, from, and about each other, building mutual respect, shared knowledge, and decision making in the best interests of the child and family

What are the purposes of health policies?

What are the five most applicable social determinants to early childhood learning and care settings? What are natural health products? What are the benefits of interprofessional collaboration?

1-41

UNIT

Occupational Health

2 CONTENTS CLASSROOM ACTIVITIES AND DISCUSSIONS..........................................................................2 Critical Thinking...................................................................................................................................... 7 First (refer to text page 100) ...................................................................................................................... 7 Second (refer to text page 113) ................................................................................................................. 7 Assess Your Learning .............................................................................................................................. 8 Resource Materials for Teaching............................................................................................................. 9

ANCILLARY MATERIAL ..........................................................................................................11 Are You Listening? ................................................................................................................................ 11

LIFESTYLE GOAL SETTING .....................................................................................................22 HEALTHY LIFESTYLE BINGO: PERSONAL ...............................................................................23 HEALTHY OCCUPATION BINGO: PROFESSIONAL .................................................................24 THE FINANCIAL DIMENSION ................................................................................................25 OCCUPATIONAL HEALTH PROBLEM SOLVING .....................................................................26

2-1

Classroom Activities and Discussions Healthy Lifestyle Bingo: Personal (see handout, page 2-22) and Healthy Occupation Bingo: Professional (see handout, page 2-23); or, with a blank grid, each student can walk around and fill in the grid with each classmate’s suggestion for dealing with stress; “bingo” when the grid is complete. Before students read this unit, ask them to identify their top three concerns regarding occupational health. Keep this list. On completion of the unit, ask students to repeat this exercise and compare it with the original. Ask them if and why there may be differences. Appendix 2.3, Health Practice: You and Your Employer (refer to text page 122, the first half) Ask students to complete and in small groups or as a class discuss the list in general terms without anyone having to share personal items (e.g., identify practices that they can improve on and how). Physical activity: Using the blackboard or whiteboard, create a list of physical activities that students are involved with •

daily

•

weekly

•

once in a while

Ask students to share how they are able to make physical activity a priority, and for others, the reasons why they are not more physically active on a regular basis. Back injuries: Prevention is key. Demonstrate proper lifting techniques and postures. You may wish to invite a chiropractor or physiotherapist in as a guest speaker; 45 to 60 minutes should be sufficient (refer to Table 2.4, text page 86; Table 2.2, text page 72; Figure 2.1, text page 83, Figure 2.2, text page 84; Figure 2.3, text page 84). While doing a field placement with toddlers, you notice that you are starting to get lower back pain and are concerned that, as a young adult, this is already bothering you. You realize that you need to make some changes immediately in both your personal and professional practices to ensure that you prevent further back pain (refer to text page 88). Suggestions: Evaluate your current lifting technique with the proper techniques covered in Figure 2.1 (refer to text page 83), Figure 2.2 (refer to text page 84), and Figure 2.3 (refer to text page 84); use Table 2.4 (refer to text page 86) to identify possible workplace problems that may be contributing to your back issues and follow the recommendations consistently; consider the need for training in proper lifting that can be arranged by the director; consult with your health care provider or complementary practitioner on ways to strengthen your back muscles; ensure all 2-2

components of physical fitness are considered (i.e., aerobic fitness, flexibility, strength, and endurance) and incorporate regular exercise into your daily routine at work and at home. Refer students to Appendix 2.2 (refer to text page 120): •

In groups of 5 or 6, ask each student to remove one shoe. Refer to Appendix 2.2’s footwear policy criteria for the categories for working in an ECLC program: not appropriate, better but not best, and best. Have each student evaluate where her or his shoe falls in these categories, and why; then share the evaluation with the small group.

•

Perhaps each group can choose the best shoe for work with the class, and everyone can vote on the winning shoe (only for fun, not competitive!).

•

Another interesting activity in the large group could be for each student to place his or her shoe in the most suitable category pile at the front, to determine whether the majority of footwear in the class would be not appropriate, better but not best, or best for work.

WHMIS: Show students a WHMIS poster (usually easily available) and ask students if they can identify any of the products. Some, due to work experiences, may be aware of WHMIS and controlled products. Perhaps the health and safety officer at your college or the local public health inspector could speak about WHMIS in relation to programs and the type of products used in them. Workplace environmental issues: Discussions on issues such as the quality of programs’ ventilation/air quality, noise levels, temperature control, and lighting provide students with the opportunity to evaluate the classroom’s environment, which is where they will be spending the next year or two. This may be an eye-opener since so many college/university environments are not particularly conducive to the physical or emotional health of the employees or students. Using a typical classroom, have students evaluate features such as the following: •

Lighting: Is there more than one light switch to allow some lights to be on and others off, which is particularly useful for viewing videos and overheads?

•

Are there windows and, if so, can they be opened by you, or do you have to rely on a caretaker with a key or window crank? Are there curtains/blinds that allow you to control the amount of sunlight on particularly sunny days in the summer?

•

What is the quality of the air exchange in rooms when there are no operable windows?

•

Heating/cooling system: Is there a thermostat in each room and can you control it, or does a caretaker use a special key? Or is the whole school controlled with one,

2-3

which can’t accommodate for rooms on the south and west walls with more summer light, or the north and west walls exposed to more of the winter winds? •

What are the noise levels in the classroom, including the overhead projector’s fan and those coming from the hall?

•

Comfort level of classroom furniture: Is it ergonomically correct for adults, which is of particular interest when used in two- to three-hour classes, and are you able to easily make rearrangements (e.g., small-group discussions)?

•

Do left-handed students have access to appropriate desks?

What are some strategies to improve the environment? •

Consult with the college’s health and safety officer.

•

Speak with the campus manager regarding structural issues (e.g., cold rooms in the winter).

•

The instructor can speak with the department responsible for servicing audiovisual equipment.

•

Document concerns that require action either in the short term or during renovations, and for replacing classroom furniture (perhaps the department responsible can consider your concerns and student teaching needs when purchasing new furniture in the future).

It may be difficult for us to acknowledge that the college’s environment is not conducive to health. However, it may be seen to be very inconsistent to support a health promotion model at work when we are not. Students may learn that working together for change brings results. They may be disappointed if they don’t get the results they had hoped for, but the instructor can help them to identify what the barriers are and possibly to reshape their plan. Often there has been some improvement and this needs acknowledgment. Creating a supportive environment: Ask students to role-play workplace situations, and then as a class discuss how they will resolve the situation and how the situation could have been prevented in the first place (see the Are You Listening? handout, page 2-11; refer to Table 2.6, text page 114). Scenario 1 Josée—“I’m leaving now, Maria. I have a doctor’s appointment so I asked Rita (director) if I could come in early tomorrow instead.” Maria—“You didn’t tell me you were leaving early, Josée. I’m the one who is really affected so why didn’t you let me know before now? Now I have to put everything away and close up the building by myself. It’s not fair.” 2-4

Josée—“Oh well, Rita should have told you. Gotta go. Bye.” Scenario 2 Lucy calls the director, Mrs. Fitts, at 6:00 a.m. and tells her that she isn’t feeling well, has a really awful head cold, and can’t come in today. Mrs. Fitts—“Oh, Lucy you can’t stay home. Mike is on vacation and the toddlers will be very upset if they see a stranger in their room this morning. At least come in for a few hours, and then go home if you’re still feeling sick.” Against her better judgment, Lucy arrives at the program and is feeling worse by the minute. The toddlers would be a lot happier with an educator who has energy and is able to cope, even if she is new to them, she thinks. I need to take care of me. Lucy asks Mrs. Fitts to come in and relieve her. Mrs. Fitts, who is obviously very angry, says, “You made your mind up that you wanted today off, no matter what, didn’t you?” Lucy, feeling so sick and upset, can’t answer her. She takes a taxi home, even though she can’t afford it. Scenario 3 Annie, an enthusiastic student in her program placement, insists that she doesn’t need breaks during the day. Although the staff in the room point out opportune times to leave the floor for 10 or 15 minutes, Annie says she’s fine and doesn’t want to miss a minute of learning opportunity. The educators appreciate her eagerness but are concerned that this is not a physically, emotionally, or socially healthy pattern to get into. What is your opinion?

2-5

Suggestions: Benefits of Taking Breaks

Benefits of Not Taking Breaks

physical and emotional benefits (e.g., rest/relaxation, nutritional, time to think about self rather than others’ needs) and social benefits (e.g., with educators and fellow students)

if you’re in the staff room when your ECE instructor arrives, you may be concerned that it would give the impression that you’re not motivated enough

reduces the risk of burnout—not taking as a student, you may miss a learning breaks can lead to exhaustion at the moment while off the floor end of the day, which can affect your personal life and increase risk of burnout develops a healthy, balanced work style that affects your overall lifestyle demonstrates a sense of self-worth by making yourself a priority when tired or unfocused, may not be able to take full advantage of learning opportunities classmates will not see you as a keener: setting up expectations for others to match recognizes that child care is a physically and emotionally demanding job and that regular breaks are as important here as in any other job

In groups of three or four, students can discuss problem-solving scenarios. The instructor will decide how the information will be brought together as a group (numerous possibilities). (See the Occupational Health Problem Solving handout, which you can copy and distribute to students, page 2-25.)

2-6

•

Discuss the pros and cons of working in unionized and non-unionized ECLC workplaces.

•

Discuss how you could approach the director about workplace environmental issues, such as indoor climate control, air quality and ventilation, noise levels, and poor lighting.

As one example of a strategy to manage stress, consider introducing mindfulness meditation to the class. You may want to invite a speaker or visit a site such as 15 Best Meditation and Mindfulness Apps for guided mindfulness sessions: https://www.developgoodhabits.com/best-mindfulness-apps/. Check YouTube for a range of videos on mindfulness by Jon Kabat-Zinn.

Critical Thinking First (refer to text page 100) Identify an issue that you are going to find stressful when you begin your career in ECLC. List three strategies that will help reduce your apprehension and build your confidence as you begin your career. Suggestions: The solution is going to depend on the specific issue; discuss your issue with fellow students, educators, and your instructors to gain insight and validate or allay your concern about this perceived stress factor; complete Appendix 2.3 (refer to text page 122) to identify if your stressor is in the list and to follow the recommended prevention strategies; when the issue has validity, a prevention plan would include when the issue is related to working conditions, you can ask relevant questions during the job interviews and ask to observe in the ECLC programs you are considering, using Table 2.6 (refer to text page 114) to decide if the environment is a good fit for you; have a method to self-evaluate the issue against your work experience during the first few months of employment to gauge the degree of stress you are experiencing; take an active role in problem solving and see the issues as learning opportunities; remember that you are promoting your own health by increasing your coping skills, in other words, think about what you can control in your work life and what you cannot (e.g., Do you have a tendency to look at a glass as half empty rather than a glass as half full? Do you overanalyze others’ comments directed at you and begin to see them as major sources of stress rather than as an innocent or unintentional comment?); stop negative self-talk; cue your relaxation response to calm yourself in times of stress (refer to the Canadian Mental Health Association’s website: https://cmha.ca/). Second (refer to text page 113) As a student, you are frustrated by a clique of three students who sit together and regularly disrupt the class. What do you do? Suggestions: An appropriate first step may be to approach the three students at a break or after class; perhaps they don’t realize how their behaviour affects others, so you can say something like, “I really find it hard to concentrate in class when you three are talking among yourselves”; they may be surprised and respond with an apology and stop, or they may become defensive and respond with denial of the behaviour and will continue with the talking, or they may become defiant and respond Copyright © 2019 by Nelson Education Ltd.

2-7

with something like, “So, what are you going to do about it?” Regardless of the specific reaction, make it clear that you would appreciate that they stop this behaviour and will need to speak with the instructor if they don’t stop. To summarize, you have •

been direct, ensuring that they are aware of the situation rather than complaining to your classmates, which eventually will get back to the three students, who will probably resent the lack of direct communication that further complicates matters.

•

indicated your next step, thus being clear about a sequence and consequences.

Direct, tactful communication is most often the most appropriate strategy for preventing problems from becoming more complicated in the classroom and the workplace.

Assess Your Learning Evaluate your options in each situation. 1. A colleague buys her lunch from the nearby fast-food restaurant almost every day. You can’t resist having her pick up something for you, too, even though you often feel full after eating the nourishing hot lunches with the children before you have your lunch break. The fries or burger tastes great, but you feel sluggish all afternoon. Suggestions: Go to the fast-food restaurant with your coworker, make healthy food choices, eat together, and then go for a walk; reverse the order, motivate each other to incorporate walking before eating, and then see if you still want to eat out; stop asking her to pick up your food and bring in raw vegetables and fruit to munch on during your lunch break, but still go walking. 2. You and a coworker rarely agree on program-related issues. As a result, your relationship deteriorates to the point where you speak as little as possible, and the tension is felt by the other staff, children, and families. Suggestions: Recognize when you need help—most directors should have already identified the problem but are taking the wait-and-see approach to see if the two of you can resolve it; approach the director and ask for a process that would help rebuild the relationship and working conditions. 3. You and two coworkers have been injured over the past month from pinching fingers in a cupboard door while putting things away (out of children’s reach). Each of you completed a detailed injury report and submitted it to the director, yet none of you have heard anything from her about this situation. Suggestions: Talk with the director about an update on the resolution of the issue; refer to the program’s policy manual to review the process that is to be followed upon the submission of injury reports; when such a policy is excluded from the manual, this omission can be the topic for a staff meeting as the first step in 2-8

writing the policy; contact your program’s Workplace Health and Safety Committee (where available); contact the president or chair of the program’s board of directors about the incident; contact your provincial or territorial child care office; see the Canadian Centre for Occupational Health and Safety (CCOHS) website, which covers the occupational health and safety legislation surrounding due diligence by employers. 4. You enjoy communicating with family members of your program, but you are not confident trying to communicate with individuals whose first language is not English. You feel that you are being patronizing, speaking loudly and very slowly and making hand gestures. Suggestions: Parents are resources with specific knowledge and skills that they can share; enroll in courses or workshops; seek community resources that may provide language training and possible translation services for your parent handbook and information sheets; inquire if the parents are taking EAL classes; perhaps the program can provide an opportunity for professional development if cost or time away from work is required. 5. To the best of your parents’ and your knowledge, you never had rubella as a child. You are now pregnant, and three children in your preschool program have contracted rubella. Suggestions: Contact your physician immediately (refer to Table 2.3, text page 80).

Resource Materials for Teaching Canadian Centre for Occupational Health and Safety (CCOHS): https://www.ccohs.ca/ This site has an extensive amount of information and online modules that you may find helpful in your teaching. Canadian Heart & Stroke Foundation: http://www.heartandstroke.ca/ Canadian Mental Health Association: https://cmha.ca/ Child Care Human Resource Sector Council: http://www.ccsc-cssge.ca/ •

Occupational Standards for Early Childhood Educators (n.d.): To download the PDF, visit http://www.cccf-fcsge.ca/wp-content/uploads/occupational-standardsfor-ece_en.pdf

CSEP (n.d.) Canadian Physical Activity Guidelines for Adults—18–64 Years. To download the PDF, visit http://csepguidelines.ca/wpcontent/uploads/2018/03/CSEP_PAGuidelines_adults_en.pdf Day Nursery Centre’s Guide to Workplace Health, Safety and Wellness. A 15-minute DVD that introduces their child-hazard analysis process and helps students to understand Copyright © 2019 by Nelson Education Ltd.

2-9

the breadth of workplace health and safety. A great springboard for discussion. The video can be purchased for $25 from Day Nursery Centre, Winnipeg, MB. Please contact the executive director at 204-775-6513, or email dnced@mymts.net for more information. Health Promotion 102 is a free three-part online session on workplace health promotion (developed by the Ontario Health Promotion Resource Centre). It contains nine learning modules. Refer to the list on the left-hand side of their Web page for a list of modules. It will take you 10–20 minutes to complete each module. There are no restrictions as to when, how, or in which order you choose to complete the modules. To access, visit http://www.ohpe.ca/node/11945 ParticipACTION: https://www.participaction.com/ WHO Collaborating Centre in Health Promotion, University of Toronto: http://www.dlsph.utoronto.ca/global-health/who-collaborating-centre-in-healthpromotion/

2-10

Ancillary Material Are You Listening? When you and I are talking together … •

you make me feel as if this is the most important thing you could be doing right now and that your time is truly mine.

•

your attention is divided. You interrupt our conversation by answering the phone or addressing the needs of others who come by your door.

•

you begin shaking your head or saying “no” before I finish.

•

you make references to other conversations; there is a history to communication.

•

you fidget and squirm and look at the clock as though you cannot wait to get on to other, more important projects and conversations.

•

you begin asking questions before I finish my message.

•

you look me in the eye and really focus your attention.*

•

you ask questions that let me know you were not really listening.

•

you finish my sentences for me as though nothing I have to say could be new to you.

•

you express interest by asking thoughtful questions and by contributing your insights.

•

you change the agenda by taking over and changing the content of the conversation.

•

you follow up on what we discussed and keep me posted on what is happening.

•

you are sensitive to the tone of what I have to say and respond respectfully.

•

you give me credit for ideas and projects that grow out of our communications.

•

you try to speed things up and leap ahead with ideas or conclusions as though we are in a rush.

Often

Seldom

2-11

•

you smile at me and make me feel comfortable and valued.

•

you make jokes about things that are serious to me and thereby belittle my concerns.

•

you get defensive and argue before I can fully explain my point.

•

you seem to assume I have something worthwhile to say.

•

you ask questions that demonstrate your efforts to understand what I have to say.

•

whether or not you agree with me, you make me feel that my opinions and feelings are respected.

*Making direct eye contact during conversation is considered disrespectful in some cultures. This practice alone doesn’t indicate poor communication. Source: Reprinted with permission from “Are You Listening?” Child Care Information Exchange, P.O. Box 2890, Redmond, WA 98073, 1-800-221-2864.

Assignment Ideas 1. Personal nutrition and physical activity: Suggest students record what they have eaten and their physical activity for a week, either on paper or register with eaTracker.ca: http://www.eatracker.ca/ Developed by the Dieticians of Canada, you can use eaTracker to check your food and activity choices, analyze your recipes, and plan your meals. Sign up to set goals and to track your progress. 2. Goals for change. Design an assignment or a sample self-assessment informational tool (see Lifestyle Goal Setting handout, page 2-21) to encourage students to selfevaluate their wellness and take steps to improve it. There are various ways to develop this assignment: A. Appendix 2.3 (refer to text page 122) is a good starting point for students. Students will •

identify one practice that could be improved in o their personal health o their professional health

• 2-12

o barriers for you to make changes o resources that assist or support your change o checkpoints and simple formative and summative evaluation tools (i.e., how will you know if you are reaching your goals) B. Using the Dimensions of Personal Wellness approach (refer to Table 2.1, text page 63, and for an example of a checklist for the Financial Dimension, see handout, page 2-24). You can also refer to a range of textbooks on wellness to see itemized checklists for each of the more widely used dimensions (e.g., An Invitation to Health, fifth edition, by D. Hales & L. Louzon, Nelson Education, 2018). To set goals based on information attained from the Dimensions of Personal Wellness checklist, students can write a goal for each dimension, indicating a goal statement, specific action steps, a target date, how they will know whether they have met the goal, and a narrative statement indicating (a) resources that will help to succeed, (b) possible barriers and a plan to deal with these, and (c) what accomplishing the goal will mean to her or him. C. A third possibility for a wellness self-assessment assignment is to use a tool developed by the Quality of Life Research Unit at the University of Toronto entitled the Quality of Life Model (see information below or their website: http://sites.utoronto.ca/qol/qol_model.htm). This comprehensive approach allows for consideration of multiple perspectives. It includes nine domains in being, belonging, and becoming: BEING Physical being Psychological being Spiritual being

BELONGING Physical belonging Social belonging Community belonging

BECOMING Practical becoming Leisure becoming Growth becoming

3. There are 13 psychosocial factors assessed by Guarding Minds at Work: The 13 Psychosocial Factors are significant for all organizations and employees in Canada, whether public or private sector, big or small. The following link includes the definition of each of the 13 Psychosocial Factors: https://www.guardingmindsatwork.ca/about/about-psychosocial-factors • After reading the definitions, which 5 psychosocial factors do you think would be most important for your workplace? • For the 5 factors you have chosen, why does each have more relevance for you than those not chosen? Students should try to consider at least one important psychological factor for themselves as a) an individual, b) team member, and c) as part of the workplace (the organization). Copyright © 2019 by Nelson Education Ltd.

2-13

Test Questions Promoting Your Physical Well-Being Objectives: To identify and evaluate a personally balanced lifestyle. (LO 3) To identify physical risks to educators working in programs (infectious diseases, musculoskeletal injuries). (LO 2, 3) To discuss prevention strategies for physical risks. (LO 2) To list the three rights of the worker. (LO 3, 6) To identify workplace environmental issues and possible solutions. (LO 3, 5, 6)

•

(T or F) You’re likely to be successful at incorporating physical activity into your routine when you begin with a dramatic start.

•

(T or F) Everyone requires at least eight hours of sleep a night to allow us to be fully awake during the day.

•

(T or F) Finding ways to relax each day will have a positive effect on your wellbeing.

•

(T or F) Immunizations will protect educators from all the diseases that children contract.

•

(T or F) Whenever a child or educator is injured, an injury report should be completed.

•

List four (4) of the eight (8) dimensions of personal wellness. (answer: refer to Table 2.1, text page 63)

•

In Canada, it is recommended that every 10 years, adults receive booster shots (vaccinations) for _________ and _________. (answer: diphtheria; tetanus)

•

To prevent back injuries during any work activity, you will try to maintain the _________ _________ of your spine. (answer: natural curves)

•

___________ is the component of fitness that refers to the ability of your joints to move through the full range of their motion. (answer: flexibility)

2-14

•

_________ fitness refers to your heart’s ability to pump blood throughout your body. (answer: aerobic or cardiovascular)

•

_________ refers to the ability of your muscles to exert force in one motion. (answer: strength)

•

Eating Well with Canada’s Food Guide is based on two principles: a. avoid all additives and only eat organic foods b. eat often and relax daily c. eat well and be active today and every day d. none of the above

•

From the following list, which behaviour(s) do(es) not contribute to your health? a. talking to your coworkers about how angry you are at your supervisor rather than discussing it with your supervisor b. dieting c. avoiding second-hand smoke d. women conducting monthly breast self-examinations e. both a and b

•

In analyzing the program’s indoor environment, identify a reasonable suggestion that could help prevent musculoskeletal problems: a. avoid picking up children b. place lightest items at waist height, heaviest above, when organizing cupboards c. make use of built-in steps under the change table for toddlers to climb up and down (assisted by an adult) d. wait until the end of the day to remove large bags of garbage, to avoid repetitive movement e. none of the above are reasonable suggestions

•

The communicable diseases that female educators need to be aware of in terms of avoiding contact during pregnancy are a. CMV, rubella, shingles, mumps b. CMV, rubella, chickenpox, mumps, measles

2-15

c. mumps, rubella, polio, chickenpox d. polio, mumps, chickenpox, shingles e. tetanus, rubella, chickenpox, CMV •

Good lifting techniques include a. keep back straight, knees straight, and bend at waist b. stand in front of what you are going to lift and as close to it as possible c. look ahead before straightening your knees after lifting to avoid twisting d. b and c only e. a, b, and c

•

List two (2) possible indoor environment discomforts that could be causing an educator’s headaches and a possible solution for each. Identify who would be responsible for fixing the problem: the employer or the employee. Problem 1: Solution: Who is responsible for fixing?: Problem 2: Solution: Who is responsible for fixing?:

•

Use Table 2.4 Worksite Analysis of the Child Care Work Environment to identify common problem postures and suggest recommendations. (answer: refer to right column of Table 2.4, text page 86)

•

A footwear policy in ECLC programs a. is intended to protect the safety of both adults and children in the program b. recommends a tight fit around the toes to prevent aching feet c. requires closed-toe shoes to minimize injuries d. requires footwear to grip the heel firmly (i.e., closed heel or back strap)

2-16

•

List three (3) criteria for the best (safest) footwear in an ECLC program. (answer: good fit and support, good traction, closed toe, grip heel [closed heel or heel strap], protection to the top of the foot [metatarsal bones] and the toes, instep and outside of the shoe should be connected)

•

What does WHMIS stand for? (answer: Workplace Hazardous Materials Information System)

•

List three (3) ways that educators can manage the noise level during the day. (answer: alternate quiet and active activities; guide children to use their indoor voice; alternate educators doing playground supervision; take staff breaks in a separate space; other appropriate suggestions/ideas from students)

•

List the three (3) rights of the worker. (answer: refer to text page 92)

•

The three (3) rights of the worker are the right to know, the right to refuse unsafe work, and the right to ________________. (answer: participate)

2-17

Promoting Your Psychological Well-Being Objectives: To discuss the major role that communication at work plays in educators’ psychological well-being. (LO 1, 3) To identify possible sources of personal, professional, and societal stress and their impact on our well-being. (LO 3) To list strategies to eliminate, reduce, or manage stress. (LO 1, 3) To understand the role and benefits of effective communication in the workplace and networking with community professionals and agencies. (LO 5)

•

The following strategy will help manage your stress in a professional ECLC environment: a. You are angry with your supervisor and get it off your chest by complaining about her to your coworkers. b. You don’t ask for help when you are confused—you believe doing it all on your own will increase your competence and self-esteem. c. You evaluate situations as they arise and decide whether you can handle them on your own or would benefit from support by others. d. You send anyone with a question to the supervisor, believing that if you are expected to make decisions, this will increase your stress level. e. You cope with your frustration with the noise level by yelling; this makes you feel better, and the children stop making noise immediately, achieving your aim.

•

The following is true about educators’ well-being in ECLC programs: a. Physical and psychological aspects of staff health are all important to consider. b. Immunizations will protect educators from all the diseases that children contract. c. Educators should follow Health Canada’s five principles of healthy eating, which include the recommendation to diet by reducing food intake. d. We should focus only on the aerobic component of our fitness level. e. All of the above

2-18

•

What are two (2) significant contributing factors, identified in research, to staff turnover in programs? (answer: refer to Figure 2.11, text page 111)

•

The quality of relationships between children and _________ is essential for quality early childhood learning and care. (answer: educators)

•

List four (4) practices that directors should be implementing to promote the staff’s well-being. (answer: refer to the Does Your Employer … section in Appendix 2.3, text page 124)

•

The National Standard on Psychological Health and Safety in the Workplace a. has the role to protect mental health in the workplace. b. marks a historic moment that has been put forward after 150 years of occupational health and safety development. c. is a standard that is voluntary, not required. d. All of the above statements are true.

•

Presenteeism refers to employees who regularly go to work when unwell. Common reasons for presenteeism include a. lack of supply staff b. financial reasons c. pressures from supervisor d. all of the above e. none of the above

•

The two most common reasons for educators’ absenteeism are a. injury (e.g., sprained ankle) b. ergonomic issues (e.g., back or neck pain) c. physical illness (e.g., flu, cold, infection) d. mental health issue (e.g., feeling anxious, overwhelmed, sad) e. need for day off

•

The term “juggle struggle” refers to the educator’s challenge in managing the personal, _________________, and societal stressors, which are a fact of life. (answer: professional)

2-19

•

The two best ECLC workplace predictors of health and well-being are ___________________ and __________________. (answer: psychological protection, and recognition, benefits, wages)

•

The well-being of the ECLC workplace should be supported at all three levels of health promotion: individual, community, and societal. For each of the examples below, identify whether it is A) individual B) ECLC workplace (community) C) societal level _____ Link employees to mental health services when needed. (B) _____ Set a mandatory workplace requirement to follow the National Standard on Psychological Health and Safety in the Workplace. (C) _____ Aim to achieve work–life balance. (A) _____ Work toward positive relationships with coworkers and supervisors. (A) _____ Develop policies, practices, and programs that address potential harm to employees (e.g., bullying, harassment, violence). (B) _____ Implement a national child care plan (federal). (C)

•

Describe three (3) work-related qualities of a director supportive to a staff’s wellbeing. (answer: support and encourage staff; communicate clearly and freely; provide opportunities in decision making and for professional growth; encourage staff's sense of autonomy; advocate for the staff and program; provide guidance in difficult or controversial situations; maintain confidentiality; act as a role model)

•

Define coping. (answer: the ways a person tries to eliminate or reduce a stress factor, or her or his response to it)

•

What is an appropriate question to ask yourself, suggested by the Canadian Mental Health Association, when you are trying to decide which coping skill to use in a given situation? (answer: there are three (3): Is this an appropriate thing to do in this situation? Is this a positive way of coping? Is this going to help in the long run?)

•

Provide two (2) examples for each of the three (3) sources of stress: o personal stress factors o professional stress factors o societal pressures (answer: refer to The Juggle Struggle: Stress, text page 101)

2-20

•

Give one (1) suggestion for each of the three (3) levels of the Health Promotion Action Plan to support occupational health. (answer: refer to text page 116)

2-21

LIFESTYLE GOAL SETTING Health Behaviour

Goal to Improve Health

Nutrition

One way to improve your eating patterns (refer to text page 68):

Compare what you ate yesterday with Eating Well with Canada’s Food Guide Grain Products (5–12 servings with focus on whole grain for fibre): Vegetables & Fruit (5–10 servings with focus on vegetables): Milk Products (2–4 servings with focus on low fat): Meat & Alternatives (2–3 servings with focus on lower fat, including alternatives): Glasses of Water (6–8 glasses): Other Foods (keep butter, sugar snacks, etc., to a minimum): Your Physical Activity Over Past Week

One specific goal to increase your level of

Activity:

Physical Activity:

Fitness Component (aerobic, endurance, strength, flexibility):

Fitness Component:

Duration: Your Leisure/Rest Activity Over Past Week

One specific goal toward

Leisure Activity:

Leisure Time:

Duration:

Rest:

Rest: Duration:

2-22

HEALTHY LIFESTYLE BINGO: PERSONAL eat whole-grain breads and cereals:

visit my dentist/hygienist at least once a year:

engage in vigorous physical activity (at least 30 min.) 3 or more times per week:

do something fun or have working smoke eat breakfast each relaxing every day, detector(s) and morning: carbon monoxide just for me: detector(s) in my home:

limit my daily time on electronic devices:

wear a bicycle helmet when riding:

read the nutrition often use the stairs table on food labels: instead of the elevator:

vegetables are some always use my seat of my favourite belt in the car: foods:

keep caffeine intake don’t smoke and to 400 mg or less a avoid second-hand day: smoke:

know the name of my doctor:

wash my hands before eating and after toileting:

stay connected with friends:

recycle and compost:

find positive coping strategies for managing stress:

belong to at least one organization:

2-23

HEALTHY OCCUPATION BINGO: PROFESSIONAL know CPR and first aid, and know and follow program have current certificates: policies and practices:

know what WHMIS stands for:

use proper lifting most of the time to prevent back injuries:

take the assigned breaks and lunch:

consistently put cleaning and sanitizing techniques into practice:

as a student, I read the placement program’s written responsibilities for students:

evaluate myself through self-reflection during program placements:

my community or program reuses/recycles/reduces:

use direct but tactful communication when I have a question or concern:

find ways to incorporate physical activity during my working day:

listen to and incorporate constructive feedback from my peers and supervisor:

enjoy learning about family get enough sleep to be my diversity: best at work:

set goals and work toward them consistently:

2-24

THE FINANCIAL DIMENSION _______

I have written down my dreams and have a clear view of my priorities.

_______

I know my net worth (assets minus liabilities) and what my debt–equity ratio is.

_______

I have calculated my monthly cash flow (in/out).

_______

I recognize my spending patterns and am able to take control of them to work for me rather than against me. I know that I can work toward financial wellness if I live within my means.

_______

If I have one, I use a credit card for convenience only, and I pay the balance when the monthly statement comes in. I do not view the credit card as an effective method of long-term payment.

_______

I pay down my debts, giving priority to those with the highest interest rates (e.g., credit cards).

_______

I consistently use a budget, allocating funds for specific items. I don’t see borrowing as an option. Instead, I use a savings plan to afford desired items or vacations.

_______

I know how to get what I need and want from my banking institution (e.g., the best bank fees, the account type that suits my needs).

_______

If my situation allows it, I have an emergency fund and a regular savings plan in place (e.g., TFSA), routinely putting aside a reasonable amount.

_______

I save for my retirement every year (e.g., RRSP).

_______

I take advantage of all tax deductions to which I am entitled and file my annual taxes.

_______

I use tax refunds to pay down debt or to invest (e.g., RRSP), rather than spending them on consumer items or vacations.

_______

I understand the programs that are mandatory and optional with my employer (e.g., vacation, sick leave, extended health, life insurance, pension).

_______

I am financially literate, keep up-to-date in understanding basic financial information, and can communicate with investors in my best interest.

_______

I am working toward having control over money rather than having it control me.

2-25

OCCUPATIONAL HEALTH PROBLEM SOLVING Scenario 1—An ECLC program where you are working has a wonderful physical space, with child-sized equipment throughout. However, you know the risks of musculoskeletal problems and injuries for adults in the room. When the staff discuss this with the director, she asks each staff team (infants, toddlers, preschool, and school-ager) to make three priority suggestions to improve this reality. The director plans on taking these ideas to the Board of Directors for approval. What are your suggestions? (Refer to Table 2.4, text page 86.) Infant Program Toddler Program Preschool Program School-Age Program Scenario 2—At first you thought that your sore throat, watery eyes, and constant drowsiness were caused by a communicable illness that was going around at the ECLE program, because some of the children had those symptoms as a result of a viral infection. However, when this problem continued and no one else was sick, you went to see your doctor, who informed you that your symptoms were probably caused by the indoor work environment. What could be the cause, and what could you do about it? (Refer to Workplace Environmental Issues, text page 94.) Scenario 3—You and your preschool-room partners have been working in the ECLC profession for a few years. At a pub one Friday evening, the three of you share how you’re worried about “burning out” with all the demands of the work, and you decide to take action to prevent this from happening. You all want to improve your physical, emotional, and social well-being, recognizing that some of it you can do, but some of it needs the support of your employer.

2-26

UNIT

Illness Prevention

3 CONTENTS CLASSROOM ACTIVITIES AND DISCUSSIONS..........................................................................2 Critical Thinking...................................................................................................................................... 8 First (refer to text page 159) ...................................................................................................................... 8 Second (refer to text page 164) ................................................................................................................. 8 Assess Your Learning .............................................................................................................................. 8 Resource Materials for Teaching........................................................................................................... 10

ANCILLARY MATERIALS ........................................................................................................10 Water Tables ........................................................................................................................................ 10 Rubber Gloves ...................................................................................................................................... 10

ASSIGNMENT IDEAS .............................................................................................................11 TEST QUESTIONS ..................................................................................................................11 Our Body’s Natural Defence Mechanisms ............................................................................................. 11 How Infections Spread ......................................................................................................................... 13 Breaking the Chain: Developing an Infection Control Strategy .............................................................. 15

HERE’S THE ANSWER—WHAT’S THE QUESTION? ...............................................................22 SELF-TEST ON INFECTION CONTROL TRUE OR FALSE: UNIT 3 ............................................23 VEHICLES OF TRANSMISSION ACTIVITY ...............................................................................24

3-1

Classroom Activities and Discussions Here’s the Answer—What’s the Question? (see handout, page 3-22) Self-Test on Infection Control True or False: Unit 3 (see handout, page 3-23). •

Have students complete the handout before starting their reading of Unit 3. You would then collect and keep the handouts until the end of the unit (from experience, if students were to keep them, they probably wouldn’t be able to find them or remember to bring them in for the class).

•

At the end of the unit, distribute a second copy of this handout, and then have them compare their answers with the one they completed earlier.

•

answers: 1-F; 2-F; 3-F; 4-F; 5-T; 6-T; 7-T; 8-F; 9-T; 10-F

Hand-sanitizing products: To initiate a discussion around the use of hand-sanitizing products, you can download and play Two Hands of Fear by Barb Pimento (four-minute podcast on YouTube). To download, visit https://www.youtube.com/watch?v=4CGkybggKSw 10 minutes: Have the students discuss the following questions. Turn to the person next to you and discuss/answer the following questions: What is the main point made in the video? _____________________________________________________________________ _____________________________________________________________________ Do you agree/disagree, and why? _____________________________________________________________________ _____________________________________________________________________ What/when are the most appropriate uses of hand-sanitizing products in ECLC programs? _____________________________________________________________________ _____________________________________________________________________

3-2

What are the pros and cons of children using hand-sanitizing products? Pros: _____________________________________________________________________ _____________________________________________________________________ Cons: _____________________________________________________________________ _____________________________________________________________________ What considerations must be made in using hand-sanitizing products? _____________________________________________________________________ _____________________________________________________________________ Antimicrobial resistance: •

View this video: “Superbugs in the Supermarket” (aired February 11, 2011, Marketplace on CBC). To view, visit http://www.cbc.ca/marketplace/episodes/2011-episodes/superbugs-in-thesupermarket

•

Have a classroom discussion about the growing concern regarding the use of antibiotics in meat and poultry sold in grocery stores (refer to Antibacterial Products, text page 161).

•

Note to students that the terms antibacterial and antimicrobial are used interchangeably.

Making germs visible: •

Contact your college’s laboratory technician or dental or nursing program, if available; your local hospital’s laboratory; or a medical supply store to purchase petri dishes with nutrient agar (jelly-like substance in the dish), which is an ideal medium to grow germs and help students see that germs are everywhere.

•

You need the dishes (10 is plenty), along with a wax pencil to write on the bottom side of each plastic container, cotton swabs (e.g., Q-Tips), and a small bottle of sterile normal saline (e.g., for contact lens wearers).

•

Here are a few ideas—there are hundreds of possibilities: o Use one dish for one sample. o Have a student cough into one, and another student spit in another.

3-3

o Place smaller objects directly on the agar. o Wet a swab with saline, and then wipe it on surfaces that are too large to put in the petri dish (e.g., table, counter, tap), and then rub the swab on the agar and repeat on a variety of surfaces (e.g., doorknobs, sink taps, tabletops, puzzle pieces, toys, countertops, diaper-changing surfaces). o Place one dish for one hour in an area that is unoccupied, and then another dish for one hour when the area is being used (e.g., lunchroom); this is a great way to demonstrate how germs spread through the air, and how the number of germs increases when it is crowded. o Have one student wipe his or her fingertips across the agar, and another who has just finished washing her or his hands. •

Once you have collected all the samples, wrap masking tape around each lid to prevent the dishes from being opened until you are ready to look at them one at a time in the next class. Don’t let anyone touch what has grown in the dish or smell it. Because of the concentration of germs on the dish due to multiplication (growth) on the agar, handle with caution.

•

Perhaps the lab in your college is willing to incubate them for you. If not, place each dish upside down, so you can see the bottom of the agar on top, and store them in a warm spot in your office for three or four days. Storing them upside down prevents the condensation that will form from dripping onto the agar and whatever is growing in the dish.

•

The objective of this activity is not to identify the specific germs found in the environment, but just to demonstrate that germs are everywhere.

•

Check with your petri dish supplier about destroying these dishes safely after your class. You will begin to have an odour problem in your office if the dishes remain there for more than a week or two.

Glo Germ: A great way to simulate germs on our hands and effective hand washing: •

There are a number of ways to organize this activity, but one that works well is having groups of three students: o one who will open doors and carry the textbook with the hand-washing routine, and apply the Glo Germ to the other two; one who will wash her or his hands the way she or he always does; and the second following the eight steps read out by the first student. o Have the students return to the classroom and gather in a close group.

•

3-4

Turn off the lights, and then use the kit’s black light to look at all those who washed their hands their regular way, and then those who followed the routine. The room has to be dark, so if you have windows in the classroom, you may need Copyright © 2019 by Nelson Education Ltd.

to use the washroom and, depending on the size, have portions of the class come in at a time. •

Note that none of the students will have washed off all the Glo Germ product, but there should be a difference between the two groups; likely you’ll see the product collected on the knuckles, on the wrists, between fingers, and on and around rings, especially those with stones. This shows students that wearing extra jewellery, especially when working with infants and toddlers (i.e., feces), may not be such a great idea.

•

Under the black light, you’ll see white particles on your (dark-coloured) clothes and on the floor, which are from shaking the powder onto the students’ hands; this demonstrates how germs spread through the air.

•

The students may want to go and wash their hands again after the activity.

•

One kit will last you years, or perhaps the public health inspector can loan you his or her kit for a class.

Cleaning and disinfecting: Provide students with an itemized list of surfaces, toys, and objects, and ask them to decide how each will be cleaned and/or disinfecting, how often, and the reasons for their decisions. Vehicles of Transmission Activity (see handout, page 3-24): This chart can assist students in applying their understanding of illness and the ways that illnesses are spread. This activity can be done individually at home or in small groups in class; then discuss as a class. Reinforce to students that this activity is an exercise to become familiar with the spread of illness, not one that has to be memorized. Thank you to Rita Barron, professor at George Brown College, for this activity. The following scenarios are examples of incorrect practice or procedures based on inaccurate information. In small groups, have students discuss why each of the scenarios is incorrect: •

Measles-mumps-rubella (MMR) vaccination is not expected in your program’s health policy because of the proven correlation between the MMR vaccine and children developing autism.

•

After diapering the infant, you carry him directly back into the playroom. You put him on the carpet with another infant and an educator, and you return to the change table to clean and disinfect.

•

The preschoolers have come in from outdoor play and go to find their place at one of the small group tables for lunch. After eating, you ensure that they go to the sink to wash their hands before nap time.

•

It is your turn to empty the communal water table at the end of the day. You then disinfect and let it air-dry overnight.

3-5

•

You are on the playground with the preschoolers. It is a muddy day and after “making mud cakes” in the sandbox, two of the children come to you with muddy hands and want to clean them before going on the tricycles. No worries … you have hand sanitizer and wipes outside.

Public health agencies’ infection control standards and requirements of ECLC programs: The content in this textbook maintains a balance between health, safety, and common sense, referencing the Canadian Paediatric Society’s Well Beings as our national standards. Well Beings was written collaboratively, including public health inspectors, pediatricians who are experts in infection control, and EC educators. There are ECLC directors who remove water tables from their programs because the expectations of the public health agency are unattainable and they feel they don’t have a mechanism to counter such a requirement. Students in placement will see practices that contradict what is said in this textbook, for example, a public health agency’s requirement to wear disposable gloves for every diaper change. You might want to structure a discussion that includes role-playing, followed by a wider discussion. Provide each small group with a different topic to role-play. Each group would include a public health inspector and a director and educator. The role-play could take 10 to 15 minutes. Then the class can come back together to discuss each of the topics, focusing first on what is the common ground between the two positions and then working collaboratively to reach an agreement on the differences. Here are a few topics that could be discussed, but we’re sure that your students will come to class with a variety of observations: •

Water play requirements

•

Diaper changes

•

Toothbrushing routine, including storage

Is it necessary to keep the diapering area separate from the eating area, and if so, why? From what you have learned in this unit, why is the use of disposable change-table paper unnecessary? What physical type of diaper change surface should be used? How can programs that use cloth towels for diapering, cleaning, washing babies’ faces at meals, etc., organize them for separate uses? What is the rationale behind not using individual cloth towels to turn off the taps? What is the rationale for not permitting children to share water blow toys, pipes, and straws at the water table? What, if any, are the implications for ECLC programs from outbreaks or threats of an outbreak of illness (e.g., H1N1, West Nile virus)? 3-6

When a tissue isn’t immediately available when you or a child is going to cough or sneeze, a popular option is to turn your head into the crook of your elbow. The theory is that the germs and droplets will get trapped in the sleeve of your clothing. How do you think this recommended practice measures up when caring for young children? Suggestions: Here are some questions you can pose to students: •

What do you do if there is visible mucus on your sleeve?

•

What do you do if the shirt has short sleeves or no sleeves at all?

•

What do the educators do when after coughing or sneezing into their sleeves, they need to hold or carry infants and toddlers?

•

Would a better alternative be to simply cough or sneeze into your hands and then immediately wash them? Keep in mind that even when you use tissue, you should be washing your hands afterward.

•

The use of hand sanitizers is only appropriate when you do not have access to running water (this excludes outdoor play areas next to your facility as you can go back inside).

•

Carry lots of tissue in your pockets when you are outside with children.

During the practicum, educators supervising the playground routinely use hand-sanitizing products, although they are not required to do so. When one of them asks you why you aren’t using them, she suggests that it’s easier than washing hands, and hospitals use them. She says, “Anyway, we know that we’ll have to use them in an outbreak, so we may as well get used to it.” List the reasons for and against using them routinely. Which position wins, and why? Suggestions: Refer to Hand Sanitizers on text page 160. Pets in programs. Discuss the pros and cons. Suggestions: Pros: learn responsibility and nurturing, enjoy relationship, learn about the natural world Cons: effect on allergies and asthma, possible bites, cost, possibility of spreading illness, more work for staff Considerations: do not have reptiles, birds, turtles, or wild animals as pets; keep children away from pet food bowls and litter boxes; have the pet examined by a vet; make sure children are gentle with the pet; tell parents and the health department if a child is bitten or scratched, and the child should see a doctor; monitor allergies; maybe fish are easier! Copyright © 2019 by Nelson Education Ltd.

3-7

Critical Thinking First (refer to text page 159) List the opportunities and challenges involved when having a pet in the program. If a program opts not to have animals or fish living at the centre, what are other ways to provide similar opportunities? List the challenges, if any, for each of your suggestions. Suggestions: Refer to text page 158 and the Well Beings’ index under Animals (2015). Second (refer to text page 164) After reading the health promotion action plan on immunization, identify an action for each of the three levels using the topic of antimicrobial resistance as the point of reference. Suggestions: •

Individual: Don’t purchase products with antimicrobial properties (e.g., triclosan).

•

Community Action: Use social networks on the Internet to organize a boycott of a product that you want to encourage others to no longer purchase.

•

Societal Change: Search for “triclosan” on the Environmental Defence website to find a number of results: https://environmentaldefence.ca/?s=triclosan

Assess Your Learning Evaluate your options in each situation. 1. One of the daily disinfecting routines in the program is to add a capful of bleach to the water table each morning. This practice saves water and time because staff empty the water once a week. Suggestions: A pool of water is an ideal medium for germs to thrive; we know that disinfecting products work best when the organic material is removed by washing first, and after one day of play, let alone five days, bleach will have no effect; besides how much water is in the table, and whether a capful of bleach satisfies the recommended dilution, this practice is putting the children at risk of infections and so, even if this routine seems tedious, it is a priority; review your hygiene routines with the recommendations in Well Beings (2015); perhaps you can free up time for this practice when you assess that you are spending time on other routines that are unnecessary or are done too frequently.

3-8

2. While demonstrating the diaper-changing procedure, one of the educators tells you not to bother washing the infant’s hands after diapering. She says it is a time-waster; instead, she wants you to ensure that the baby’s hands are busy with a toy to prevent them from becoming contaminated during diapering. Suggestions: The diaper-change area is always to be considered potentially contaminated regardless of disinfecting the surface after each change due to the nature of the task performed there; compare it to cleaning your bathroom and then sitting on the floor to eat a meal; a child could have had his or her hand down the diaper before coming to the change table, and thus it is contaminated and you will want to remove those germs; there is a real possibility that the child will touch the area, objects, or her- or himself or your hands during the change process, even though the educator didn’t see the hands touch anything; poor hand washing and having children in diapers are the leading causes of the spread of diarrhea in a program; hand washing is a lifelong health habit that needs to be established as early as possible with support, role modelling, and supervision. 3. You are in your first program placement. You are feeling nervous and, understandably, unsure of yourself. During your first few days at the program, you observe that all the educators wear disposable gloves whenever a child has stool in the diaper. When one of the educators runs through the diapering routine with you, she makes it clear that you are expected to wear gloves. Suggestions: As a student, it is difficult to question program practices, especially during your first placement; ask the educator to explain the rationale behind staff wearing gloves during routine diaper changes; perhaps they use gloves to feel more comfortable and, if this is so, it should be appropriate for you to choose not to wear gloves; perhaps they use gloves to protect them from germs such as HIV based on outdated medical/public health recommendations; explain that this practice is contrary to what you have learned in class and in the textbook; bring in resources such as your textbook and/or Well Beings (2015) to share with educators; this discussion, which is a student’s right and responsibility, can be the impetus for a program to review their policy and procedures; on the other hand, there is no doubt that this may be difficult for a student to do, and therefore not every student will feel confident enough to do so. 4. You believe in environmentally friendly cleaning products, so when your room partner suggests getting rid of the bleach and using vinegar and baking soda instead, you are thinking about it. After all, that’s usually what you use at home to keep surfaces clean. Suggestions: Public health dictates the types of disinfecting products that licensed ECLC programs can use as a condition of the program’s licence; unless the program’s PHI approves the use of such homemade products, they cannot be used for the purpose of disinfecting. 5. When a new child enrolls in your program, the parents let you know that he has an allergy to the program’s pet guinea pig. Copyright © 2019 by Nelson Education Ltd.

3-9

Suggestions: This issue is really not much different from one where a new employee is allergic to scents and, as a result, all the staff stop wearing perfumes and colognes to work and replace the scented cleaning products with unscented ones; in this situation, the program can seek an adoptive home; perhaps one of the families would consider taking the guinea pig home and then be able to provide updates on the pet; this is a teaching moment where the children learn about tolerance, acceptance, and cooperativeness; consider an alternative such as a fish aquarium.

Resource Materials for Teaching Glo Germ: Germs You Can See. (Kit includes ultraviolet light, a liquid, and powder to simulate germs; this product is an effective tool to help train children and adults about hand washing.) Canadian; distributed by Marlatek Inc., GermWise Division: http://www.germwise.com/ There are many videos and printed resources available on topics covered in this unit. These resources are changing frequently; therefore, we aren’t recommending specific titles. In addition, your regional and national early childhood associations, child care licensing agency, and public health agency provide resources. You are encouraged to review and critique those resources and use those that fit your program.

Ancillary Materials Water Tables In Well Beings (2015), the Canadian Paediatric Society recommends that the water table be washed with detergent and water, and rinsed before disinfecting; this is ideal if this step can be realistically applied. Water tables come in a variety of sizes, usually in sizes that are awkward to move about. It is unrealistic to expect that a communal water table can be easily washed with detergent and water, and then rinsed with multiple pails of water to remove the detergent. Keep in mind that communal water tables are not used by infants and toddlers. The older children are not drinking the water from these tables, nor are they mouthing toys that are in the water. With water tables and all other disinfecting routines in an ECLC program, we must balance between infection control strategies and the degree of risk, with the fact that these programs are not hospital settings.

Rubber Gloves In Well Beings (2015), the Canadian Paediatric Society includes the use of reusable gloves in the toileting routine for toddlers, and in the steps for cleaning up large blood or body fluid spills. In both routines, the gloves need to washed with soap and water, rinsed, and then immersed in the bleach solution for at least two minutes before air-drying. Such a recommendation requires that you mix up a fresh bleach solution in a pail to soak the gloves in; it must be kept out of the reach of the children; and you have to remember to take the gloves out of the pail again, empty the pail, and air-dry the gloves. The use of the disposable gloves for these routines is practical in the program. During most toileting routines, the stool can be easily wiped off the potty with toilet paper. Fortunately, blood 3-10

spills large enough to need gloves for the cleanup are rare. The very occasional use of disposable gloves in either of these routines is neither cost prohibitive nor taxing our landfills. As well, there is far less chance of contaminating the surrounding area by removing and disposing of these gloves than attempting to wash, rinse, and soak reusable gloves in a disinfecting solution and hang to dry.

Assignment Ideas 1. Animal control: •

Use Well Beings (2015) and other resources, including your child care regulations, to develop the rationale for the decision to permit pets in the program or not.

•

Outline the educators’/programs’ responsibilities around keeping pets.

•

If they choose not to permit animals, how can they provide children with an opportunity to become familiar with them, or is that even a responsibility of the program?

2. Cleaning and disinfecting: •

Provide students with the inventory of a program’s play area and specify the age group.

•

Have them refer to Well Beings (2015, p. 165) to develop a cleaning and disinfecting schedule.

•

Include the rationale for their decision for each item in the inventory.

Test Questions Our Body’s Natural Defence Mechanisms Objective: To identify and describe our body’s natural defence mechanisms. (LO 1, 3)

•

Which of the following statement(s) about germs is/are true? a. Viruses, bacteria, fungi, and parasites are germs. b. Germs die on contact with a surface. c. Germs may live on surfaces for a week.

3-11

d. a and b only e. a and c only •

Defence mechanisms in our body: a. help keep germs from “taking over” and causing disease b. include your skin, hair follicles, and nasal hair c. include mucus from the mucous membranes, tears from the eye, and stomach secretions d. all of the above e. none of the above

•

Antibodies relate to germs/illness in the following way: a. Our body’s immune system produces antibodies specific to the germs that enter our body. b. Our body’s immune system produces general antibodies to fight off germs that enter our body. c. Antibodies are a type of germ that spreads within our body and causes antibacterial resistance. d. Antibodies always prevent illness. e. a and d

•

Immunization: a. protects children from all childhood illnesses b. results from our body actively forming antibodies against the specific disease’s antigen c. requires more than one dose for measles, mumps, and rubella d. often results in life-threatening reactions e. b and c only

•

The introduction of germs into the body, stimulating the production of antibodies, usually results in almost total protection to a specific communicable disease and is known as a. antigens

3-12

b. immunization c. sterilization d. natural immunity •

Naturally acquired immunity refers to a. routine immunization b. immunity that is passed on to babies from their mother before birth c. immunity acquired by coming into contact with pathogens d. none of the above

•

Our __________ is the first and one of the most important defence mechanisms in our body. (answer: skin)

•

In addition to our skin, what are two (2) other defence mechanisms of our body? (answer: secretions from the hair follicles; nasal hair and cilia; mucus from the mucous membranes; stomach secretions; coughing and sneezing; bacteria in the gastrointestinal and urinary tract; urine’s bacteriostatic action; antibodies)

•

Briefly describe antibodies in relation to germs/illness. (answer: Our body’s immune system produces antibodies specific to the germs [antigen] that enter our body; antibodies help defend us against specific germs and may either prevent the illness or possibly reduce the severity of the illness.)

How Infections Spread Objective: To explain how germs are spread. (LO 1, 3)

•

(T or F) Blood-borne diseases are spread by casual contact.

•

(T or F) Viruses die on contact when they land on countertops, toys, and other objects and surfaces.

•

(T or F) Children do not spread germs until the signs/symptoms appear.

•

A host can spread germs __________, during, and sometimes __________ an illness. (answer: before; after)

3-13

•

Vehicles of transmission include a. direct and indirect contact b. hands c. food d. mouthing toys e. all of the above

•

Infants and toddlers get more illnesses than older children because a. they wear diapers b. they share mouthing toys c. they have a mature immune system d. all of the above e. a and b only

•

The chain of infection tends to happen in this order: a. b. c. d. e.

the germ, a vehicle of transmission, and a new host the host, the germ, a vehicle of transmission, and a new host the germ, the host, a vehicle of transmission, and a new host the host, the germ, a new host, and a vehicle of transmission all the above orders are possible

•

List and describe each link in the chain of transmission. (answer: the germ [bacteria, viruses, fungi, parasites; may live on surfaces for hours to weeks]; the host [person who is ill; may spread germs before, during, after an illness]; the vehicles of transmission [germs spread directly or indirectly and examples of possible hands/objects]; the new host [new person who becomes ill])

•

Explain why infants and toddlers get more illnesses than older children. (answer: immature immune system [key point]; not fully immunized; wear diapers; learning to wash hands; share mouthing toys; physically affectionate; put everything in their mouth; crawling; older toddlers learning to use toilet; require a lot of hands-on care)

3-14

Breaking the Chain: Developing an Infection Control Strategy Objectives: To explain the role that policies and procedures play in infection control. (LO 6) To describe the principles and recommended practices for immunization. (LO 1, 3) To state the rationale for effective hand washing as the most important health practice in reducing the spread of infections. (LO 6) To describe the when, what, and how of hand washing for educators and children. (LO 4, 6) To explain the rationale behind the steps in diaper-changing and toileting routines. (LO 6) To understand why certain items must be cleaned and disinfected before and after use or on a daily or regular schedule. (LO 6) To state the rationale for routine practices and how to put them into practice. (LO 3, 6)

•

(T or F) Only paper towels (not cloth) must be used in programs.

•

(T or F) Wearing rubber gloves while rinsing cloth diapers eliminates the chance for germs to be spread.

•

To break the chain of infection, a program’s infection control strategy will include policies and procedures on the following: (answer: hygiene practices; cleaning and disinfecting routines) a. immunization b. _________________________________ c. _________________________________ d. health observations e. documentation of health observations f. exclusion criteria g. effective communication with parents

3-15

•

Children are routinely immunized against all of the following communicable illnesses except for a. measles, mumps, and rubella b. impetigo c. polio d. tetanus and diphtheria

•

The purpose of ___________ an object or surface is to eliminate as many germs as possible. The purpose of ___________ an object or surface is to remove dirt and germs from objects and surfaces. (answer: disinfecting; cleaning)

•

The most effective strategy for controlling infections in programs is ______________ by both children and educators. (answer: hand washing)

•

The most important times to wash your hands are a. b. c. d. e.

•

before handling food, and after toileting or changing diapers after handling food and before changing diapers before and after handling food before and after toileting or changing diapers none of the above

The most important times to wash hands are o Before: ______________________________ (answer: refer to text page 143) o After: _______________________________ (answer: refer to text page 144)

•

What is the active ingredient in most hand sanitizers? (answer: alcohol)

•

Under what circumstances would we consider using hand sanitizers instead of hand washing? (answer: when activities such as field trips do not provide easy access to running water)

•

Give one rationale (reason why) discussed in the text for each of the following diapering practices: (answer: refer to text page 151) o Wash the child’s hands before returning him or her to a supervised area (i.e., playroom): ______________________________. o The routine use of disposable gloves is not recommended because ______________________________.

3-16

•

The three (3) most important aspects of hand washing to ensure that germs are washed away are: running water, soap, and ________________________________. (answer: friction or rubbing or scrubbing)

•

______________ is the introduction of germs into the body, which stimulates the production of antibodies, usually resulting in almost total protection from a specific communicable disease. (answer: immunization)

•

The following statement(s) is/are true about the use of gloves in the program: a. They should be worn for routine diaper changing. b. They should be worn when there is risk of exposure to blood or to bloody body fluids. c. The use of gloves makes hand washing unnecessary. d. The unnecessary use of gloves is not a problem because they are inexpensive and biodegradable. e. all of the above

•

To prevent the spread of blood-borne diseases (e.g., hepatitis B, HIV) in centres, according to routine practices, educators will a. wear disposable gloves when changing diapers b. wear disposable gloves to handle or touch items or surfaces soiled with blood c. wash children’s clothing stained with blood after a nose bleed or injury before sending them home with the parents d. ask parents if their child is HIV positive e. all of the above

•

The single most effective strategy to prevent the spread of infectious diseases is a. good ventilation b. keeping the room very warm c. regular and thorough hand washing d. keeping toys clean e. none of the above

3-17

•

The following is true about cleaning and disinfecting in the ECLC environment: a. The purpose of disinfecting is to remove most of the visible dirt, whereas cleaning kills as many germs as possible. b. The purpose of cleaning is to remove most of the visible dirt, whereas disinfecting kills as many germs as possible. c. Cleaning and disinfecting is only done when necessary, possibly once a week. d. none of the above

•

Recommendations to reduce germs in communal water tables include a. putting a drop of bleach in after filling it so that the water won’t need changing daily b. emptying, washing, rinsing, disinfecting, and air-drying the tub/table and water toys daily c. closing the water table during an outbreak of diarrhea d. b and c only e. a and c only

•

Two (2) important daily practices listed in the text for communal water tables are (answer: refer to text page 155) 1. _____________________________________________________________ 2. _____________________________________________________________

•

Reorder the following eight (8) steps for effective hand washing, according to the textbook (write the appropriate number beside each step): Rinse your hands well under running water for 5 to 10 seconds. Rub your hands vigorously for 10 to 15 seconds. Wash all surfaces, including the backs of hands and between fingers. Dispose of the cloth or paper towel. Wet your hands and add soap. Dry your hands well with a towel. Turn off the taps with a single-use towel. Use warm running water.

3-18

Apply hand lotion, as needed. (answer: 5; 3; 4; 7; 2; 6; 1; 8) •

Identify one (1) common direct and one (1) common indirect vehicle of transmission by which infectious illnesses are spread in ECLC programs: Direct: Indirect:

•

Reorder the following 11 steps of the diapering routine, according to the textbook (write the appropriate number beside each step): Place the child on the changing surface and remove the soiled diaper. Fold the soiled surface inward and set it aside. Assemble all the necessary supplies. Clean and dry the child’s skin. Put a fresh diaper on the child. Dispose of the diaper and, if used, the disposable paper covering. Wash the child’s hands. Return the child to a supervised area. Put away all diapering supplies. Wash your hands. Spray the disinfecting solution onto the entire surface of the changing surface. Leave on the surface for the length of time based on the product’s instructions. Dry the changing surface with a single-use towel. Dispose of the cloth or paper towel. Record skin condition and bowel movements, as necessary. Wash your hands thoroughly. (answer: 2; 1; 3; 5; 4; 7; 8; 6; 9; 11; 10)

•

Insert the following diaper change steps that have been “left out” into the list in the correct order: o Wash your hands. (8) o Dry change surface with one-use towel and throw out. (9) o Wash child’s hands. Return to play area. (4)

3-19

o Put away all diapering supplies. (7) 1. Assemble all necessary supplies. 2. Place child on changing surface and remove soiled diaper. 3. Clean and dry child’s skin and put on fresh diaper. 4. _______________________________________________ 5. Dispose of diaper. If cloth, bag without rinsing. 6. Spray disinfecting solution on change surface. Leave on the surface for the length of time based on the product’s instructions. 7. _______________________________________________ 8. _______________________________________________ 9. _______________________________________________ 10. Wash your hands thoroughly. 11. Record skin condition and BMs, as necessary. •

List the steps, in order, that educators must follow for effective hand washing. (answer: refer to How We and Children Wash Our Hands, in text page 146)

•

Explain the rationale for the following two (2) steps in the diapering routine (the why): o Step 3—When necessary, use a facial tissue to apply ointments or creams. (answer: provides a barrier between your hands and the ointment, which keeps you from contaminating the container/tube and remaining ointment; use tissue to spread the ointment, which keeps any germs on your hands from going back onto the child’s freshly washed skin and you won’t try to wash off the ointment sticking to your hands) o Step 4—Wash the child’s hands. Return the child to a supervised area. (answer: the child may have already been able to get her or his hands in the diaper; the diapering area is always considered dirty; the child may touch the wet/soiled diaper or the changing surface during the change, and then if the hands are not washed, the germs will contaminate the play or eating area when the child is returned; the start of a lifelong health habit)

•

3-20

An educator asks you why your program does not use disposable paper when changing diapers to prevent the spread of germs. What would you say to her? (answer: urine/stool can leak through this paper and contaminate the diaper surface [key point]; surface must be disinfected whether paper is used or not; diapering area Copyright © 2019 by Nelson Education Ltd.

is always considered dirty and the use of paper doesn’t change that; costly; environmental concerns about the unnecessary use and disposal of paper) •

What is the purpose of o cleaning (answer: to remove most of the visible dirt and germs for objects and surfaces) o disinfecting (answer: to disinfect objects or surfaces to ensure that as many germs as possible are eliminated)

•

What is the underlying principle for routine practices? Explain how it applies to ECLC programs. (answer: educators must assume that anyone could be infectious whether they know it or not [key point]; therefore, hygiene practices and cleaning and disinfecting must be implemented at all times, not just when someone is ill; students may also connect routine practices with the reason we do not routinely screen children and educators for specific diseases [e.g., HIV])

•

______________________ ______________________ is the name of the practice for treating blood and bodily fluids that may contain blood from any person as potentially infectious. (answer: routine practices)

•

List four (4) of the seven (7) areas of infection control policies and procedures that will break the chain of transmission. (answer: immunization; hygiene practices; cleaning and disinfecting routines; daily observation of children; documentation of health observations and sharing them with parents and physicians; exclusion criteria; effective communication with parents)

•

List three (3) of the seven (7), recommendations for reducing germs in communal water tables and their contents. (answer: fill with fresh water each morning; empty it at the end of each day; wash with detergent and rinse, sanitize (disinfect), and air-dry; sanitize (disinfect) and air-dry the water toys; clean and sanitize (disinfect) blow toys; encourage children/educators to wash their hands before playing; discourage ill children from using the table; close the table during an outbreak of diarrhea)

3-21

HERE’S THE ANSWER—WHAT’S THE QUESTION? Here’s the answer.

What’s the question?

skin

What is our first-line of defence against germs?

parasites, fungi, bacteria, and viruses What are germs? hand washing

What is the most effective strategy for controlling the spread of infection?

running water, soap, and friction

What are the three important aspects of effective hand washing?

germs, host, vehicles of transmission, What are the four links in the chain of new host transmission? through direct or indirect contact, air, List the vehicles of transmission. stool, food, blood or body fluids antibodies against the specific disease(s)

What does the body produce after an immunization?

protecting staff from unnecessary exposure to potentially harmful organisms

What is the fundamental principle behind routine practices?

to remove dirt and germs

What is the purpose of cleaning?

to eliminate as many germs as possible

What is the purpose of disinfecting?

unnecessary expense; creates unnecessary garbage; offers little protection beyond good hand washing

Why are disposable gloves not recommended for routine diaper changing?

daily

How often should mouthing toys be cleaned and disinfected?

contributes to antimicrobial resistance

What is one possible effect of overuse of antibacterial products?

emergence and global spread of a flu What is a pandemic? virus leading to high numbers of illness and death

3-22

SELF-TEST ON INFECTION CONTROL TRUE OR FALSE: Unit 3 Date:

Name:

True or False—1. The immunization schedule for children is the same across the provinces and territories in Canada. True or False—2. Hand-sanitizing products require a minimum of 30% alcohol. True or False—3. Pandemics are only a concern for people living in developing countries. True or False—4. Rinse stool from cloth diapers to control the odour in the diaper pails. True or False—5. Disposable paper on the change table is recommended for all diaper changes. True or False—6. The use of potties for children toilet learning does not pose any greater risk of infection than the use of the toilet. True or False—7. You’ll get better results if you clean surfaces before you disinfect them. True or False—8. Clean and disinfect toys that infants and toddlers put in their mouths once a week, and for preschoolers’ and school-agers’ toys once a month. True or False—9. In all cleaning and disinfecting routines, the objects or surfaces are left to air-dry. True or False—10. A written schedule for all routines is unnecessary if staff are carrying out the routines consistently.

3-23

VEHICLES OF TRANSMISSION ACTIVITY Identify how each disease/infection is spread to others. You need to identify the vehicle of transmission and whether the spread is from direct or indirect contact. (refer to Appendix 4.1, text page 213) Disease/Infection

Through the Air

Through Stool

Through Food

Through Blood and Body Fluids

Respiratory Infections Common Cold Pinkeye (Conjunctivitis) Pneumonia Gastrointestinal Infections Diarrhea E. coli Giardia Rotavirus Salmonella

3-24

Direct Contact Indirect Contact

Disease/Infection

Through the Air

Through Stool

Through Food

Through Blood and Body Fluids

Skin and Scalp Infections Head Lice Herpes Simplex (Cold Sores) Impetigo Other Infections Chickenpox Hepatitis B Meningitis Tuberculosis Whooping Cough

3-25

Direct Contact Indirect Contact

UNIT

Illness Management

4 CONTENTS

CLASSROOM ACTIVITIES AND DISCUSSIONS..........................................................................2 Critical Thinking...................................................................................................................................... 6 First (refer to text page 180) ...................................................................................................................... 6 Second (refer to text page 200) ................................................................................................................. 6 Third (refer to text page 203) .................................................................................................................... 7 Fourth (refer to text page 208) .................................................................................................................. 7 Assess Your Learning .............................................................................................................................. 8 Resource Materials for Teaching............................................................................................................. 9

ASSIGNMENT IDEAS .............................................................................................................10 TEST QUESTIONS ..................................................................................................................11 Children’s Health Care .......................................................................................................................... 11 Childhood Infections and Nuisances: Just the Basics ............................................................................. 16 Antibiotic-Resistant Bacteria ................................................................................................................ 20 Administering Medication .................................................................................................................... 21 Allergies and Asthma............................................................................................................................ 21

HERE’S THE ANSWER—WHAT’S THE QUESTION? ...............................................................25 CARING FOR ILL CHILDREN—SCENARIOS ............................................................................26 Scenario 1 ............................................................................................................................................ 26 Scenario 2 ............................................................................................................................................ 26

4-1

Classroom Activities and Discussions Here’s the Answer—What’s the Question? (see handout, page 4-24) Antibiotic resistant bacteria are becoming a major concern in hospitals and in communities. Resistant bacteria are bacteria that have changed to avoid being recognized and killed by antibiotics; only the bacteria that the antibiotics recognize are killed. The resistant bacteria left behind may grow and multiply. Using antibiotics too often is one of the main reasons that the number of resistant bacteria is increasing. This is also requiring the use of more powerful antibiotics. Our chance of being infected with resistant bacteria increases every time we take antibiotics. That’s why it is so important to have antibiotics only when absolutely necessary (refer to Antibiotic-Resistant Bacteria, text page 193). •

View this video: “Superbugs in the Supermarket” (aired February 11, 2011, Marketplace on CBC). To view, visit http://www.cbc.ca/marketplace/episodes/2011-episodes/superbugs-in-thesupermarket

•

Have a classroom discussion about the growing concern regarding the use of antibiotics in meat and poultry sold in grocery stores (refer to Antibacterial Products, text page 161).

Have a class discussion about how ECLC programs can contribute to reducing the amount of unnecessary antibiotics used, rather than contributing to the problem. Discussion could include •

program’s exclusion criteria that don’t require parents to take their child to the doctor unnecessarily (refer to Appendix 4.1, text page 213)

•

Antibiotic-Resistant Bacteria (refer to text page 193)

Strategies for managing ill children: Two scenarios have been included as handouts for students to use during a discussion around what to do in the event that a child is ill in an ECLC program (see Caring for Ill Children—Scenarios, page 4-25). Divide the class into two groups. Each group can work through one of the two scenarios and then come back together to present their scenario to the class. Discuss the pros and cons of lice control with chemical treatments (e.g., NIX) versus more natural products, such as an oil and vinegar mix on the scalp (salad anyone?). Contact your local public health agency for the track record of the different treatments. Chances are that the oil (smothers the lice) and vinegar (helps them fall out) mix is becoming a more effective option than the chemical treatments, which are expensive and tend to contribute to resistance with time. Ask someone from the local chapter of the Lung Association or the Asthma and Allergy Association to come to your class for a half hour to discuss and demonstrate some of the more common medications and equipment used by/for children of different ages and severity in an asthma episode, as well as discussion of severe allergies and procedures to 4-2

prevent anaphylactic shock. (NOTE: Students may have already learned this information in their first-aid and CPR training.) Administering medication: •

Students can role-play and become familiar with eye or ear droppers and pulling on another’s earlobe or pulling down the lower eyelid, along with pouring and measuring liquid medications. Well Beings (2015), pages 220–224, outlines the steps.

•

Photocopy Appendix 7.1 in Well Beings (2015), pages 139–140, or the form used in your programs.

•

Provide students with a scenario, have them complete the parents’ portion of the form, and then proceed to give the medication.

•

Ask students to bring in empty medication containers or over-the-counter medication (for confidentiality, they may prefer to stroke out the person’s name) and appropriate measuring cups/spoons, if they happen to have them. Or you may need to purchase a few different styles from the local pharmacy.

•

Fill these empty containers with water mixed with food colouring, which helps you see the level in the measuring cup/spoon or dropper. (Do not permit students to instill drops into anyone’s eyes or ears.)

Taking temperatures: If your program supports temperature taking, refer to Well Beings (2015), pages 171–172. The following scenarios are examples of incorrect practice or procedures based on inaccurate information. In small groups, have students discuss why each of the scenarios is incorrect: •

Jamal’s mom was in a hurry this morning because the subway was slow. After she left, Jamal, four years old, felt warm to the touch. You took his temperature (39ºC via tympanic [ear] thermometer). Jamal was building a Duplo structure with a peer; you phoned his mom’s office and left a message that she needs to pick Jamal up to take him home because he has a fever.

•

When you changed Seema’s diaper, she had a very loose stool, and you remember that her mother had mentioned that Seema had been up with a tummyache during the night. You shared this information with the educators in the room and reminded them that extra vigilance with hygiene practices was important to ensure that diarrhea did not spread. After the third episode of diarrhea, you phoned the parents to pick up Seema and to see a doctor.

•

There are three children with ear infections in the toddler room. You put a parent information sheet on ear infections in each child’s cubby because you are

4-3

concerned that ear infections are “going around” and other children in the room will catch it. The school-age program is located inside the elementary school. One part-time educator works in the afternoon and after school. Two full-time educators work in the program, preparing activities and planning the curriculum in the morning, and working with children from the half-time kindergarten class in the afternoon. Classroom teachers often expect the educators to care for any mildly ill child who is also enrolled in the school-age program, rather than call the parents or keep the child in the classroom until the end of class. At times, the educators manage to accommodate an older ill child in the afternoon. As a result, the teachers expect the educators to be responsible for ill children and to notify parents when the child becomes ill in the classroom. The educators feel resentment toward these teachers. The teachers and educators need to work cooperatively and collaboratively. Debate both sides of the issue from the perspective of the teachers and the educators. How can this issue be resolved in a way that is in the best interests of the children? Design a policy and procedures for the management of ill school-agers that can be used by teachers and educators. Don’t overlook the parents. Suggestions: Perhaps arrange a meeting with educators and teachers, along with the director, principal, and parent representative(s), to identify the issues: •

educators—While the child is in the classroom, he or she is under the teacher’s supervision, and the health and safety of the child is the school’s responsibility; educators use the time when children are not in their program (i.e., mornings) for other program responsibilities; if the child care program was not located in the school building, teachers would not expect the educators to care for ill children during class time.

•

teachers—A teacher is alone with a large group of children and can’t be expected to leave the classroom to care for the ill child or the situation; the child care program is part of the child’s day, and since parents are at work, the educators should be expected to care for the child in the morning and through the afternoon; once the parties have shared their feelings and perspectives, there should be an opportunity to negotiate.

•

educators—Elaborate that obviously they care about and consider the children’s and the families’ needs.

•

teachers—Elaborate that they don’t want to take advantage of educators and they respect the close relationships they have with the children, and that the children will feel much more positive about this sick-care arrangement.

Conclusion: Guidelines are needed to determine whether the school or ECLC program would be responsible for the ill child, along with procedures for notifying parents.

4-4

Discuss the benefits and challenges of administering any medication requested by parents. With a panel of experts, Health Canada reviewed over-the-counter cough and cold medicines and ordered manufacturers to relabel these products to state, “do not use in children under six.” Parents across the country are being warned not to give cough and cold medicines to young children because of “limited evidence” that they work, and the rare but real risks of potentially serious reactions. Discuss how you would respond to a parent’s request to give a child cough syrup during the day. (Consider both the immediate and program responses to such requests.) Role-play scenarios: Divide the class into groups of three. One student plays the parent, one the educator, and one the observer to provide feedback. The observer can reference the list of questions in Documentation in Children’s Files on text page 177 to consider possible types of questions that can be asked of the parent or shared with the parent. In addition, the observer notes whether the educator is talking “at” or “with” the parent, and the level of respect shown for the parent’s knowledge of her or his child, as well as language, values, and other considerations. •

A parent and educator conversation at drop-off: Provide a few minutes for the parent to make up a sick-child situation. Then the educator has a conversation with the parent, attempting to glean the relevant health information before leaving the child for the day.

•

A parent and educator conversation at pickup at the end of the day: Provide a few minutes for the educator to make up a sick-child situation. Then the educator shares the health observations with the parent.

(You may prefer to develop “stories” for each scenario for the students to use in the role-play. Each of the three students will ideally have the opportunity to play each role.) Head lice: In early 2014, there are news reports about a large majority of head lice that are resistant to the insecticide added to the shampoos and conditioners used for treatment. For example, this article in the Winnipeg Free Press: https://www.winnipegfreepress.com/arts-and-life/life/health/mutant-lice-on-rampage-incanada-250287861.html?device=mobile How the public health agencies are going to respond to this finding is unclear at the moment. Because of the incredible challenge it is for ECLC programs to respond to a head lice infestation, it could be ideal to invite your public health agency’s representative to present to your class. Or have your students research this issue for a classroom discussion.

4-5

Critical Thinking First (refer to text page 180) Use the three levels of the health promotion action plan to identify at least one action for each level that would support families in the difficult dilemma of having a child who is too ill to participate in the program for one week, although not so ill that she or he needs to stay in bed. None of the adults in the family have paid time off. (refer to text page 180) Suggestions: •

Individual: o Family: Although parents may lose wages, split the time staying at home to care for the ill child. o Program: Develop a program that supports families in such a situation, where your program’s volunteers who are familiar with the children (e.g., grandparents, retired persons) are available to provide occasional in-home care.

•

Community Action: o Family: Network with families in their neighbourhood who among themselves can provide care to the others’ ill children. o Program: Directors in an area develop a service that supports families in these situations, ensuring that licensing requirements are maintained. o Directors, educators, and parents from multiple ECLC programs approach a community centre to develop and provide a “Get Well” program.

•

Societal Change: Enact federal legislative changes to ensure flexible family responsibility leave days.

Second (refer to text page 200) During school hours, school-agers with asthma or life-threatening allergies are encouraged to be responsible for their own puffer or adrenaline kit and to carry it with them. However, while they are in the school-age program, educators are responsible for these medications. How do we help school-agers understand that expectations differ for them between the school and the child care program? And how do educators in schoolage programs advocate for change in child care regulations to bring these programs into line with the school, to create the “seamless day”? Suggestions: A concerted effort should be made to minimize the differences as much as possible; a school-ager should be expected to identify his or her symptoms that indicate the need for medication; educators will use their observation skills to ensure a child is not experiencing symptoms; if a school-ager requires Ventolin before 4-6

sports, instead of the educator reminding the child and giving the child the puffer, the child could go to the educator and request the medication while the child is supervised taking it; advocacy—ever-increasing numbers of school-age programs are opening; some jurisdictions are reviewing the child care legislation regarding medication to reflect the developmental abilities of various age groups; there may be a school-age child care association in your community or part of the provincial/territorial association you could join who is advocating for the seamless day. Note: there will always be school-agers who do need supervision with medication and parents who want educators to monitor appropriate use of medication. For this reason, any legislation must reflect the diverse nature of school-agers and programs so that children aren’t automatically expected to be responsible for themselves. Third (refer to text page 203) A toddler who is allergic to wheat is mistakenly offered bread made with wheat by a substitute staff at morning snack. She has a tummyache at nap time, but it subsides, and upon awakening, she seems to feel back to normal. Your room partner is leaving her shift and advises you not to let the parent know about the incident at the end of day since the child is fine now. What would you do and why? Suggestions: The incident and tummyache must be documented and shared with the parents; not disclosing this information would be unethical and could possibly increase the child’s risk of more serious reactions in the future. Fourth (refer to text page 208) The dad tells you in the morning that he was up with his four-year-old daughter, Amanda, much of the night because the wheezing from her asthma woke her up often. She has had this nighttime wheezing for more than a week now. You suggest that he doesn’t need to worry because Amanda doesn’t have asthma episodes at the child care program during the day. Is this good advice? Why or why not? If not, what would you say instead? Suggestions: Your suggestion is inappropriate. Most importantly, you are not a medical practitioner, and thereby you are not qualified to minimize Amanda’s symptoms. It is not uncommon for parents to trust the educator’s opinion, and they may decide not to visit their health care professional. Amanda likely has asthma triggers during the night that are not an issue during her child care day. It is possible that she has an allergy to a family pet or lives in a home with second-hand smoke. Perhaps the sleeping position (having her head and chest in a prone position for many hours) may be causing her wheezing and difficulty breathing. Instead, empathize with the dad and Amanda about how tired they must be from not having a good night’s sleep. Suggest that the dad bring Amanda to the doctor, to help determine what her night triggers may be or to revisit her medication needs.

4-7

Assess Your Learning Evaluate your options in each situation. 1. One of the two-year-olds is listless and unhappy today. He is unable to participate in the program and needs to be held and comforted. When the director calls his mother, she asks that you take his temperature. You do so, and because the child does not have a fever, the mother refuses to pick him up early. Suggestions: This is an example of the program not establishing clear exclusion criteria and/or not discussing them with the parents at the time of enrollment, and the parents agreeing to them at the initial interview; document this conversation in the child’s file; continue to monitor the child’s behaviour, call the mother again (refer to Physical and Behavioural Signs and Symptoms, text page 171, and Fevers, text page 173). At the end of the day, the director or educator should talk with the mother privately about the day’s event, the child’s well-being, the mother’s work situation, and if she could have contacted an alternative adult to have picked up and cared for the child; share the program’s exclusion criteria; at a staff meeting, discuss this situation and rethink the practice of taking temperatures in the program, the enrollment interview, and the information included in the parent book. 2. A preschooler has a number of food allergies, so she is often offered other foods at lunch and snack. She cries and says she wants only what the other children eat. Meanwhile, some of the other children only want to eat the same food she eats. Suggestions: Acknowledge all the children’s feelings: •

for the child with the allergies (e.g., “It’s hard for you to eat something different than your friends, but you know that if you eat eggs you will get sick.”)

•

for the other children (e.g., “I understand that you would rather eat what Jenny is eating. I’m sorry that we don’t have enough for everyone, and Jenny can’t eat eggs like the rest of you because she is allergic to eggs and will get sick if she eats them.”)

Find simple ways to help children understand what food allergies are, which helps normalize the situation for Jenny and the other children. As often as possible, try to offer everyone the same food by working around the allergies. When substitutes must be made, attempt to make it look similar to what the rest are eating so children don’t focus on the different food. Perhaps make enough that if other children do notice and want to try it, there is some for them. 3. One of the families goes to a naturopath as their health practitioner. You also believe that naturopaths have a lot to offer in promoting health. The parents ask you to administer the homeopathic (i.e., not prescribed by a medical doctor or advanced

4-8

practitioner) medicine to their child daily. They are willing to sign the medication form. Are you able to administer this medication? Suggestions: From a legal standpoint, it is critical that educators know their provincial/territorial child care regulations around this issue. Several provinces/territories would allow the administration of homeopathic medicines because the regulations simply stipulate that there be written parental permission and that medication is brought in the original container and stored in a locked container out of the reach of children. Even if the regulations allow it, your program may have a policy or practice that requires/recommends that parents administer nonprescription medication at home rather than in the program. They may also recommend that parents ask physicians that whenever possible, prescription medication is prescribed for times in the day where those medications can be administered at home. 4. One of the preschoolers who has asthma often needs her “reliever” medication (Ventolin inhaler) to prevent severe episodes. Today you are going on a field trip away from the centre, but you didn’t notice until you are ready to leave that the inhaler is empty. The parent has already left for work. What do you do? Suggestions: An individual who can potentially have a severe asthma episode must have access to the medication at all times. This is a similar situation to those with allergies who can have an anaphylactic reaction and would require adrenaline. There must never be an exception. The risk of an episode is likely higher when the child is off-site, depending on the triggers. Unfortunately, if the parent is not available to return to the program with the medication, the child will be unable to go on the field trip. In addition, if the parent or another emergency contact person is not able the bring medication immediately, they would need to take the child home. Obviously, this stressful situation for the child, family, and educators can be prevented by ensuring that a full inhaler (backup) is always available at the program.

Resource Materials for Teaching Canadian Allergy, Asthma, and Immunology Foundation: http://www.allergyfoundation.ca/ Food Allergy Canada’s website (a list of resources available for download): https://foodallergycanada.ca/resources/printmaterials/https://foodallergycanada.ca/resources/printmaterials/https://foodallergycanada.ca/resources/printmaterials/https://foodallergycanada.ca/resources/print-materials/ The Hospital for Sick Children’s website (a health library on topics from A to Z): https://www.aboutkidshealth.ca/

4-9

Assignment Ideas 1. Options for mildly ill children: •

Investigate the types of services available in your community for a mildly ill child who is excluded from his or her program.

•

For each service, outline the benefits and drawbacks, costs to the parents, who runs it, the population using the service, and availability of each service, along with the reasons behind the service’s establishment.

•

Are there any programs that have developed some type of sick-child care for the children enrolled in their program?

2. Community agencies serving parents and educators with regard to common childhood illnesses and/or health issues: Students would be required to research the available agencies within their community who provide services and/or materials (e.g., local chapter of the Allergy and Asthma Association, public health agency, parent resource centres, community health centres). The students would submit a list of these agencies and the complete contact information, along with a short description of the available services each agency provides (e.g., speakers, written material, website, videos, pamphlets, etc.). 3. Consider having your students write a 500-word comparison/critique of Manitoba’s Department of Early Learning and Child Care’s Bed Bug Guide for Licensed Child Care Facilities with a local or regional bedbug resource (https://www.gov.mb.ca/fs/childcare/resources/pubs/bed_bug_guide.pdf). If not bedbugs, perhaps assign a topic such as head lice. Research your community’s public health agency or provincial/territorial child care licensing agency for specific information on managing bedbugs in licensed ECLC settings. Read both documents and answer the following questions: •

Were you able to understand the general information on bedbugs?

•

Are there policies and procedures specific to bedbugs in licensed ECLC settings? If so, is the information easy to understand and put into practice?

•

Are there strategies for responding to bedbugs respectively to children and families who may be dealing with bedbugs at home?

•

Does information include lines of communication in your community?

•

Of the two resources, which did you find the most readable and practical from the perspective of licensed ECLC settings?

4. Resource Material Portfolio: Over the semester, students would prepare a (paper or online) portfolio of materials for parents and educators on health issues. Students would obtain/download a copy of the material in each language in which it is 4-10

available. Students would be required to explore their community for places where such material is displayed and readily accessible to the public (e.g., local pharmacy, doctor’s office, parent resource rooms in hospitals, YMCA-YWCA, Planned Parenthood office, etc.). 5. Critique Health Documentation: •

Partner students and provide them with an example of a completed health document (ensure that the program and child identifiers have been removed).

•

Have the students critique the form and content for clarity and determine if the information provided will assist the parents and health care provider in the subsequent medical examination. You may wish to include some or all of the following questions to guide the students in the critique: o How has the child’s behaviour changed to lead you to believe that the child may be ill? o What are the signs and symptoms that the child is experiencing? o When were these first noticed and how long have they lasted? o Have they changed? If so, how? o How is the child’s appetite? o Has the child had difficulty urinating or passing stool? o Has the child eaten a new food, been recently immunized, taken a new medication, or been recently injured? o Have the parents been notified? If so, when?

•

What considerations could a program make for those parents who are not literate in the language used in the form?

Test Questions Children’s Health Care Objectives: To describe the why, how, and what of daily health observations. (LO 4) To identify the signs and symptoms of illness and describe how to proceed with concerns. (LO 3, 4) To explain the principle of exclusion and consider the issues surrounding exclusion from the ECLC program. (LO 2, 3, 4, 6) Copyright © 2019 by Nelson Education Ltd.

4-11

•

(T or F) Fevers are dangerous.

•

(T or F) A child whose main indicator is a runny nose with green mucus should be excluded from the program and seen by a doctor.

•

(T or F) A change in a child’s behaviour is a reliable indicator of an illness.

•

(T or F) Observing a child’s behaviour is not as important as taking a child’s temperature.

•

(T or F) Children with a fever can continue to attend the program if they feel well enough to participate in the program.

•

(T or F) An important policy to follow is to exclude all children with fever.

•

(T or F) Children do not spread germs until the signs and symptoms appear.

•

Infants and toddlers can __________ very quickly when they have diarrhea or are vomiting. (answer: dehydrate)

•

To break the chain of infection, a program’s infection control strategy will include policies and procedures on (answer: health observations, exclusion criteria) a. immunization b. hygiene practices c. cleaning and disinfecting routines d. ____________________ e. documentation of health observations f. ____________________ g. effective communication with parents

•

When talking with the toddler and parent at drop-off in the morning, the educator will a. ask the parent how well the child slept last night b. lift up the child’s shirt to check the skin for a rash c. ask the parent to complete the program’s infant and toddler daily report form before she or he leaves for work d. a and c only

4-12

e. a, b, and c •

Documentation of children’s signs and symptoms of illness: a. is not an educator’s role b. is shared with parents and possibly health professionals c. needs to be objective, clear, and concise d. b and c only e. none of the above

•

Daily baseline health observations: a. call on the educator’s senses and observation skills b. happen at the end of each child’s day c. happen at home and are communicated by the parent to the educator d. include a physical examination of each child, lifting clothing, and using a flashlight e. b and d only

•

How do staff conduct daily health observations? (answer: using their senses) ______________________________ Give two (2) reasons why a daily health observation is important at the start of the day: (answer: refer to text page 171) 1. ______________________________ 2. ______________________________

•

Which of the following can cause our body’s temperature to rise? a. overdressing b. physical exercise c. an infection d. all of the above e. none of the above

4-13

•

Fevers: a. are dangerous b. are one of our body’s defence mechanisms that helps us to fight infections c. should always be treated with fever-reducing medication d. are caused by teething e. all of the above

•

The program’s exclusion policy should state that children will not be able to attend the program when a. an illness prevents the child from participating in routine activities b. the child has a fever and/or a runny nose c. a child poses an increased risk of infecting other children or educators d. all of the above e. a and c

•

When caring for infants and toddlers with diarrhea, an educator will a. call the parents to pick up the child after the first episode of diarrhea b. have the director notify the public health agency when one child has diarrhea c. try to ensure that a child with diarrhea doesn’t become dehydrated d. all of the above e. b and c only

•

The following statement is true about indicators of illness: a. Fevers are dangerous. b. A child whose main indicator is a runny nose with green mucus should be excluded from the program and seen by a doctor. c. A change in a child’s behaviour is a reliable indicator of illness. d. Observing a child’s behaviour is not as important as taking a child’s temperature. e. None of the above statements are true.

4-14

•

Parents or educators would seek immediate medical attention if the child had any of the following signs or symptoms: (NOTE: All signs and symptoms indicated in each response must require immediate medical attention for the response to be correct.) a. changes in breathing; pain or difficulty swallowing; stiff neck; rash with fever; rash with change in behaviour b. rash with a change in behaviour; stiff neck; difficulty swallowing; fever c. runny nose; diarrhea; vomiting; pain or difficulty swallowing d. stiff neck; cranky behaviour; rash with fever; runny nose e. none of the above

•

For each body part listed below, list two (2) possible physical indicators of illness: o face: (answer: sad; tired; angry; upset; flushed) o eyes: (answer: whites of eyes are red or yellow; puffy eyelids; watery, clear, or thick discharge; rubbing sores or sties) o breathing and/or voice: (answer: wheezing; congested; coughing; sounds stuffed up; hoarse) o skin: (answer: rashes or patches of irritated skin; cuts, scrapes, or abrasions; bruises; bumps; skin has a yellow colour; scratching skin)

•

List three (3) of the seven (7) behavioural changes in children for which parents or educators would seek medical attention. (answer: lethargy; much sleepier that usual; not alert; lack of interest in environment; unusually cranky, fussy, or irritable; inconsolable; refuses to eat or drink)

•

List three (3) of the five (5) physical symptoms in children for which parents or educators would seek immediate medical attention. (answer: changes in breathing; pain or difficult swallowing; stiff neck; rash with fever; rash with a change in behaviour)

•

Identify what educators are concerned with about managing illness for each individual/group listed below: o the ill child: (answer: want to ensure the child’s comfort during the day) o other children and staff: (answer: prevent spread of the infection to others; ensure quality of supervision if one educator is needed for the ill child) o parents: (answer: consider the effects of the child’s illness on the family)

4-15

•

Describe the three (3) reasons why an ill child would be excluded from a program. (answer: too ill to participate; unable to provide care for ill child and the other children; reduce risk of exposing other children to infectious disease)

Childhood Infections and Nuisances: Just the Basics Objective: To describe how to respond to the most common childhood infections and nuisances. (LO 2, 3, 4, 6)

4-16

•

Pinkeye: a. is not spread by indirect contact b. causes itchy, pink/red eyes and is always contagious c. can be caused by bacteria, which then requires an antibiotic treatment for 24 hours before the child returns to the program d. all of the above e. a and b only

•

One (1) toddler has diarrhea in the program. How can the educator stop the spread of germs? a. Pay more strict attention to hand-washing and diapering routines. b. Take extra care with food handling. c. Ensure all children are wearing clothes over diapers. d. Exclude the child after a second episode of diarrhea within 24 hours. e. all of the above

•

One (1) toddler has diarrhea in the program. How can the educators stop the spread of germs? Describe three (3) preventative practices. (answer: stricter attention to hand washing and diapering; extra care for food handling; attend to mouthing toys; ensure all children are wearing clothes over diapers; watch others for diarrhea; exclude the child after a second episode of diarrhea within 24 hours)

•

When children or staff in the program have colds, list three (3) educator practices. (answer: wash hands carefully; model and encourage covering mouth when coughing/sneezing; discard used tissues and ensure one is never used on more than one person; clean and disinfect mouthing toys after one child has used them; ensure that children are feeling well enough to participate; reassure parents that if children are feeling well enough to be at the program, they are well enough to go outside)

•

List three (3) ways that staff can significantly reduce the opportunities for head lice to be spread among the children. (answer: cubbies/lockers or hooks far enough apart so children’s clothes don’t touch; put hats and scarves down coat sleeves; individual combs/brushes, and stored separately; launder dress-up clothes weekly)

•

Which of the following statements about chickenpox is incorrect? a. Health Canada recommends that children over 12 months of age be immunized against chickenpox.

4-17

b. Chickenpox spreads quickly in children who have not been immunized because the varicella-zoster virus spreads easily through the air and by touching the liquid in the pox. c. The red spots (pox) appear a day or two after the child has come in contact with the virus. d. All of the above statements are correct. e. Both b and c are incorrect. •

For each of the statements below, identify whether the “nuisance” refers to A) Head lice B) Bedbugs C) Both head lice and bedbugs D) Neither are tiny, greyish insects that live on human hair (A) They do not spread disease to humans. (C) Children should be excluded from the program. (D) Children should not be excluded from the program, but parents should be informed of your findings when they arrive to pick up their child. (C) Their eggs are white and so small that they are almost impossible to see. (B) unexplained bite marks or welts on children, or others at the facility (B) They indicate uncleanliness. (D) They don’t live long off the scalp. (A) Their flat shape allows them to hide almost anywhere. (B) Carefully inspect all second-hand or donated items for signs before they are brought into the facility (e.g., books, stuffed animals, furniture). (B) They require a lot of attention, cleaning, and perhaps outside help to rid the facility of them. (B) They require attention to the scalp (e.g., medicated shampoo, conditioner) and careful combing to rid the child or adult of them and their nits. (A)

4-18

•

Complete the blanks below: Infection

Description and Management

Elaborate on When to Exclude

Ear Infection

Often are __________ (answer: secondary) infections after colds, because germ buildup gets into the Eustachian tubes. Can be painful, with child tugging at ears and cranky. Stool is very loose and watery. Care must be taken to ensure that child doesn’t get __________. (answer: dehydrated) The most important infection strategy to limit the spread of diarrhea is _______________________. (answer effective hand washing) The whites of the eye are pink or red. There is pus discharge. The child rubs the eye because it is itchy.

Unless child is too ill to participate, generally do not need to exclude because ______________. (answer: not infectious) Child needs to be excluded after __________________________. (answer: the second episode of diarrhea)

Diarrhea

Pinkeye

Common Cold

•

Runny nose, sore throat, cough, decreased appetite. Model and encourage children to ______________________________. (answer: cover their mouth when they cough and sneeze)

Often spread by __________ contact. (answer: indirect) Child is initially excluded to see the physician. Further exclusion is required for _______ when _________________________. (answer: 24 hours, an antibiotic is prescribed) Only excluded if child is _____________________. (answer: too ill to participate)

For each of the four (4) below, complete the rationale for management: Infection

Description and Management

Rationale for the Management

Ear Infection

Often are secondary infections after colds, because bacteria buildup gets into the Eustachian tubes. Can be painful, with child tugging at ears and cranky. Stool is very loose and watery. Child may also have cramps, nausea, vomiting, or a loss of appetite. Child excluded after two (2) episodes of loose (diarrhea) stools. Care must be taken to ensure that child doesn’t get dehydrated. Most important practice to limit spread of diarrhea is proper hand washing.

Generally, do not need to exclude because:

Diarrhea

Most important practice is proper hand washing because:

4-19

Pinkeye

Common Cold

The whites of the eye are pink or red. There may be clear or pus discharge. The child rubs the eye because it is itchy. If the doctor determines pinkeye is due to bacterial infection, prescribes antibiotic drops in eyes for 24 hours before returning to centre.

Describe how pinkeye is spread: • Directly:

Runny nose, sore throat, cough, decreased appetite, model and encourage (or help) children to use tissues for mucus, cough into sleeve, etc. Only exclude if child too ill to participate.

Although contagious, no need to exclude (unless child is too ill to participate) because:

•

Indirectly:

Why exclude if cause of pinkeye is bacterial?

Antibiotic-Resistant Bacteria Objective: To outline the significant role educators can play in decreasing the unnecessary use of antibiotics. (LO 1)

•

4-20

Identify whether the following statements are true or false regarding antibiotic resistance: o

(T or F) When prescribed an antibiotic, stop taking it once you start feeling better to reduce the spread of antibiotic resistance.

(T or F) Links have also been made between giving drugs to animals and the development of resistance in humans.

(T or F) Although antibiotics have saved lives and improved the quality of life for many, more potent antibiotics are being formulated to treat infections caused by bacteria resistant to previously effective antibiotics.

(T or F) When antibiotics are used inappropriately, the weak bacteria are killed, while the stronger, more resistant ones survive and multiply.

(T or F) Germs that develop resistance to one antibiotic do not have the ability to develop resistance to another antibiotic.

When antibiotics are used inappropriately, the weak bacteria ___________ (are killed), while the stronger, more resistant ones ____________________ (survive and multiply). Germs that develop resistance to one antibiotic have the ability to develop resistance to ___________________ (another antibiotic). Copyright © 2019 by Nelson Education Ltd.

Administering Medication Objective: To describe the safe administration of medication to children. (LO 6)

•

Remember the following points when giving medication to children: a. Call the medicine “candy” if it will help the child want to take it. b. Explain to the child what you are going to do and how she or he can cooperate. c. Give the child the medication in the play area around other children. d. all of the above e. none of the above

•

When giving medication to a child, the following considerations are important: a. Ensure that you have the right child, medication, dosage, time, and route. b. If the medication is nonprescription, ensure that you have the parent’s verbal permission to administer it. c. As an ECE student in placement, ensure that you have your supervising teacher’s permission to administer the medication. d. a and b only e. a and c only

•

When getting medication ready to give to the child, you will check the “five rights” three (3) times. List the “five rights.” (answer: child, medication, dosage, time, route)

Allergies and Asthma Objective: To understand the importance of working with parents in the daily management of asthma and allergies. (LO 2, 3, 4)

4-21

•

(T or F) The symptoms of anaphylactic shock take several hours to develop.

•

(T or F) Effective communication is essential between educators and parents to prevent allergic reactions.

•

(T or F) Anaphylactic shock is a mild allergic reaction.

•

(T or F) You cannot be sure that a child’s asthma is well managed if she rarely has an asthma episode during the day.

•

Asthma: a. is an illness that prevents children from participating in the program’s activities b. is a mild respiratory infection c. is a chronic (or long-term) medical condition that makes breathing difficult d. is an illness that only develops in teenagers and adults

•

Asthma: a. can be cured with reliever medication (i.e., Ventolin) b. results in sticky mucus building up on the mucous membranes in the lungs’ airways c. varies in severity and is diagnosed when children have recurring episodes of wheezing, coughing, and shortness of breath d. is not an issue for educators because children will only be taking their medication at home e. b and c only

•

Which of the following can cause severe allergic reactions? a. peanuts b. eggs c. bee and wasp stings d. penicillin e. all of the above f. a and d only

4-22

•

Asthma episodes can be triggered by a. an exposure to the child’s allergens, such as dust mites’ feces, pollen, or cat dander b. strenuous play, particularly in cold weather c. a cold d. all of the above e. a and b only

•

The following is true with regard to anaphylactic shock: a. The symptoms of anaphylactic shock take several hours to develop. b. Anaphylactic shock is a mild allergic reaction, commonly to peanuts or bee stings. c. Anaphylactic shock affects the entire body, and the person may die if emergency action with adrenaline (e.g., EpiPen) does not occur immediately. d. A medical alert bracelet serves no purpose for life-threatening allergies that may trigger anaphylactic shock. e. all of the above statements are false

•

You know that a child’s asthma is well managed when a. the child is absent from school only once a month due to the asthma b. the child’s coughing, wheezing, or chest tightness does not wake her or him at night c. the child uses the inhaler several times each day d. the child stays indoors during outdoor playtime to prevent an asthma episode e. a, b, and d only

•

ECLC programs should do the following to ensure that specific children are not exposed to food allergens: a. carefully follow licensing guidelines for peanut-free environments b. inform all staff of children with allergies, review menus, and talk with parents c. post an allergy list in the kitchen and eating areas d. isolate children with food allergies

4-23

e. a, b, and c •

From enrollment forms, program staff know that several children have food allergies. Describe three (3) things educators should do to ensure that the children are not exposed to allergens. (answer: inform all staff; review menus and talk with parents; substitute foods; post allergy list in kitchen and eating areas; help these children say “no”; read ingredient labels when shopping; supervise children to ensure they don’t trade foods; pay special attention to foods eaten out of program and foods brought in on special occasions)

•

List two (2) indicators that an individual’s asthma is poorly managed. (answer: refer to text page 206)

4-24

HERE’S THE ANSWER—WHAT’S THE QUESTION? Here’s the answer.

What’s the question?

the right child, medication, dose, time, What are the five (5) rights for administering and route medication? Avoid taking antibiotics unnecessarily. What is one way to reduce the increase of antibiotic-resistant bacteria? when the cause is bacterial and she or When should a child be excluded for pinkeye? he can return after 24 hours of medication No. The infection is in the middle ear, Are ear infections contagious? not spread to other children or staff. one of our body’s natural mechanisms What is fever? to fight infections to share valuable health information What is the purpose of documenting health with parents and health care providers observations? Educators use four (4) of their senses What do educators use in health observations? to note any significant behavioural changes in the child. at the beginning of each child’s day at When are baseline observations conducted? the program a change in a child’s behaviour Which is the most reliable sign of possible illness? dehydration What can result when a young child has several episodes of diarrhea or vomiting? It can occur within 10 minutes. How quickly does anaphylactic shock occur? dust mites’ feces, pollen, and cat What are the most common allergens that can dander result in an asthmatic episode? The illness prevents the child from What is the most common reason for excluding participating in activities. children? Children have recurring episodes of What are common symptoms of asthma? wheezing, coughing, or shortness of breath. wingless and red-brown nuisance that What is a bedbug? bites, does not cause disease, but causes infestations tiny, greyish insects that live on human What are head lice? hair and are a nuisance but do not cause disease

4-25

CARING FOR ILL CHILDREN—Scenarios Scenario 1 Steven, one of the two-year-olds, is listless and unhappy today. He is unable to participate in the program and needs to be held and comforted. When the director calls his mother, she asks that you take Steven’s temperature. Because he does not have a fever, his mother refuses to pick him up early as the program’s exclusion policy lists fever as the number one reason for exclusion. 1. How should the educators handle Steven’s immediate situation? 2. If Steven is staying at the program for an indefinite period of time, what measures can be taken to reduce the risk of transmission to other children? 3. An hour later, Steven begins to have difficulty breathing. What are your options now? 4. How can the program try to prevent these situations (i.e., parent refusing to pick up the child because of not having a fever) from happening in the future?

Scenario 2 Three-year-old Laura arrived at the program with a runny nose and cough. Her mother informed the educators that it was probably just allergies and left for work. In addition to having a part-time job, Laura’s mother is a student at the local community college and is parenting on her own. Shortly after Laura’s mother left, the educators discovered that Laura feels warm to the touch and is complaining of a sore throat. 1. How should the educators and director handle Laura’s immediate situation? 2. If Laura is allowed to stay at the program, what measures can be taken to limit the risk of spreading illness to other children? 3. If Laura is at the program two hours later, and she begins crying inconsolably, what are your options? 4. How can the program help Laura’s mother avoid similar situations in the future?

4-26

UNIT

Nutrition

5 CONTENTS

CLASSROOM ACTIVITIES AND DISCUSSIONS..........................................................................3 Critical Thinking...................................................................................................................................... 9 First (refer to text page 239) ...................................................................................................................... 9 Second (refer to text page 286) ................................................................................................................. 9 Third (refer to text page 300) .................................................................................................................. 10 Fourth (refer to text page 307) ................................................................................................................ 10 Assess Your Learning ............................................................................................................................ 10 Resource Materials for Teaching........................................................................................................... 12

ASSIGNMENT IDEAS .............................................................................................................13 TEST QUESTIONS ..................................................................................................................14 Factors That Shape Eating Habits .......................................................................................................... 14 Nuts and Bolts of Nutrition ................................................................................................................... 15 Nutrition Labels and Growing and Processing Foods ............................................................................. 20 Healthy Eating Habits ........................................................................................................................... 23 Providing Foods and Menu Planning ..................................................................................................... 29 Food Safety .......................................................................................................................................... 33

HEALTHY EATING FOR CHILDREN BINGO.............................................................................35 YOUR HEALTHY EATING BINGO ...........................................................................................36 THE DIGESTIVE TRACT: IDENTIFY THE ORGANS...................................................................37 NUTRITION FACTORS—EATING HABITS...............................................................................38 CHOOSE A FOOD LABEL .......................................................................................................39 Copyright © 2019 by Nelson Education Ltd.

5-1

NUTS AND BOLTS OF NUTRITION ........................................................................................41 POSITIVE EATING ENVIRONMENT CHECKLIST .....................................................................42 FOOD SAFETY: APPROPRIATE PRACTICE ..............................................................................43 MENU CRITIQUE ACTIVITY ...................................................................................................44

5-2

Classroom Activities and Discussions Healthy Eating for Children Bingo (see handout, page 5-34) Your Healthy Eating Bingo (see handout, page 5-35) Food meanings: 1. Use Table 5.1 (refer to text page 234) to start small groups or the class discussing other food associations and examples (see Nutrition Factors—Eating Habits handout, page 5-37) or 2. You or students could call out the names of foods (e.g., ice cream) and ask for associations (e.g., some may think of different types of ice desserts, such as gelato or sherbet or flavours; others may think of experiences like childhood summer holidays, a treat after a soccer game, a first date, celebrations; and others may have feelings such as comfort, pleasure, distaste) Digestive system: Distribute to each student The Digestive Tract: Identify the Organs handout (page 5-36) to complete. Then in pairs, using their completed handout, they describe how the food travels through the digestive tract, identifying the organs to the other. (answers: refer to Figure 5.1, text page 248) Build My Food Guide: The Government of Canada provides a link for individuals to build their own food guide based on their gender and age, and the foods they like to eat. The PDF file can be generated in a variety of languages. •

Have students visit http://www.healthycanadians.gc.ca/eating-nutrition/healthyeating-saine-alimentation/food-guide-aliment/my-guide-mon-guide/mfg_p1eng.php

•

Build the guide in English, and when applicable, build in another language.

•

Print and bring it to class.

•

In small groups, share similarities, food preferences, and cultural differences.

Cultural diversity: •

Come to class with a favourite family recipe or food such as a fruit or vegetable.

•

For a fruit or vegetable, how is it prepared, eaten, etc.?

•

In small groups, share the recipes and the answers to these and other questions among the group: o Why is it a favourite?

5-3

o Is it served all the time or at specific times during the year? •

Hang flip-chart paper on the walls, one for each of the following categories: main dishes, vegetables, fruit, breads, and desserts/sweets: o Have students add either their recipe or specific food to the appropriate sheet. o Analyze each of the sheets for possible themes and similarities and differences between all the entries on a sheet.

Promoting breastfeeding: If there is class time, and if the benefits of breastfeeding are not fully covered in other courses, take the opportunity to refer to/discuss recent research on the link between breastfeeding and brain development (as well as the many other benefits of breastfeeding, emphasizing nutritional properties). Also refer to •

Best Start Resource Centre on o Breastfeeding: https://www.beststart.org/cgibin/commerce.cgi?search=action&category=B00E&advanced=yes&sortkey=s ku&sortorder=descending o Feeding babies: https://www.beststart.org/cgibin/commerce.cgi?search=action&category=D00E&advanced=yes&sortkey=s ku&sortorder=descending For example: Feeding Your Baby: A Guide to Help You Introduce Solid Foods: https://www.beststart.org/resources/nutrition/feedingyourbaby/D12-EFeedingYourBaby.pdf

•

Canadian Paediatric Society’s website: https://www.caringforkids.cps.ca/ will take you to child health information written for parents. There is a range of topics related to breastfeeding and many other health-related issues.

Infant formulas: •

Government of Canada’s Infant Feeding: https://www.canada.ca/en/healthcanada/services/food-nutrition/healthy-eating/infant-feeding.html This website includes the nutrition recommendations for birth to six months and six to 24 months.

•

Best Start Resource Centre: Infant Formula: What You Need to Know: https://www.beststart.org/resources/breastfeeding/B19/FormulaBooklet_B19E.pdf

•

Well Beings (2015), by Canadian Paediatric Society Suggestions: •

5-4

•

Discuss inappropriate ones, such as condensed milk, canned evaporated milk, and goat milk without modification.

•

Include how to handle formula and expressed milk in programs.

Vegetables and fruit: •

Using Table 5.3 (refer to text page 244) as a point of reference, ask students to complete each of the following sentences related to vegetables and fruit: o One vegetable or fruit that I love is: o One vegetable or fruit that I do not like is: o As a child, I loved: o As a child, I did not like: o I have never tasted this: o As a child, I never tasted this: o I never buy: o I do not know how to eat or prepare:

•

In groups of four or five students, share their answers.

•

Follow with a class discussion: o Ask them if they eat at least one vegetable or fruit from each colour in the table. o Ask them how they can use their personal experiences when helping children try new vegetables and fruit in general and specific ones.

Labels and additives: (see Choose a Food Label handout, page 5-38) For extensive information and resources on the Government of Canada’s nutrition labelling regulations, visit the website: https://www.canada.ca/en/healthcanada/services/food-nutrition/food-labelling.html •

Benefits of this class: o Sharing this information either in small groups or the class as a whole is a real eye-opener. This exercise can spark discussion about the students’ personal lives (i.e., many may decide to become more aware of food ingredients in their purchases).

5-5

o In regard to ECLC—discuss nutrition policy, which aims to provide optimal nutrition and reduce exposure to saturated fats, sugar, and sodium, excessive processing, and questionable additives. •

Two to three weeks before the classroom exercise, ask students to bring in food labels of food they commonly eat: o The label should list the ingredients and include the nutrition facts table. o If students cut the label from the box or package, ask them to write the name of the product and weight of food (to compare with the serving size of the nutrition information) if it is not easily identifiable, although the whole package will have a broader visual impact. o To avoid food spoilage and infestations, request that the packages are empty and containers are rinsed out; perhaps put a box outside your office during the day for students to drop off items. o Examples: plastic (bags) packages (e.g., rice, bread), paper wrappers on cans, ready-to-eat pasta, snack foods, processed meats, frozen entrees, desserts, boxed foods (e.g., pizza, cake mixes, flavoured rice, pasta, cookies, crackers, cereals), condiments. o You may want to bring some foods that demonstrate products that are natural with few or no additives (e.g., orange juice) and two similar foods, one with few and the other with many additives (e.g., peanut butter can have just peanuts, while others have salt and sugars added).

•

In the designated class, each student chooses one product and refers to the list of ingredients on the label—some suggestions: o Point out that the ingredients are listed in descending order by weight (e.g., a can of meat stew: if meat is one of the last items on the lists, the consumer may want to look for a brand that has meat higher on the list). o Note the order of fat (e.g., oils, lard) on the list and explain the difference in types of fats (particularly the new label information on saturated fats), sugars (including words ending with “ose”), and salt (sodium words). Are all or any of these ingredients necessary for the quality of the product? o Point out some of the popular claims (e.g., light or lite) and what they mean (refer to the Government of Canada’s food labelling information). o There may be opportunity, depending also on the focus of your course, to talk about cost and smart choices—health-wise and economically. o From the Nutrition Facts Table, discuss the meaning of the percentage of daily value and compare daily value between two food labels. For example, on a

5-6

soup label, one serving may provide 20% of the daily value (maximum value) of sodium, whereas one serving of canned legumes may provide 10% of the daily value of sodium. For a person on a low-sodium diet, how is this information helpful to not exceed the daily value of sodium? A discussion of Health Canada’s poster Let’s Eat Healthy Canada! helps students become aware of the current state of our diets and our risk for chronic diseases: https://www.canada.ca/content/dam/hc-sc/documents/services/publications/foodnutrition/infographic-lets-eat-healthy-canada/infographic-lets-eat-healthy-canada.pdf This discussion can lead into the following activity where students can discuss ways to moderate fat, salt, and sugar. Fat, salt, and sugar: You could discuss how to promote moderation of saturated fat, salt, and sugar in our lives and in ECLC programs. However, point out the importance of fat in young children for growth and development: •

•

Moderating saturated fat: •

Limit processed meats (e.g., hot dogs, salami).

•

Limit fried foods.

•

Limit the use of potato chips, ice cream, and pastries.

•

Limit the use of high-fat sauces, cream cheese, etc.

Moderating salt: o Encourage taste preference for natural flavours without a lot of salt by not adding a lot of salt, if any, when cooking. o Avoid having salt at the table. o Read labels for sodium and salt.

•

Moderating sugar: o Encourage taste preference for natural flavours without a lot of sugar (e.g., fruit on cereal). o Limit very sweet foods (e.g., jams, sugar, cookies). o Offer fresh fruit and water to drink rather than a lot of juice. o Avoid having a sugar bowl at the table.

Class discussion about other current nutrition issues (e.g., tainted food recalls, genetically modified food) would likely be interesting for the group, especially if they/you have Copyright © 2019 by Nelson Education Ltd.

5-7

brought in newspaper, magazine, or online articles on the topic. As described in Unit 1’s Classroom Activities and Discussions, these articles usually provide a good opportunity to identify levels of the health promotion action plan. Positive eating environment for in-class discussion on how to support children’s eating experiences (refer to Table 5.13, text page 276). See Positive Eating Environment Checklist handout, page 5-41. Food Safety: Appropriate Practice—scenarios (see handout, page 5-42): •

groups of two to four students

•

assign each group one or two questions to develop the appropriate practices, and then share with the class

Menu planning: •

Provide each student with a copy of the Menu Critique Activity (see handout, page 5-43).

•

In small groups, use Table 5.15: Menu-Planning Checklist to critique and improve this menu (refer to text page 299).

•

Provide students with a copy or website link to your province or territory’s child care licensing agency recommendations for meals and snacks in order to evaluate how their menu would be scored against these recommendations. If such recommendations are not available, you may want to use Toronto Children’s Services’ standards for meals and snacks, Nutrition: Early Learning and Care Assessment for Quality Improvement: https://www.toronto.ca/wpcontent/uploads/2017/10/86e6-aqi_nutrition_guidelines.pdf

What are the potential benefits and drawbacks in providing a basket with a variety of fruit or crackers to the children at a meal or snack time? A light-hearted exercise: What are differences between baked beans and jelly beans? (from Nova Scotia Department of Health) •

obvious differences—colour, shape, smell, taste, feel, cost

•

nutritional differences—baked beans provide body with important vitamins, minerals, protein, and fibre, while jelly beans are all sugar, dentally unhealthy, and contain additives and colour

At a program, the parents provide lunches for their children, and the staff warm foods in the microwave oven, as required. Educators have observed that one toddler’s lunch routinely consists of highly processed foods. A typical lunch for Peter is a cut-up wiener or piece of salami, French fries, and a store-bought dessert (e.g., a cupcake with brightly coloured icing or a chocolate-covered granola bar). Vegetables or fresh fruit are rarely 5-8

provided. The most natural and nutritious part of the meal is the milk provided by the program. When an educator speaks to the parents about the lunches and about providing more variety, Peter’s mother says that those are the only foods he will eat. The educator explains that Peter eats the variety of foods that the program provides for snacks each day. At a staff meeting, one of the other educators suggests that no further action be taken about Peter’s lunches. If you were working in the program, how would you feel about this situation? Has this situation been resolved to your satisfaction and in the best interests of the child and family? Support your position. Suggestions: Ideally, students will not agree with the educators because Peter is eating food high in fat, salt, sugar, and nitrates, with no variety, and lacking selections from the four food groups, and he is not learning healthy lifelong eating habits; have a meeting with the parents and explore Peter’s eating habits and work with the parents about introducing healthy, nutritious food choices; perhaps have a parent night with a theme around nutrition, with a portion of the meeting spent on lunch box ideas with hands-on preparation of quick, inexpensive, interesting, nutritious foods; distribute a booklet of recipes that educators prepared with the possible assistance of the dietitian; provide pamphlets/booklets on lunch ideas

Critical Thinking First (refer to text page 239) After having read the six factors that have an influence on our eating habits, identify one that is most relevant to you. Eating habits are not pure science; a lot of subjectivity is involved. How do you think the factor you have chosen affects your work with young children? Consider the positive influence it can have on promoting healthy active living in your career with children and families. Suggestions: Not required as this will vary with each student’s experience. Second (refer to text page 286) The parents of an eight-month-old girl haven’t yet introduced semisolid foods, not even infant cereal. Marie’s source of nutrition is her mother’s breast milk. Marie is interested in what the other children are eating. She is hungry half an hour after you feed her a bottle of expressed breast milk. However, when you mention this to her mother, she assures you that she will be starting Marie on infant cereal soon. That was three weeks ago, and Marie’s mother hasn’t followed through. What are the issues of concern for educators? How should you proceed? Suggestions: Book a meeting with parents and come to the meeting with resources for parents; encourage the parents to talk about their concerns or questions; reassure them that she is physically and psychologically ready for semisolid foods (e.g., she is hungry soon after her bottles, very interested in the other children’s foods); provide public health’s nutritional information on the introduction of foods; possibly benefit Copyright © 2019 by Nelson Education Ltd.

5-9

from a meeting with a dietitian; recommend Best Start Resource Centre’s Feeding Your Baby: A Guide to Help You Introduce Solid Foods: https://www.beststart.org/resources/nutrition/pdf/BSRC_FeedingYourBaby_2015.pdf Third (refer to text page 300) When viewing the week-long summer menu in Appendix 5.2 (page 319), focus on the lunches. You know that several of the children do not drink cow’s milk, for a variety of reasons. In addition to having other milk substitutions available for those who require it (e.g., goat, soya, and almond), list one good calcium, non-dairy-based food to incorporate into each of the five lunches. Refer to Table 5.7 (page 255) for substitution ideas. Suggestions: Consider other foods offered during that lunch when recommending a high-calcium substitution for dairy. For example, Friday’s lunch includes lentil and vegetable rice soup, which has a legume that is high in calcium. Avoid using hummus as a substitute for havarti cheese cubes on crackers because chickpeas are also a legume. Instead, an alternative could be crispy cubes (oven baked) of firm tofu that is set with calcium, to serve with crackers. Fourth (refer to text page 307) You notice a pot of spaghetti meat sauce sitting on the kitchen counter early one afternoon (spaghetti is on the menu for tomorrow). You ask the cook whether it should be in the fridge. She answers, “I’m letting the sauce cool down first because it has to be at room temperature before it goes into the fridge. Otherwise, it will go bad.” Is it safe? Why or why not? How would you handle the sauce to ensure its food safety? Suggestions: This is a common practice and belief that comes from the time when ice boxes were kept cold with ice blocks: if hot food was put in the ice box, it would speed up the ice melting, but this is not an issue with refrigerators; the danger of leaving food on the counter is that the longer the food’s temperature remains within the danger zone, the opportunity exists for bacteria to multiply; leaving food on the counter even for a few minutes can put it out of one’s mind, and then it can be left out for hours; review the program’s food safety policy and procedures with the cook; place the sauce into smaller containers with lids so there isn’t so much food to cool down in one pot, and place in the fridge or fill the sink with cold water and ice cubes, place the pot in the sink, stir the sauce as it cools quickly, and then place the pot and lid/container in the fridge; provide the cook with the Department of Health’s or Agriculture’s food safety pamphlets/booklets; contact your public health inspector about the food handler’s course.

Assess Your Learning Evaluate your options in each situation. 1. The practice at your program placement is for the educators to serve food and to insist that the preschoolers eat everything. There have been a number of power struggles 5-10

lately, and lunchtime has become an unpleasant experience for everyone. The staff have asked you for suggestions. Suggestions: Two main issues: children are not given autonomy over eating and lack control over how much food is served and eaten. Suggestions for educators: revisit the program’s philosophy, which should be fostering children’s autonomy and self-control, and compare it to the mealtime practices; in order for children to develop body awareness (i.e., sense of fullness, learning portion control for themselves), gradually introduce family-styled servings starting with at least one food; make available child-friendly serving utensils, serving bowls, pitchers; rolemodel serving yourself and stopping when full; guide to serve themselves small amounts and have seconds. 2. Although the preschoolers eat in small groups at tables, there are a number of groups in the room. The noise level can get high, creating a less-than-calm eating environment, especially for children who are easily distracted. Suggestions: Stagger lunch so half are involved in a quiet activity while others eat; this is another reason for the extended morning snack time; look at what is the distraction (e.g., too long a wait for food, not enough transition time, particular combinations of children at tables); revise supervision and role-modelling; encourage children’s involvement, autonomy, control in the meal; provide calming music/relaxation techniques. 3. An 18-month-old who has been in the program for three months will eat only jarred or puréed baby food that his parents provide. He refuses the more textured food that the program serves. Related to this, educators are concerned that his language development is being affected. The parents are worried that if they don’t provide puréed food, their son will go hungry. Suggestions: Meet with the parents to talk, rather than on the run; reassure them that by working together, you can help him make the transition from puréed to semisolid and then solid food, which will have long-term benefits for language development and eating behaviour; begin with parents continuing to bring in his familiar food that they would cut up/grind rather than purée, and gradually decrease the foods from home and increase foods served in the program. 4. You are working in the school-age program at a local school and have decided to volunteer in the breakfast child nutrition program. You notice that most of the children in your after-school program who would benefit most from a nutritious breakfast do not get to school until the bell rings and therefore are not able to take advantage of this opportunity. One of the other volunteers has stated that they are not getting the number of children they expected in the program. The two of you have talked about proposing other options than breakfast to the coordinator. Suggestions: Ensure that families are aware of the existing breakfast child nutrition program; survey the families to identify barriers to access and develop solutions; consider adjustments of the hours of operation of the existing program; Copyright © 2019 by Nelson Education Ltd.

5-11

explore establishing the “walking school bus” program using volunteers; explore options to provide access to food at alternative times (e.g., such as making snacks available in morning recess, having a salad bar at lunch); offer cooking classes to students in order for them to gain nutrition understanding and food prep skills that they can use at home; explore innovative programs using the Internet, for example, President’s Choice Children’s Charity at https://www.presidentschoice.ca/en_CA/community/pccc.html and FoodShare: Demonstrating a Sustainable and Accessible Food System for All at https://foodshare.net/ 5. You’re planning a half-day summer trip to a park with the toddlers and preschoolers. Your responsibility is to make arrangements for the food and beverages and write a list of important food safety considerations for handling the food. Suggestions: Review your program’s food safety policy and procedures, and Department of Health or Agriculture pamphlets/booklets on food safety for picnics; avoid high-risk foods (e.g., meats, eggs, mayo, milk products, as well as dips/sauces); select low-risk foods that all can be eaten cold, which helps you keep everything cold together; wash and prepare fruits and vegetables, refrigerate and freeze sandwiches, and put all into coolers just before leaving with freezer packs; put baby bottles and semisolid foods in a cooler; bring enough plates, cups; picnics consist of finger foods, so find out if running water will be available: if so, bring soap and paper towels, or if not, bring wet wipes with an alcohol base; ensure coolers are kept in the shade.

Resource Materials for Teaching Best Start Resource Centre. This website offers a wide variety of resources: •

Nutrition: https://www.beststart.org/cgibin/commerce.cgi?search=action&category=D00E&advanced=yes&sortkey=sku &sortorder=descending

•

Breastfeeding: https://www.beststart.org/cgibin/commerce.cgi?search=action&category=B00E&advanced=yes&sortkey=sku &sortorder=descending

All of these resources can be downloaded or ordered in print. Breastfeeding Inc.: https://www.breastfeedinginc.ca/ This site provides you with access to resources on a range of topics related to breastfeeding. CBC’s Marketplace website: http://www.cbc.ca/marketplace/ Review the list of past episodes, looking for nutrition stories that would work well with your class.

5-12

Ellyn Satter’s website: https://www.ellynsatterinstitute.org/ Excellent source of information on the division of responsibility in feeding. Nutri-eSTEP: Dieticians of Canada has the Nutri-eSTEP screening questionnaires and Web tools to find out about how your choices as a parent or caregiver are measuring up in promoting children’s healthy eating habits: http://www.nutritionscreen.ca/ Nutrition Action Healthletter: https://cspinet.org/nutrition-action-healthletter Visit the Centre for Science in the Public Interest’s fabulous website to subscribe to the monthly newsletter, which can be emailed or posted. The content provides you with great ideas to bring to the classroom. Nutrition Resource Centre: http://opha.on.ca/Nutrition-Resource-Centre/Home.aspx UnlockFood.ca. Produce nutrition labelling videos: http://www.unlockfood.ca/en/Videos/Nutrition-Labelling.aspx

Assignment Ideas 1. In an ECLC program placement (or a child in a home), observe a child(ren) during mealtime and record observations according to tools used in a child development course. Along with their observation, use Table 5.12 (refer to text page 273) to objectively comment on developmental characteristics related to eating. 2. Menu critique: Design a two-day menu (a.m. snack, lunch, p.m. snack) for the students to critique with rationale and suggestions, using Table 5.15 (refer to text page 299) as a reference. This could be done as an assignment, or in small groups have students create a two-day menu plan in class. Later, or in the next class, the plans can be rotated among the groups and then critiqued with rationale and suggestions. 3. Five-day menu plan: •

Divide students into groups of three.

•

Each student will be allocated the same mark unless there are extenuating circumstances.

•

Provide students with a blank form of a five-day menu plan with two snacks and a meal, which they can copy to use for drafts and to submit a final version.

•

Assignment specifics: o menu is for a full-time ECLC program o appropriate for preschoolers

5-13

o account for all nutritional requirements and requirements for appeal and variety (refer to Table 5.15, text page 299, and Getting Down to Writing Menus, text page 298) o include at least two meatless days, introduce several new foods or recipes, and show creativity •

Completed assignment has two components:

A. As a group of three, submit: •

the completed menu plan

•

appendices: o list the main ingredients of recipes (when needed to clarify) o identify the “new” foods o identify which snacks and meals preschoolers will help to prepare

B. As individuals, each member independently answers the following questions: •

How would you adapt this menu for toddlers (12 to 24 months old) and for school-agers (6 to 12 years old)?

•

How would you incorporate food preparation for each of these two age groups?

•

How would you change the menu for a child who is allergic to any food containing wheat? (or give one or more other possible allergies)

•

Selecting one of the days from this menu, how would you individualize it for a nine-month-old child? Create a scenario for that child, keeping in mind that each child is unique.

Distribute the Nuts and Bolts of Nutrition handout (see page 5-40) to help students become familiar with material in the Nuts and Bolts of Nutrition section of the textbook (refer to text page 239), as well as Appendix 5.1. (answers: refer to Appendix 5.1, text page 315)

Test Questions Factors That Shape Eating Habits Objectives: To list and discuss six factors that shape our eating habits. (LO 1, 6) 5-14

To acknowledge food insecurity in Canada. (LO 1, 6)

•

(T or F) Educators should try to be aware of and reinforce ethnocultural food preferences.

•

(T or F) The more a child experiences different foods, the less likely he or she is to develop a taste for them.

•

(T or F) Dieting is an effective way to achieve healthy body weight.

•

Explain why diets that restrict calories can be counterproductive. (answer: refer to text page 236)

•

Define the term “food insecurity.” (answer: refer to text page 238)

•

Food banks are _________________ solutions to poverty and food insecurity experienced by families in Canada. (answer: band-aid)

•

List and describe four (4) of the six (6) factors that shape our eating habits. (answer: physical, emotional, social, cultural, body image, economics; for the descriptions, refer to Several Factors That Affect Eating Habits, text page 232)

•

For each of the meanings below, describe a positive or negative association with food: o security o punishment o comforter o fear o weapon o individuality (for selection and answer, refer to Table 5.1, text page 234)

Nuts and Bolts of Nutrition Objectives: To list the seven categories of nutrients and describe their main functions. (LO 1, 6) To describe the digestive process. (LO 1) Copyright © 2019 by Nelson Education Ltd.

5-15

To explain the important aspects of Eating Well with Canada’s Food Guide that relate to children. (LO 1, 4, 6) •

(T or F) Most vitamins and minerals are absorbed into the epithelial cells that line organs in the digestive tract. Therefore, vitamins and minerals are not considered to be part of the digestive system.

•

(T or F) The lentil is an example of an item in the meat and alternatives food group.

•

(T or F) Eating Well with Canada’s Food Guide does not include the number of recommended daily servings from each food group.

•

(T or F) Vitamins are categorized according to whether they are starch soluble or water soluble.

•

(T or F) Research has shown that sodium causes high blood pressure and damage to blood vessels in children, which in turn increases their risk of stroke and heart disease.

•

(T or F) Children and adolescents who eat vegetables and fruit five or more times a day are substantially less likely to be overweight than are those whose vegetable and fruit consumption is less frequent.

•

(T or F) Phytochemicals are low in vegetables and fruit.

•

(T or F) Very small amounts of toxins in many vegetables and fruit keep insects away, and also serve to trigger a beneficial stress response.

•

(T or F) The fact that low-nutritive foods tend to cost more than high-nutritive foods, such as vegetables and fruit, makes vegetables and fruit affordable for families on a very limited budget.

•

Which fat is each of the following: A) unsaturated fat B) saturated fat solid at room temperature (answer: B) found in butter and lard (answer: B) found in salmon and trout (answer: A) should make up a minority of fats in the diet (answer: B) liquid at room temperature (answer: A) found in avocados, nuts, seeds (answer: A)

5-16

found in animal fat (answer: B) good cholesterol (HDL) (answer: A) should make up the majority of fats in the diet (answer: A) bad cholesterol (LDL) (answer: B)

•

The vast majority of digestion and absorption of nutrients by the blood is completed in the ________________. (answer: small intestine)

•

________________ are compounds that give vegetables and fruit their colours. (answer: phytochemicals)

•

There are no bad foods. Instead, some foods with little nutritive value should be eaten in ________________. (answer: moderation)

•

One of the reasons that foods with refined grains, added sugars, and fats are often consumed more by children than vegetables and fruit is that: ___________________ ____________________________________________________________________. (answer: they tend to be less expensive, are good tasting to many children, and are convenient; refer to text page 242)

•

Provide an example of a complementary protein: _____________________________ (answer: refer to text page 259)

•

Health Canada expects companies and food manufacturers to replace trans fats with healthier alternatives, such as _________________ and _________________ and not to replace trans fats with _________________. (answer: monounsaturated and polyunsaturated fats; saturated fats)

•

The primary digestive system organs include all of the following, except the a. esophagus b. small intestine c. tongue d. colon (large intestine) e. stomach

•

Vegetarianism: a. generally means choosing a plant-based way of eating b. includes a range of options c. requires an understanding of how to complement protein to obtain a complete protein

5-17

d. all of the above e. none of the above •

The term “flexitarians” refers to people who a. want to reduce the amount of red meat that they consume in order to lower their cholesterol and fat intake b. eat all foods without restriction c. only eat foods of plant origin d. only eat animal products e. none of the above

•

Eating Well with Canada’s Food Guide is a. designed to be flexible enough to include most foods b. designed for meat-eaters only c. available in a number of languages, and also highlights culturally specific foods d. a, b, and c e. both a and c

•

Identify the statement that is false about phytochemicals: a. They are the compounds that give vegetables and fruit their colour. b. They play a role in our health, such as serving as antioxidants. c. They work on their own, independent of other nutrients occurring naturally in the vegetables or fruit. d. Eating a “rainbow” of vegetables and fruit has maximum benefits. e. All of the statements above are true.

•

With regard to young children and dietary fats, we must keep in mind that a. they need more fat and energy in their diet for brain development and rapid growth b. skim products are inadequate because they do not provide the concentrated source of calories needed

5-18

c. children need to eat small amounts of food throughout the day since their small stomachs tend to fill up quickly d. children should be encouraged to eat healthy foods when hungry and to stop eating when they are full e. All of the above statements are true. •

The combining of dairy and meat products is a. permitted in the Kosher dietary rules b. permitted in the Halal dietary rules c. not permitted in either one d. permitted in both

•

From Eating Well with Canada’s Food Guide, list the food groups and provide two (2) examples for each. (answer: grain products; vegetables and fruit; milk and alternatives; meat and alternatives [many possible examples])

•

Rank the following calcium-rich foods from highest to lowest amount of calcium per serving: (answer: 1. cheddar cheese, 2. toasted almonds, 3. cooked broccoli; refer to Table 5.6, text page 252) Foods Toasted almonds Cooked broccoli Cheddar cheese

•

Rank

Identify the food group that provides you with the following key nutrients: o Carbohydrate, fibre, riboflavin, niacin, and iron: _______________ (answer: grain products) o Protein, fat, vitamin B12, vitamin A, and vitamin D: _____________________ (answer: milk and alternatives)

•

For the nutrients listed below, assign them to their corresponding overall function(s): o proteins o minerals o water o fibre

5-19

o carbohydrates

o fats o vitamins Categories of Nutrients

Functions • are essential for helping the body regulate their functions • provides calories needed for us to work and exercise • support regular functioning of intestines • essential for brain and nerve function and healthy skin, and provide energy

(answer: refer to Table 5.2, text page 239)

Nutrition Labels and Growing and Processing Foods Objectives: To identify the type of information found on food labels and describe how this information helps consumers evaluate its nutritive value. (LO 6) To state the function of pesticides and how this relates to organic foods. (LO 3) To describe what food additives are, and their functions. (LO 6) To describe how being an informed consumer influences choices around selecting and eating foods with questionable additives, fortified and enriched food sweeteners, and genetically modified and irradiated foods. (LO 3)

•

Answer true or false to each of the following statements about nutrition labels and food processing: o (T or F) Ingredients are listed in increasing order by weight (i.e., the first ingredient is the smallest amount). o (T or F) Providing nutritional information on the label is voluntary on the part of the manufacturer.

5-20

o (T or F) A date must appear on all foods that will spoil within 90 days (except meats). o (T or F) Generally, the more processed the food, the more additives are used. o (T or F) Nutrition claims on labels are regulated by Health Canada’s criteria to prevent misleading claims by food manufacturers. •

(T or F) Organic farming is not 100% pesticide free.

•

Answer true or false to each of the following statements about food additives: o (T or F) The legal definition of a food additive includes sugar, salt, and vitamins. o (T or F) Food additives that enhance the shelf life of the food are called preservatives. o (T or F) Food additives are listed toward the end of a product’s list of ingredients. o (T or F) All additives are unnecessary and questionable. o (T or F) Often low-nutritive processed foods use artificial colours to be attractive to children.

•

Answer true or false to each of the following statements about sweeteners: o (T or F) There are many adults and children, for example diabetics, who may use non-nutritive sweeteners due to necessity. o (T or F) When children eat foods with non-nutritive sweeteners, they are less likely to develop a “sweet tooth.” o (T or F) The use of non-nutritive sweeteners prevents or fights obesity. o (T or F) A recommended daily intake (RDI) based on body weight has been set by the Canadian government for most sweeteners.

•

Answer true or false to each of the following statements about genetically modified foods and the irradiation of food: o (T or F) Labelling of genetically modified foods is mandatory if there is a health or safety issue. o (T or F) Irradiated food products in Canada do not need to be labelled. o (T or F) While foods absorb a small amount of radiation, irradiated foods are not radioactive.

5-21

o (T or F) The genetic modification of foods is a food technology of the 21st century. o (T or F) The full extent of human health risks of GM foods is not known, with the possibility of allergic reactions, nutritional changes, and the creation of toxins. o (T or F) Spices are the least commonly irradiated food worldwide. •

Provide two (2) statements about organic foods covered in the textbook: (answer: refer to text page 264) 1. ______________________________ 2. ______________________________

•

Define the term “food additive.” (answer: refer to text page 264)

•

List two (2) functions of food additives: (answer: maintain food’s nutritive quality, enhance its shelf life, make it attractive, help in processing, packaging, or storage; refer to text page 264) 1. ______________________________ 2. ______________________________

•

Why are people concerned about serving too many foods containing nitrites/nitrates to children? (answer: ongoing consumption of processed meats means the ingestion of a known carcinogen and meats high in saturated fat and salt)

•

A number of sweeteners other than sugar (sucrose) are permitted for use in Canada. These include a. sugar alcohols (xylitol and maltitol) b. non-nutritive sweeteners (aspartame, agave, sucralose) c. purified stevia extract, which comes from the leaves of the stevia plant d. all of the above e. none of the above

•

List three (3) types of information available from food labels. (answer: list of ingredients, nutrition facts including the % of daily value per serving and % of fats, nutrition claims such as high source of fibre, allergen information such as may contain traces of peanuts, lists the best before date, etc.)

•

Why are pesticides used in non-organic food production? (answer: refer to text page 264)

5-22

•

What can you personally do to reduce the amount of pesticides you eat? _________________________ What can we do as a society to reduce the amount of pesticides we eat? _________________________ (answers: refer to text page 264)

•

Define the term “fortified or enriched food.” (answer: refer to text page 267)

•

What are the two (2) reasons foods are fortified in Canada? (answer: replace nutrients, prevent certain chronic diseases)

•

Define the term “genetically modified.” (answer: refer to text page 268)

•

Define the term “food irradiation.” (answer: refer to text page 269)

Healthy Eating Habits Objectives: To state the practices that create a positive eating environment and encourage children to try new foods. (LO 4) To describe appropriate principles and practices in infant feeding, including a supportive breastfeeding environment. (LO 4, 6) To consider the unique aspects of the growth and development of toddlers that affect their nutrition and eating habits. (LO 4) To identify developmental issues for preschoolers and school-agers that affect their eating behaviour. (LO 4) •

Refer to Video title: Canada Food Guide in NelsonStudy

After watching the short video, the instructor can use True & False statements to discuss the information regarding sustainability as related to the impact from Canada’s agriculture. _____Farmers are more efficient and innovative than ever, using increased precision and automation. (True) ______The Agricultural Sector has not taken significant steps to protect the environment. (False). ____Dairy farmers produce the same amount of milk as they did in 1997, but with nearly half the cows and 20% less greenhouse gases (True) ____We're one of the world's smallest exporters. (False)

5-23

_____ The food processing sector is strong and dynamic. It's a cornerstone of our economy. And it's diversified, from family-run micro-breweries to macro, globallyintegrated companies. (True) _____With our high-quality food and first-class producers and processors, Canada may meet the world's growing demand. (True)

•

Answer true or false to each of the following statements about breast milk: o (T or F) Antibodies provide infants with short-term immunity against some infections. o (T or F) Breast milk’s protein is harder to digest than protein in cow’s milk. o (T or F) It has the right balance of all essential vitamins, including vitamin D. o (T or F) The large amount of lactose (sugar) helps in the development of the central nervous system. o (T or F) Human milk is perfectly suited for infants because milk is speciesspecific. o (T or F) The essential fatty acids promote the best possible nerve and brain development.

•

(T or F) The adult helps the infant feed smoothly by paying attention to cues coming from the infant about timing, tempo, frequency, and amounts.

•

The optimal period of time to begin offering semisolid food is around ______ months of age. (answer: 6)

•

________ are often the first semisolid foods fed to infants. (answer: cereals)

•

2% milk should not be fed to children under ______ years old because ______________________________________________________________. (answer: two; children under two years old need the milk fat found in whole milk for growth and development; not yet eating a varied enough diet)

•

Educators have _________ control of feeding while children have __________ control of eating. (answer: indirect; direct)

•

Satter’s division of responsibility on feeding states: o Adults are responsible for ______, ______, and ______. (answer: what, when, and where)

5-24

o Children are responsible for _________ and __________. (answer: whether and how much) •

For each of the following statements, indicate which age group is most relevant: I) infant T) toddler P) preschooler S) school-ager They need to understand the rationale/reason/purpose of what they are doing and are concerned with mastery and accomplishment as part of their selfesteem. (answer: S) They are often afraid to try new things, and coaxing will probably make them less likely to try. (answer: T) New foods need to be introduced slowly, with three to five days between introductions in order to observe possible reactions. (answer: I) They take increasing initiative as they become better at everything they do (e.g., opportunities to serve themselves at snack/mealtime is important). (answer: P) At times, the need for security and support from a trusted adult overrides their need for autonomy. (answer: T) The power of peers is evident in how children react to each other about food. (answer: S) Many have a hard time sitting for long enough to eat a whole meal, if it is holding them back from doing other things. (answer: T) Foods become less puréed and more choppy as the child is ready for the texture changes (e.g., better able to chew). (answer: I) Autonomy is an important aspect of their development, and coaxing them to eat can result in power struggles. (answer: T)

•

In a positive eating environment a. children’s rights are respected; they are encouraged to develop their five senses in enjoying foods b. children are expected to conform to rules that result in perfect table manners c. distractions are welcomed and children are encouraged to listen to upbeat music while eating d. a and b only

5-25

e. a and c only •

Current evidence in several countries suggests that a. an infant who is at high risk for developing an allergy usually has a close relative (parent or sibling) with a food allergy, asthma, or allergic rhinitis b. delaying the introduction of certain “trigger” or “high-risk allergy” foods (e.g., peanut, fish, or egg) has a protective effect on preventing food allergies c. delaying the introduction of certain “trigger” or “high-risk allergy” foods (e.g., peanut, fish, or egg) does not have the protective effect on preventing food allergies that was originally thought d. both a and c are true

•

Which of the following best describes toddler nutrition? a. Toddlers usually enjoy sitting and focusing on eating. b. Toddlers are developing a sense of autonomy, and an adult making demands on how much they eat is appropriate. c. Toddlers have growth spurts that affect their interest in eating. d. a and b only e. b and c only

5-26

•

When preschoolers are eating, educators keep in mind that a. food jags, dawdling, and fear of new foods are issues that tend to diminish during the preschool years unless adults have paid a lot of attention to these behaviours b. they have a genuine interest learning about others and food provides opportunities to do this c. preschoolers like to take initiative, and therefore serving themselves provides a developmentally appropriate opportunity to do so d. all of the above e. none of the above

•

The following statement(s) about school-age nutrition is/are true: a. Children who have been introduced to a variety of foods will probably be less open to trying new foods and accepting others’ food choices. b. Their developmental need for mastery and accomplishment suggests that cooking experiences (preparing food) can be very positive for school-age children. c. Concerns about dieting and the fear of fat don’t usually emerge until the teenage years. d. a and b only e. b and c only

•

Identify which suggestion(s) are appropriate for encouraging children to try new foods (circle the number[s]): 1. Present a number of new foods at the same time. 2. Introduce a new food when children are hungry. 3. Offer large amounts of the food. 4. Talk about the colour, textures, tastes, shapes, and smell of the food. 5. Insist that the children taste the new food. 6. Ask children what they didn’t like about the new food.

•

List five (5) reasons why breast milk is the best nutritional choice for infants. (answer: refer to text starting on page 278)

5-27

•

List three (3) ways that educators have indirect control of feeding children in ECLC programs. (answer: select and present nutritious foods; set routine times for snacks and meals; create a pleasant atmosphere; maintain developmentally appropriate standards of behaviour at the table; help children attend to their eating)

•

Explain what children are responsible for with regard to eating. (answer: whether they will eat and how much they eat)

•

After checking for children’s food allergies, what are three (3) things educators should keep in mind when children of all ages are introduced to food they are unfamiliar with? (answer: introduce one at a time; serve with familiar foods; encourage to taste but don’t force/coax; offer several times over several weeks; let them explore food; model openness to new food)

•

List five (5) (there are 17!) considerations in creating a positive eating environment for children. (answer: refer to Table 5.13, text page 276)

•

Define food jags. (answer: children refuse all but one or two favourite foods for a period) How should educators and parents respond when a child is experiencing a food jag? (answer: continue to offer a range of foods with the favourite one[s], and don’t focus on it because it will pass)

•

What are two (2) physical signs of an infant’s readiness to start with semisolid foods? (answer: better able to sit up; can move head back to indicate fullness or lack of interest; can move head forward to indicate hunger or interest; can hold a spoon, although it will be months before the infant will be able to use it effectively; shows interest in semisolid food and others’ food)

•

List three (3) important considerations in introducing semisolid foods. (answer: parents should introduce each food at home before it is offered in the program; wait a few days between new foods to observe possible reactions; introduce cereals first, then meat and alternatives, and then vegetables and fruit)

•

After the introduction of infant cereals, foods recommended to introduce next are ______. (answer: meats) Why? __________________________________________. (answer: by six months of age, the baby needs to eat iron-rich foods [iron-rich cereals and meat to prevent anemia], before vegetables and fruit)

•

What are three (3) helpful and practical hints to make eating easier for toddlers? (answer: provide some finger foods; serve soup thin enough to drink or thick enough to eat with a spoon; use child-sized unbreakable plates, bowls, and utensils; serve or encourage children to take small amounts of food and offer seconds, thirds as requested; cut foods into bite-sized pieces; try not to have very chewy foods; expect children to sit while eating)

•

Provide one (1) tip for feeding children from 9 months to 1 year for each food group: (answer: Table 5.14, text page 287)

5-28

o Vegetables and Fruit: _____________________________________________ o Grain Products: __________________________________________________ o Meat and Alternatives: _____________________________________________ o Milk and Alternatives: ______________________________________________

Providing Foods and Menu Planning Objectives: To outline ways in which foods can be provided in an ECLC program. (LO 6) To explain rotation menus and list the steps in writing menus. (LO 6)

•

(T or F) Foods and beverages served as snacks are not part of the daily recommended servings from Eating Well with Canada’s Food Guide.

•

Answer true or false to each of the following statements about menu planning: o (T or F) Snacks are high in sugar and low in nutrients. o (T or F) Serve fruit instead of unsweetened fruit juices. o (T or F) Foods that have been through a number of food processes and/or have several additives are not served. o (T or F) Serve two strong-tasting foods together. o (T or F) Drinking water is not made available to ensure that children drink their milk or juice and eat as much as possible. o (T or F) All foods should have a soft texture for children. o (T or F) Vegetables need not be served daily if fruit is being offered.

•

Educators should eat meals with children because a. they can clean up spills b. they serve as role models for appropriate behaviour for the children c. they can correct the children’s table manners d. they can serve food onto the children’s plates

5-29

e. none of the above •

Developing four 6-week rotation menus, one for each season, has the following advantage(s): a. takes advantage of availability and lower costs of seasonal foods b. provides a way of introducing new foods, balancing with familiar foods c. avoids ever having the same meal twice d. a and b only e. a, b, and c

•

When menu planning, educators should consider a. feeding the children whenever they are hungry b. using the adult version of Eating Well with Canada’s Food Guide c. eliminating foods that can cause potential choking d. serving dessert if the children finish their main course e. providing a sweet treat every day

•

Reorder the following six (6) steps to menu planning, according to the textbook (write the appropriate number beside each step): Choose foods for the afternoon snacks (select from two of the four food groups). Add the milk or alternative for the five lunches. Choose foods for the morning snacks (select from three of the four food groups). Select the grain products that would complement the meat and alternatives for the five lunches. Select the vegetables and fruit for the five lunches. Select meat and alternatives for the five lunches. (answer: 6; 4; 5; 2; 3; 1)

• 5-30

A nourishing morning snack is important. Indicate three (3) reasons why a child may not have eaten before coming to the program in the morning. (answer: doesn’t like to Copyright © 2019 by Nelson Education Ltd.

eat as soon as he or she gets up; time pressures on the family; poor sleep may mean decreased appetite; food insecurity; doesn’t see parents eating; may refuse to eat; may have eaten small amounts on the run) What are two (2) reasons why it is important for educators to understand principles and have skills to plan and critique menus? (answer: identify menus that are adequate or not; know how to correct or improve menus; suggest appropriate substitutions [e.g., food allergies]; identify food wastage or unnecessary spending—food budget)

•

Make one (1) specific change or give an example of a particular food for each snack and lunch that would improve the menu for preschool children. Provide the rationale (why) for each change. Do not use the same rationale more than once. (Suggestions: instead of the student just leaving it as fruit, say apple slices to add crunch and colour; provide students with two consecutive days from a menu plan for critique; use one full page in the landscape orientation [page setup] for this question, which provides students with enough space in each box to write both the change and rationale.) For example:

P.M. SNACK

LUNCH

A.M. SNACK

•

Monday Granola with milk Grape juice

Changes

Tuesday Pancakes Milk

Baked whitefish Rice Stewed tomatoes Milk

Cheesy noodle bake Steamed peas Applesauce Juice

Yogurt with strawberries Milk

Fresh fruit salad

Changes

5-31

A.M. SNACK LUNCH P.M. SNACK •

Wednesday Granola Fruit Juice

Changes

Thursday Pancakes with maple syrup Fruit Juice

Lasagne with meat and spinach noodles Veggies Fruit and yogurt

Chicken fingers Rice Stewed tomatoes Milk

Raw veggies and dip Fruit juice

Coffee cake Fruit

Changes

Using your knowledge of the menu-planning checklist, identify deficiencies in this one-day preschool menu plan, and explain why each one is a deficiency. A.M. SNACK LUNCH

P.M. SNACK

Wednesday • rye toast • orange juice • lasagne with hamburger, noodles, mozzarella cheese, tomato sauce • canned peach slices • milk • yogurt • banana and apple slices

Two (2) Nutritional Deficiencies: 1. _____________________________________________________ 2. _____________________________________________________ Two (2) “Other” Deficiencies: 1. _____________________________________________________ 2. _____________________________________________________ 5-32

Food Safety Objective: To outline ways to reduce the risk of choking, reduce the incidents of allergic reactions, prevent foodborne illnesses, and use a microwave oven safely. (LO 6)

•

Select the food(s) that present a high risk for food-borne illnesses: a. peanut butter b. eggs c. cream fillings d. all of the above e. b and c only

•

If a microwave oven is used to warm baby bottles, the following practice is not recommended: a. Heat the formula/breast milk until the bottle feels warm (1 minute at full power for a 240 ml [8 oz] bottle). b. Use a glass measuring cup to warm milk, if possible. c. Remove the cover and nipple from the bottle before putting it into the microwave oven to let heat escape from the bottle. d. After warming, put the nipple back on the bottle, and then invert the bottle 10 times to ensure consistent temperature mixing.

•

With regards to food safety, what is the role of Health Canada and the Canadian Food Inspection Agency? _________________________________________________ (answer: refer to text page 302)

•

Identify three (3) foods that educators should not serve to children under four years old because of the potential risk of choking. (answer: examples—popcorn; hard candy; raisins; whole nuts and seeds; foods served on toothpicks/sticks; whole grapes; hot dogs)

5-33

•

Identify how to prepare the following foods for children under four to reduce the risk of choking: o raw carrots: (answer: grate) o grapes: (answer: cut in two or four) o fish: (answer: remove all bones)

•

List three (3) food-handling practices that contribute to making food unsafe to eat. (answer: inadequate personal hygiene; using soiled cooking surfaces and equipment; improper food handling and preparation; serving spoiled foods; improper food storage; not controlling infestations)

•

List five (5) ways that can help prevent insect infestations. (answer: store food properly; don’t leave food on counters/tables; clean and disinfect cooking/eating surfaces to remove food particles; sweep regularly; don’t store food under sinks; check boxes and packages brought into the building—cockroaches; maintain screens and other ways insects can enter; close off spaces around pipes under sinks, cracks, and holes in walls; act quickly when you notice the first insects; properly store garbage containers in and out of the building, and empty regularly)

•

List two (2) guidelines that help ensure the safe preparation of foods when using a microwave oven. (answer: use microwave-safe containers, preferably not plastic; stir and test all food before serving; invert bottle 10 times and test before feeding; clean oven of spills and splatters; ensure school-agers know how to use it safely)

5-34

HEALTHY EATING FOR CHILDREN BINGO gives an example of defines what a food a lunch for jag is: preschoolers that includes all food groups:

lists 2 positive lists 2 nutritional reasons for adults to benefits of breast sit with children milk: during lunchtime:

explains why you shouldn’t insist that children finish everything on their plate:

lists 2 examples of nutritious and fun foods that can be served for celebrations:

lists 2 examples of how you can encourage toddlers and preschoolers to develop independent eating skills:

lists 2 foods that can notes the percentage lists 2 positive ways cause choking in of fat in milk to introduce new suggested for a 3toddlers: foods: year-old:

explains why it is better for children to eat fruit rather than drink fruit juice:

lists 2 positive emotional associations with food:

lists 2 negative emotional associations with food:

explains whether you should use a microwave to warm baby formula:

lists 2 examples of explains 1 benefit of alternatives for meat serving snacks in for lunch: small groups:

5-35

YOUR HEALTHY EATING BINGO

Eggs

Fish Legumes (beans)

Zoodles (zucchini noodles)

lists the 4 food groups in Eating Well with Canada’s Food Guide: High Vit. C foods

Oatmeal

Cheese

Berries

Pasta (incl. whole wheat or rice pasta)

5-36

Apples

High Vit. A foods

High-fibre foods

Whole-grain breads

Poultry

Milk

THE DIGESTIVE TRACT: IDENTIFY THE ORGANS

On this diagram, write the name and draw a line to each organ listed below: §

Anus

Pancreas

Colon

Rectum

Esophagus

Salivary Glands

Gallbladder

Small Intestine

Liver

Stomach

Oral Cavity

Tongue

5-37

NUTRITION FACTORS—EATING HABITS Using Table 5.1 (text page 234), identify and give an example of one positive and one negative association that you have had with food. Emotion: Positive or Negative Association:

Emotion: Positive or Negative Association:

5-38

CHOOSE A FOOD LABEL Brand and Food Name: Total Weight/Volume of Food: List the three (3) main ingredients in order of quantity in the food: 1. 2. 3. Nutrition Facts Table What weight/volume of the food is considered one (1) serving? ____ How many servings in the entire container? _______ % of Daily Value Calories Fat •

Saturated

•

Trans

Cholesterol Sodium Carbohydrates

Is there information on vitamins and minerals? If yes, list a maximum of three (3) and the percentages of daily value: Vitamins and Minerals

% of Daily Value in One Serving

5-39

Words That Mean Sugar in List of Ingredients

Words with Sodium in List of Ingredients

Popular claims or other information on the label includes:

Would/do you use this product regularly? YES or NO Why or why not?

5-40

NUTS AND BOLTS OF NUTRITION 1. List the seven (7) general categories of nutrients: 2. What are the three (3) categories that provide energy (through calories)? 3. What nutrients are characterized by whether they are fat-soluble or water-soluble? What is the relevance of fat- or water-soluble? 4. Calcium, phosphorous, magnesium, and potassium are: _____________. 5. Name the nutrient that is indigestible: _____________. Why then do we need it? 6. Define “key nutrients” with reference to Eating Well with Canada’s Food Guide. 7. Identify the specific nutrient by its function: A mineral that builds and maintains strong bones and teeth, promotes normal blood clotting, and promotes healthy nerve function. Antioxidants found in fruits and vegetables, which play a part in our immune system and provide some protection against cancer and heart disease. A vitamin that prevents oxidation of fat in tissues, important in red cell membranes and lungs. A mineral that combines with protein to form hemoglobin and myoglobin, which provide oxygen to cells. The energy provider that supplies the body’s main source of energy. Fatty acid found in vegetable oils. Builds and repairs body tissues and manufactures antibodies necessary to fight infection. The main constituent of the body, necessary for transporting nutrients, regulating body temperature, and eliminating body waste.

5-41

POSITIVE EATING ENVIRONMENT CHECKLIST Using the Positive Eating Environment: Checklist (Table 5.13 on text page 276) and your experience in your most recent placement: Describe one area where you could answer “Yes” with confidence, and why:

Describe one area where you would likely answer “No” more often than “Yes,” and why:

Identify the age group you worked with in your placement:

5-42

FOOD SAFETY: APPROPRIATE PRACTICE Identify potential risks, if any, in each scenario and make the appropriate revisions in practice: Scenario 1—After cutting raw chicken on the wooden cutting board, the cook disinfects the knife and uses the same board to cut vegetables for the salad. Scenario 2—During lunch, one of the educators notices that the milk tastes a little off. The children haven’t noticed. Another educator comments that they should use up the milk rather than wasting it. Scenario 3—“Dippidy-doo and vegetables too” is one of the preschoolers’ favourite snacks. The educator places the bowl of dip in the middle of the table for all to share. Scenario 4—Packages of frozen hamburger have been placed on the kitchen counter to thaw. Hours later, the cook decides that she doesn’t need one of them and puts it back in the freezer. Scenario 5—While feeding an older infant, the educator places the tip of the spoon in his own mouth to test the food’s temperature before feeding it to the child. Scenario 6—After helping toddlers to use the toilet or potty, the educator goes into the kitchen to cut up cheese and fruit for a snack.

5-43

MENU CRITIQUE ACTIVITY A.M. SNACK

Monday

Tuesday

Wednesday

Thursday

Friday

Granola Bar

Pancakes with maple syrup

Toast with jam

Plain donuts

Bagel with cheese

Orange slices

Fruit salad

Milk

Juice

Milk

Spaghetti with meat sauce

Hamburger with tomato

Macaroni with cheese

Beef stew with vegetables

Applesauce

Fruit salad

Applesauce

Bread and butter

Milk

Juice

Fruit yogurt

Juice

Juice Applesauce

LUNCH Bologna sandwich

Milk

Juice P.M. SNACK

Mini pizzas

Nacho chips

Vanilla cake

Cinnamon buns

Apple

Bananas

Oranges

Apples

Juice

Use Table 5.15: Menu-Planning Checklist (refer to text page 299).

5-44

UNIT

Healthy Active Living

CONTENTS CLASSROOM ACTIVITIES AND DISCUSSIONS..........................................................................2 Critical Thinking...................................................................................................................................... 5 First (refer to text page 352) ...................................................................................................................... 5 Second (refer to text page 364) ................................................................................................................. 7 Third (refer to text page 369) .................................................................................................................... 8 Assess Your Learning .............................................................................................................................. 8 Resource Materials for Teaching........................................................................................................... 10

ANCILLARY MATERIAL ..........................................................................................................10 Physical Activity Curriculum—Planning for Infants and Toddlers .......................................................... 10

ASSIGNMENT IDEAS .............................................................................................................12 TEST QUESTIONS ..................................................................................................................14 Healthy Active Living ............................................................................................................................ 14 Supporting Physical Activity ................................................................................................................. 18 Supporting Healthy Eating Habits ......................................................................................................... 24 Impact of Screen Time on Healthy Active Living .................................................................................... 26

HERE’S THE ANSWER—WHAT’S THE QUESTION? ...............................................................30 BENEFITS OF OUTDOOR PLAY ..............................................................................................32

6-1

Classroom Activities and Discussions Here’s the Answer—What’s the Question? (see handout, page 6-29) Built environment—active transportation: •

Canada Walks: http://canadawalks.ca/take-action/national-action-strategy/

•

Public Health Agency of Canada (expand data on this website for a range of resources): http://cbpp-pcpe.phac-aspc.gc.ca/public-health-topics/builtenvironment-active-transportation/

•

National Collaborating Centre for Environmental Health’s Fact Sheets for Promoting Healthy Built Environments: http://www.ncceh.ca/sites/default/files/Built_Environment_Fact_Sheets_Apr_201 0.pdf

Physical activity: •

The ParticipACTION Report Card on Physical Activity for Children and Youth was published after our 6th edition deadline: https://www.participaction.com/sites/default/files/downloads/2018_participaction _report_card_-_highlight_report_0.pdf

•

Identify different opportunities children have for physical activity in your practicum placement: o Are there times during the day when they can run, climb, jump, play active games, etc.? o When are these times and where do these activities happen? o Are there additional opportunities for movement during the week (e.g., yoga, dancing)? (Refer to Appendix 6.1, text page 379, and Appendix 6.2, text page 380.)

•

ParticipACTION offers ongoing resources and ideas for physical activity: https://www.participaction.com/en-ca/programs/participaction-150-play-list

•

Further research is needed on physical activity and sedentary behaviours in ECLC settings. Although the quantity of physical activity participation in programs is familiar, very little is known about the quality of those activities. Have a class discussion on what the students have experienced in their placements around the quality of physical activities.

6-2

Benefits of outdoor play: •

Distribute Benefits of Outdoor Play to students (see handout, page 6-31).

•

Divide the class into five groups and assign each one a domain.

•

By domain, have students write an example of how they could tell that the child is experiencing each of the domain’s listed benefits. For example, one of the benefits in the physical domain is “increases energy and improves stamina”: When the child comes inside after play, she has lots of energy.

Undereating: Undereating is an issue that tends to be of concern to parents and educators alike, as it often creates tension at mealtimes and affects the child negatively. There are specific reasons contributing to children’s lack of interest in eating or in many of the foods offered at the program. The issue is usually short term but may become long term. Ensure that students read the chart on overeating and undereating in text page 360. It is common for a child to be considered a picky eater (a term that has negative connotations; thus educators must not use it when referring to a child). Ask students in small groups to create a list of why a child may be undereating, and have someone from each group add their reasons to the whiteboard or to poster paper. As the facilitator, go through each of these reasons and discuss the possibilities, as well as considering whether each is relevant. (Help students recognize that making judgments about children, such as “he is manipulating,” etc., is counterproductive; they often create child–adult tension, and can make a short-term issue into a long-term one.) In the large group, share possible reasons for undereating and possible ways to respond: •

For example: A child may not be eating much because of individual likes and dislikes, or the child’s need to be independent. Suggestions: Keep offering food, without coercion, and often the child will try it in the future; involve the child in food preparation or setting the table.

•

A child may be a “super-taster” (25% of the population), which means that he or she has many more taste buds on the tongue than most people. These people experience the five basic tastes, especially bitter foods, with greater intensity, making it harder for them to enjoy a large repertoire of foods at once.

•

There are many other possibilities, but, obviously, the important thing for students to focus on is responsiveness and patience with children’s interests in foods, in order to support them moving in a positive direction. Keep the division of responsibility in mind. Some children eat far less than others; yet, if they are growing within the normal range, and have energy for everyday activities, they are likely quite healthy.

6-3

Childhood obesity. Discussion ideas: •

What are the social determinants of health that may contribute to individuals being overweight or obese? In addition, what may be some societal pressures that contribute to obesity?

•

Is it possible for parents to be morally obligated to prevent their children’s obesity?

•

Does being overweight automatically mean one is not physically fit?

•

Should we pay an extra tax on the junk food we buy?

•

Do parents underestimate their children’s weight and overestimate their physical activity?

•

For the first time in recorded history, our younger generations are expected to live shorter lives than their parents due to obesity.

•

Is bad genetics, junk food, or parenting to blame for overweight and obese children?

Large motor development: •

Use Table 6.1 (refer to text page 338).

•

Divide the class into five groups and assign each one an age group in the table.

•

10 minutes: Have each group supplement the list of activities with specific ideas for their age group on flip chart paper. Ask them to consider cultural diversity in their ideas.

•

Hang the papers around the room.

•

5-minute intervals: Each group rotates to a different list and adds ideas (with five age groups this portion will take about 20 minutes).

Pop consumption: To initiate a discussion around the consumption of pop, you can download and play What’s in Your Soft Drink? by K. Hamilton (3.5-minute podcast on YouTube). To download, visit https://www.youtube.com/watch?v=7NWUAYyPdag •

6-4

10 minutes: Have the students discuss the following questions.

Turn to the person next to you and discuss/answer the following questions: What is the main point made in the video? _____________________________________________________________________ _____________________________________________________________________ Do you agree/disagree, and why? _____________________________________________________________________ _____________________________________________________________________ Parents, educators, and health professionals have differing opinions regarding the advantages and concerns of computer access for kindergarten and school-age children during after-school programs. In addition to the concern about the duration of daily time spent on this activity, it has been shown that these networks, in fact, contribute to isolation and can play a role in depression, anxiety, low sense of belonging, and low selfesteem. Discuss or debate this issue, ensuring that each advantage is clear and measurable, and that each concern includes criteria for minimizing the potential negative impact of daily computer time. Canadian 24-Hour Movement Guidelines for the Early Years (0–4 Years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep (refer to Appendix 6.1, text page 379). Have students read these guidelines, and then have a small- or large-group discussion on guidelines for those under 2 years old and those 3–4 years old. Do they agree or disagree, and why? Do they see how these guidelines can relate to ECLC programming? Canadian 24-Hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep (refer to Appendix 6.2, text page 380). Have students read these guidelines, and then have a small- or large-group discussion on how these guidelines apply to children between the ages of 5 to 8 versus 9 to 12. Do they agree or disagree, and why? Do they see how these guidelines can relate to ECLC programming?

Critical Thinking First (refer to text page 352) In a suburban community, the green space is minimal, including none within the ECLC setting’s playground. The playground is composed of manufactured surfaces throughout and stationary metal play equipment. The parents and educators are concerned about the time spent in cars or transit getting to the centre and that their children have little access to green space, both at the centre and in their home surroundings. What can be done to Copyright © 2019 by Nelson Education Ltd.

6-5

make this wish a reality? For each action, identify benefits, possible challenges or barriers, and possible solutions. Include one component of a green environment that you would like to add for each age group: •

infants and toddlers

•

preschoolers

•

school-agers

How does each component support moderate or vigorous physical activity? (See the resource on the Nelson site.) Suggestions: Actions

Benefits

Bring in trees, shrubs, rocks, and logs to define a variety of places in which to run, climb, hide, and socialize

Potential for Need to ensure that direct and specific trees, plants, spontaneous and other natural interaction materials are safe for with the children, are practical world, in terms of foliage including (e.g., options for shade textures, in summer, not high in colours, maintenance, etc.), and smells; offer options for experiencing children’s play seasonal changes Children will Paths include have meanders, loop-backs, opportunities crossroads, and small to develop undulations or slopes their motor to provide interest, skills, challenge, and challenge decision-making themselves, points and problem solve Opportunities • Having enough for small space on stage for groups of some children to be children to act involved in out their dramatic play, dramatic play while others are at ideas or to the other end socialize with socializing (e.g., peers playing or having conversations)

Create an appropriate surface and winding path for riding tricycles

Set up a groundlevel stage under a large tree

6-6

Challenges/Barriers

Solutions In addition to obvious collaboration with parents, educators, director, and the board, need expert involvement (e.g., landscape designer and/or consultation with local agency involved in greening or http://www.evergreen.ca/)

Collaboration with children and other players to provide input in priorities and wish list for paths, but requires consultation with playground safety expert and landscape designer

After consultation with players for possible ideas, consult with a landscape designer

• •

Having tree large enough from early on to offer shade Storage space for materials/props for dramatic play and small-group experiences

Note: An obvious challenge for any action is financial viability, which is not addressed here.

Age Group

Green Environment Components

Infants and Toddlers

An uneven grass surface, with small mounds to crawl or walk up and down, develops the child’s balance and spatial exploration; path for riding and push toys Define a space with rocks that children can use for dramatic play; sandbox with logs as the border Garden plots; seating area where they can talk and read

Preschoolers School-agers

Second (refer to text page 364) The children are used to drinking a lot of fruit juice both at home and in the ECLC program. As the director of a centre with preschoolers and school-agers who bring in their own foods and beverages from home, you are concerned about the high-sugar, lownutritive beverages most children bring in, including fruit drinks, sports drinks, and pop. You want to promote more drinking of milk and water, as well as children eating more fruit rather than fruit drinks, which have added sugar and colours and miss out on important food components such as fibre. What are some specific ways that you can support this vision with the children, parents, and staff? Consider challenges you may face with each of your suggestions and how you will meet each challenge. Suggestions: Find a way to share information with parents (e.g., poster, pamphlets) and children (e.g., how to calculate amount of sugar in different beverages [refer to text page 361]) about this issue; ask for feedback from parents if they would like the program to organize a parent event with a dietitian; review nutrition policy and see if revisions would address this issue; provide the option for parents to not send the beverages and instead have the program provide milk and water and fresh fruit each day (this could be subsidized by the families [e.g., monthly fee]); possible challenges: lack of feedback from parents (focus on the children’s awareness of the issue; this, in turn, may encourage the parents to revisit this issue).

6-7

Third (refer to text page 369) What are the positives and negatives of screen time in an ECLC program? Write a policy on and practices for the use of TV and computers in your preschool program with threeto five-year-olds. Who would you involve in this process and how? Suggestions: •

Positives: positive values in some children’s programming; media literacy is essential for children long term

•

Negatives: inactivity; when children have access to screen time at a young age, studies are finding that as the child ages, the duration of screen time increases; the consumption of high-fat, high-energy foods increases; body weight increases

•

Policy: Ensure that the following are considered in the policy’s development: o whether screen time is part of your program o when it is, refer to text page 367

Assess Your Learning Evaluate your options in each situation. 1. A few preschoolers have recently moved to Canada from countries that are much warmer year-round. They are having a difficult time adjusting to winter. The parents have asked you to let them stay inside with another group of children, rather than take them outside to play. Suggestions: Parents need to feel confident that their concerns are heard; acknowledge the parents’ concerns/worries [e.g., “It must be so much colder here than what you are used to, isn’t it? I’m wondering if perhaps you are worried about your children catching cold if they play outside?”]; you may need to offer assurance to parents that, with time, their children will adjust to the cold when dressed for the weather; perhaps you and the parents can agree on a schedule that would gradually acclimatize the children; try incorporating games or toys that are familiar to these children to help with the adjustment; it’s a commonly held myth that you can catch a cold from going outside, but in fact you need to be infected with a cold virus; going outside and getting fresh air when you have a cold is actually good for you. 2. You are chairing an ECLC fundraising committee and are planning a family walkathon event to raise the funds needed for greening your outdoor environment. A company that produces carbonated drinks and high-fat and high-sugar snack foods has offered to provide free refreshments for everyone attending the walkathon.

6-8

Suggestions: Thanks, but no thanks; although the offer is tempting from a financial position, this beverage runs counter to your program’s nutrition policy and practice; to accept such an offer would send the wrong message to children and families and, in turn, undermine your program’s position. Water is the best beverage for a walkathon. 3. The parents of an active, healthy eight-year-old tell you that they are concerned about their son’s weight and insist that he be given only one serving of each food at mealtimes and only fruit or vegetables as snacks. No other children in the room have this restriction. Suggestions: Meet with the parents to talk, rather than on the run; invite parents to talk about why they are concerned about his weight; reassure parents that their son is in the normal height/weight range, and he is very active in the playground; evaluate menus to ensure they reflect healthy eating and take parents’ comments into consideration if revisions are necessary; provide an opportunity for parents to meet with a dietitian who can provide nutrition pamphlets; recommend books from a library/bookstore (e.g., Your Child’s Weight: Helping Without Harming (2005), by E. Satter [Kelcy Press]) 4. You are an educator in a program for four- and five-year-olds. Your colleague has access to all the newest digital media. Your ECLC program does not have a policy regarding screen time, and your room partner brings in new media weekly that she puts on for children to watch “to calm them down” or whenever it’s a rainy day. The children often ask to watch the same program over and over again. Suggestions: Approach your colleague to talk with her about your concerns around the amount of time that children are spending in front of the TV, and that the opportunities for physical activity and learning through play are significantly compromised; the director and educators should meet to decide whether screen time will be incorporated into the program, and if so, a policy and practices need to be developed. 5. One of the school-agers in your after-school program uses a wheelchair. On the playground, she watches as the other children play active games freely, and you notice that she often practises taking shots at the basketball hoop when no other children are using it. When the ball falls to the ground, however, she rarely retrieves it unless an adult is nearby to throw it back to her. Suggestions: As with all children, your observations of this girl’s skills and interests are considered in planning and implementing curriculum; educators need to be committed to ensuring that all children are included in physical activities; start by involving one or two additional children in a small-group basketball game (initially facilitated by the educator); come up with other ideas of targets that the children can aim balls at; consider a barrier behind that hoop that prevents the ball from rolling off the hard surface, which makes it impossible for the child to wheel her chair to the ball. Copyright © 2019 by Nelson Education Ltd.

6-9

Resource Materials for Teaching Active Healthy Kids Canada: http://activehealthykids.ca/ Obesity Canada: https://obesitycanada.ca/ This site requires a membership (free), and it has a wealth of information. You can also set up to receive email updates on new information, based on your preferred topics. Centre for Science in the Public Interest (Canada): https://cspinet.org/nutrition-actionhealthletter CSEP: http://www.csep.ca/home Heart & Stroke: http://www.heartandstroke.ca/ National Eating Disorder Information Centre: http://www.nedic.ca/ NutriSTEPÔ: http://www.nutristep.ca/ Ontario Physical and Health Education Association: https://www.ophea.net/ For early learning and kindergarten curriculum experiences: https://teachingtools.ophea.net/activities/early-learning-resource ParticipACTION: https://www.participaction.com/en-ca PHE (Physical and Health Education) Canada: https://phecanada.ca/ Right to Play: https://www.righttoplay.ca/en-ca/

Ancillary Material Physical Activity Curriculum—Planning for Infants and Toddlers Infants and toddlers need physical freedom on a clean floor in a safe, interesting environment. The child must practise over and over again, finding her or his own balance and making muscles do the necessary things to achieve the new skill. When implementing physical activity with an infant one-to-one: •

Try an activity with a child in a relaxed and reassuring way. If the child responds by laughing or other signs of enjoyment, continue and possibly repeat several times. If not, stop and try the activity again some other time.

•

Begin with relaxation exercises to establish trust and to set the tone. Then introduce some stretching and bending exercises to increase flexibility and range of motion. Follow with more vigorous activity to support strength, endurance, flexibility, and coordination. The process should be enjoyable for child and adult. Repeat the 6-10

activities for several days, progressing only as quickly as the child appears to want to. Follow her or his cues. •

Use favourite toys whenever possible. It can be part of the activity, help to relax a child, draw attention to a movement, or initiate a particular exercise.

•

Exercise on a soft covered mat or carpet.

•

Be totally committed to the child. Avoid distractions and try to reduce distractions for the child.

•

Adapt the timing of the activity to the tempo of the room and the day.

•

Only begin an activity when the infant is alert and willing. If the child is hungry, unhappy, or tired, it is not an appropriate time to initiate the activity.

•

Follow the child’s lead in your interactions. Do not: o Force the child or the child’s body in any way o Tire the child o Compare her or his accomplishments with those of another child. Each child is unique and will progress at her or his own pace.

When planning and implementing curriculum for walking babies and toddlers: A motor development explosion occurs because once the child learns to walk, he or she quickly develops a vast repertoire of other motor skills (e.g., involving body and spatial awareness, locomotor and nonlocomotor skills, and manipulative skills). •

An environment and adult involvement that promote freedom of movement are essential for the child to learn to assess his or her own motor capabilities.

•

When the child’s environment is modified to prevent injury, it is obviously safer and less restrictive for the child. Also, adults will be able to cope more easily with the demands of supervising busy walking infants and toddlers. Ensuring that the environment indoors and outdoors doesn’t become too cluttered during the day with scattered toys also reduces frustration and makes it easier to practise emerging and acquired motor skills.

•

Among the quantitative concepts toddlers are busy discovering are some, more, big; spatial relationships like up, down, inside, outside, behind, over, and under.

•

As toddlers acquire more language and begin to develop the ability to pretend, the adult is able to plan for simple games (e.g., ring around the rosy) and motor activities

6-11

with suggested imagery (e.g., let’s pretend we are snakes, etc.). Remember to focus on the familiar for the child, integrating ideas that come from family (e.g., foods, pets songs, stories, etc.). And remember the importance of simple directions. •

Physical activity opportunities and curriculum should be built in to the day when possible, not seen as a “structured” time of the day. Adults who have an active living “way of life” optimize opportunities for physical activity, rather than not recognizing or ignoring them. Young children should be able to move often during the day for short periods.

Assignment Ideas There is a wealth of information and organizations on the Internet on each of the topics covered in this unit. •

Use Appendix 2.1 (refer to text page 119) as a guide for this assignment, or a tool of your choice.

•

Choose one of the following topics: o Physical activity o Healthy eating o Screen time

•

Find two Canadian websites: o One site should be from a government source (any level), and the other not. o Canadian Paediatric Society’s Caring for Kids website: https://www.caringforkids.cps.ca/

•

Evaluate each of these sites using the evaluation tool.

•

Compare and contrast the sites.

•

Which site does the student prefer to use, and why?

Product labels: •

Choose one product from each of these beverage types: o pop o sports drink

6-12

o “energy” drink o fruit beverage (not 100% fruit juice) o cow’s milk o soya milk •

Using the Nutrition Facts Table: A Sample (refer to Figure 5.2, text page 263): o Compare the energy (i.e., calories) for one (1) serving size of each product. o Determine the number of teaspoons of sugar in each product and compare. Pop is the number one source of sugar in the North American diet. To figure out how much sugar is in a beverage, the students will need to do a little math. For example, the Nutrition Facts table for a 355 mL pop can may list 48 g of total carbohydrates. Take 48 and divide by 4 (there are 4 g of sugar in a teaspoon), which comes to 12. Drinking this can of pop is like eating 12 teaspoons of sugar. For larger pop bottles, multiply the number of teaspoons of sugar for one serving by the number of servings in the container. To find sugar listed in the Nutrition Facts table, look for these words: fructose, corn syrup, sucrose, and sugar. o Compare the nutrients found in each of the products based on one (1) serving size: calcium, vitamins A and D, vitamin C, and total carbohydrates (or any of the nutrients that you want them to evaluate). Reminder: the numbers are a percentage of your recommended daily intake (RDI). o Summarize your findings, including what you confirmed along with what you may have found surprising.

Note: Some students may comment that the beverage is a great source of vitamin C but has nothing else to offer. As well, we can get our daily intake of vitamin C by eating one orange. When class time does not permit for the classroom activity covering Table 6.2 (refer to text page 348), consider using it as an assignment.

•

CREATE A PLAY SPACE WITH LOOSE PARTS AND MATERIALS:

Most playgrounds in Canada have equipment that is stationary and permanent. Without loose parts and natural elements, options for play are limited and less likely to broaden children’s creativity, problem solving, and develop a range of skills. Dr. Mariana Brussoni’s team recommends less structure, and instead, loose materials such as logs, mud, tarps, crates, sticks, planks, and water to play with. “These elements can often be found in nature, vacant lots and even junkyards, but the most Copyright © 2019 by Nelson Education Ltd.

6-13

important element in any play space is, again, the psychological and physical space to take risks.” : (quote from Dr. Mariana Brussoni in The Power of Play (2019) CBC show; The Nature of Things (with David Suzuki) https://www.cpha.ca/sites/default/files/uploads/resources/play/play-promising-practicese.pdf Additional Resources: https://www.haloresearch.ca/outdoorplay/ Outdoor Play

POSITION STATEMENT on Active

https://brussonilab.ca/go-play-outside/ Mariana Brussoni and her team are currently developing a playability index to find out what elements are necessary to create a highquality outdoor play space in neighbourhoods. https://www.cpha.ca/sites/default/files/uploads/resources/play/play-promising-practicese.pdf Promising Practices for Children’s Unstructured Play: Emerging Programs, Initiatives, and Policies across Canada

Test Questions Healthy Active Living Objectives: To define physical literacy and its importance for children. (LO1) To identify at least two major causes of the global obesity epidemic. (LO 1, 2) To define epigenetics and its possible connections to obesity. (LO 1, 4) To list and describe concerns about childhood obesity in Canada. (LO 1, 2) To compare what is currently known about optimal physical activity, sedentary behaviour, and sleep for children from infancy through school age. (LO 4)

•

Answer true or false to each of the following statements about obesity: o (T or F) Not all heavy children have weight problems as adults, but as they get older the risk for remaining overweight increases. o (T or F) Pop is the number one source of sugar in the North American diet. 6-14

o (T or F) The BMI calculates the height (m2) ÷ weight (kg). o (T or F) Research suggests that insufficient sleep for children does not correlate with obesity. o (T or F) Children in the healthy weight range are not necessarily fit or eating a balanced diet. o (T or F) Children who are obese are not at risk of type 2 diabetes until they reach adulthood. o (T or F) Childhood obesity occurs because of a single factor. o (T or F) Policy interventions are required to address the underlying causes of childhood obesity. o (T or F) Living conditions, and the options and opportunities that are available to people, have significant impacts on obesity. •

Canadian 24-Hour Movement Guidelines for the Early Years (0–4 Years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep recommends the following: o Toddlers (aged 1–2 years) and preschoolers (aged 3–4 years) should accumulate at least _______ minutes of physical activity each day. (answer: 180) o Infants under 1 year old should be physically active several times each day, particularly through interactive __________________. (answer: floor-based play) o Toddlers (aged 1–2 years) need between ______ and ______ hours of quality sleep, including naps. (answer: 11 and 14) o Preschoolers (aged 3–4 years) need between ______ and ______ hours of quality sleep, which may include naps. (answer: 10 and 13) o (T or F) For children less than 2 years old, no more than 1 hour of sedentary screen time per day is recommended. o Children aged 2, 3, and 4 years should spend no more than ______ hour(s) of sedentary of screen time per day. (answer: 1)

•

Canadian 24-Hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep recommends the following: o Children should accumulate at least ______ minutes of moderate to vigorous physical activity each day. (answer: 60) o Children should participate in activities that strengthen muscle and bone at least ______ times each week. (answer: 3)

6-15

o Children aged 5–13 years should have ______ hours of uninterrupted sleep each night. (answer: 9–11) o Children aged 5–13 years should have no more than ______ hours per day of recreational screen time. •

Match the term with the most correct description. The same term may be used more than once or not at all: A) Healthy active living B) Urban sprawl C) BMI D) Physically literate E) Endurance F) Flexibility G) Strength

H) World Health Organization I) Canadian 24-Hour Movement Guidelines for Children and Youth J) Risky play K) Epigenetics L) Built environment

Activities that strengthen the heart and lungs. (answer: E) Ability of various joints to move their full range of motion. (answer: F) Builds strong muscles and bones. (answer: G) Stretching before and after vigorous activity. (answer: F) The science that studies how genes can be turned on and off without changing their DNA sequence. (answer: K) Commonly used to measure the degree of overweight and obesity. (answer: C) Communities built on the outskirts of a city. (answer: B) Guidelines for children 5–17 years old on physical activity. (answer: I) The combination of healthy eating and physical activity. (answer: A) The term that encompasses all the physical structures and elements of the human-made environments in which we live, work, and travel. (answer: L) “41 million children under the age of 5 were overweight or obese in 2016.” (answer: H) “Individuals who are _____________ move with competence and confidence in a wide variety of physical activities in multiple environments that benefit the healthy development of the whole person.” (answer: D) Manageable __________ for children is part of building confidence in oneself. (answer: J) 6-16

Physical activity guidelines for children 0–4 years old. (answer: I) •

Define the term “healthy active living.” (answer: refer to text page 321)

•

Define the term “urban sprawl.” (answer: refer to text page 325)

•

Define the term “active transportation.” (answer: refer to text page 326)

•

Define the term “body mass index.” (answer: refer to text page 324)

•

List two (2) of the major reasons for childhood obesity globally. (answer: transitions in nutrition patterns; reduction in physical activity; increased screen time)

•

How is urban sprawl connected to obesity? (answer: refer to text page 325)

•

Wellesley Institute for Public Health Policy’s broad approach to address childhood obesity by tackling social determinants of health includes a focus on a. poverty reduction b. early development c. addressing neighbourhood factors d. all of the above e. none of the above

•

With regard to preschoolers’ needs for energy, we must keep the following in mind: a. Skim milk and low-fat cheeses are beneficial for young children because they reduce the likelihood of obesity later on. b. They need to eat small amounts of food throughout the day because their small stomachs tend to fill up quickly. c. They should be encouraged to eat healthy foods when hungry and to stop eating when full. d. all of the above e. b and c only

•

Epigenetics research is looking at possible connections between obesity and chemicals. a. What are the types and an example of chemicals being studied? b. How may they affect weight?

6-17

(answers: a. endocrine disruptors—chemicals such as bisphenol A, used extensively in plastics, including the lining of cans, and perfluorinated compounds, used in some nonstick and stain-resistant materials. b. They may be interfering with the way our metabolism works, impacting weight gain. Evidence is growing that early-life, especially fetal, exposure to these chemicals plays a role in fat metabolism, which may affect weight gain later in life.) •

Answer the following questions highlighted in the Active Healthy Kids Canada report (2013): o What is active transportation, and why is it important? o Why are children not travelling actively? o What steps can we take to improve active transportation?

(answer: Highlights from the 2013 Active Healthy Kids Canada Report Card on Physical Activity for Children and Youth, pages 326–327)

Supporting Physical Activity Objectives: To list the three requirements of effective adult role modelling for children’s physical activity. (LO 3, 4) To describe the range of benefits to children from physical activity. (LO 1, 3, 4) To identify physical activity guidelines embedded in a play-based program. (LO 2, 3, 4) To list and define types of motor skills. (LO 4) To discuss educator considerations in promoting physical activity for each age group. (LO 2, 3, 4, 6) To discuss curriculum guidelines for each age group. (LO 3, 4) To discuss the reasons for and the elements of an outdoor play environment that supports physical activity. (LO 3, 4) To list and discuss benefits to greening the outdoor environment. (LO 1, 3)

6-18

•

(T or F) Children who shy away from the more vigorous and competitive activities tend to find more options to be physically active in a green play space.

•

Answer true or false to each of the following statements about motor skill development: o (T or F) A rudimentary (simple) phase starts around two years old. o (T or F) Nonlocomotor skills involve moving the body in one place, such as bending and balancing. o (T or F) Motor development starts with small motor skills, followed by large motor skills. o (T or F) Locomotor skills involve moving the body from one place to another. o (T or F) The sports-related movement phase begins around four years old.

•

Manageable risk is part of building ________________ in oneself. (answer: confidence)

•

Some children view a challenge as a task to be ______________, while others __________ a challenge with doubt that they can overcome it. (answer: mastered; avoid)

•

It is the __________ role to support developmental needs and skills, while keeping ______________ as safe as necessary in taking and managing risks. (answer: educator’s; children)

•

Identify the statement below that is not a requirement for role modelling physical activity to children: a. Understand the development and health risks of inactive lifestyles. b. Understand the barriers that adults and children are experiencing in maintaining their involvement in physical activity. c. Understand the importance of indoor physical activity for children’s long-term lifestyle. d. Understand the importance of outdoor physical activity for children’s long-term lifestyle.

•

When implementing physical activity on a one-to-one basis with an infant, which statement is false? a. Follow the infant’s lead in your interactions.

6-19

b. Use favourite toys whenever possible. c. Compare the infant’s development with that of another child. d. Begin when the infant is alert and willing. e. None of the above statements are false. •

When implementing physical activity with toddlers, which statement is false? a. Ensure that the toddlers are expected to stay involved with the activity you are facilitating. b. Ensure that the toddlers’ physical activities are embedded in play, not in a structured time of day. c. Incorporate the concepts that toddlers are discovering, such as more, big, up, and down. d. Focus on what is familiar to the toddlers, ideally integrating ideas from their families. e. None of the above statements are false.

•

When implementing physical activity with preschoolers, which statement is false? a. Adult-guided activities can include games that help preschoolers learn when to stop and listen to the leader. b. Introduce new physically active games with patience so that preschoolers have time to practise and master new skills. c. Whenever possible, educators should provide preschoolers with access to outdoor play spaces. d. Educators consider preschoolers’ natural activity patterns, which are typically spontaneous and intermittent. e. None of the above statements are false.

•

When implementing physical activity with school-agers, which statement is false? a. Educators encourage cooperative games with school-agers while trying to keep competition to a minimum. b. Most school-agers are not ready to problem solve the rules of games. c. When school-agers are involved in active play, the need for the educators to facilitate the activity is minimal or not at all. 6-20

d. Educators can introduce school-agers to a range of physical activities to promote lifelong wellness. e. None of the above statements are false. •

Which of the following statements is false in regards to greening an outdoor environment? a. Exploring nature is a joy that should be a right for every child. b. Natural, moveable materials, such as sand, sticks, leaves, and stones, promote imaginative play. c. Natural, moveable materials, such as sand, sticks, leaves, and stones, promote physical activity. d. A green outdoor environment offers fewer options for children of varying needs and abilities than a non-green space. e. None of the above statements are false.

•

The likelihood of broken bones or head and internal injuries from playground equipment is minimized when a. the equipment is developmentally appropriate b. protective surfaces are adequately maintained c. children use the equipment properly

6-21

d. educators actively supervise children’s activities e. all of the above •

For each of the four (4) components listed below, give two (2) considerations to effectively embed physical activity into a play-based program (refer to Physical Activity Guidelines, text page 334). Development

1. 2.

Educator/Curriculum

1. 2.

Safety/Environment

1. 2.

Family/Community

1. 2.

•

Give one example of what an educator can do within the environment to support the practice of the skill observed: The infant pulls herself to standing using a sturdy table.

The toddler repeatedly kicks and runs after a large, soft ball on the grass.

The preschooler gallops with her friend around the perimeter of the playground.

The school-ager dribbles the basketball and throws it to his friend.

6-22

•

For each of the following developmental domains, list the specified number of benefits of outdoor play for all children (refer to Table 6.2, text page 348): Physical

1. 2. 3. 4. 5.

Cognitive

Emotional

1. 2.

Social

Cultural

•

Motor development follows two fundamental principles: _______________________ and _________________________________________________________________. (answer: refer to text page 337)

•

You are working with a group under two years old. List five (5) skills that fit into their developmental range. (answer: refer to Table 6.1, text page 338)

•

You are working with a group of two- and three-year-olds. List five (5) skills that fit into their developmental range. (answer: refer to Table 6.1, text page 338)

•

You are working with a group of four- and five-year-olds. List five (5) skills that fit into their developmental range. (answer: refer to Table 6.1, text page 338)

•

You are working with a group of six- and seven-year-olds. List five (5) skills that fit into their developmental range. (answer: refer to Table 6.1, text page 338)

•

You are working with a group of eight- and nine-year-olds. List five (5) skills that fit into their developmental range. (answer: refer to Table 6.1, text page 338)

•

List six (6) of the benefits children gain from physical activity. (answer: refer to text page 333)

•

What are five (5) elements in an outdoor play space that optimize the infants’ and toddlers’ experience? (answer: refer to text page 347)

6-23

•

A study by Evergreen Canada found that children want outdoor spaces that include a number of features. List three (3). (answer: refer to text page 350)

•

Give three (3) examples of how educators can provide opportunities for risky play. (answer: refer to text page 353)

Supporting Healthy Eating Habits Objectives: To identify the primary benefits of the NutriSTEPÔ preschool nutrition screening tool. (LO 2, 3, 5) To identify reasons why there may be concerns about children’s under- or overeating and appropriate responses. (LO 1, 2, 5) To explain the concerns about children’s consumption of carbonated drinks (pop) and ways to promote healthier beverages. (LO 3)

•

(T or F) NutriSTEPÔ is administered by parents or educators, and it takes a considerable amount of time to complete.

•

(T or F) NutriSTEPÔ focuses on nutrition risks for preschoolers, identifying children who should be seen by a dietitian as a prevention strategy.

•

(T or F) Drinking one (1) can of pop a day for a year results in the consumption of 15 kg of added sugar.

•

(T or F) The regular consumption of carbonated drinks contributes to the nutrient needs of growing children.

•

(T or F) Heavy consumption of pop and other nutrient-poor beverages pushes numerous minerals, vitamins, and dietary fibre out of the diet.

•

Ways that educators can promote healthy beverages in the ECLC program would not include a. encouraging children to drink water when thirsty b. making it clear with your pizza lunch and pop fundraisers that this is an exception c. ensuring that nutrition policies include food and beverages brought into the setting for celebrations d. role modelling healthy beverage choices 6-24

e. sharing information about healthy beverages with families on bulletin boards and other venues •

Identify observations of children’s patterns that may suggest why a child is overeating (i.e., gaining weight resulting in obesity): a. chooses foods that are low in fat rather than higher-fat foods b. participates fully in physical activity c. eats because of emotions (e.g., boredom, comfort) d. b and c only e. a, b, and c

•

What is/are observation(s) of children’s patterns that may suggest why a child is undereating (i.e., losing weight and not growing in height)? a. level of physical activity uses more food energy than they are eating b. not active, resulting in lack of appetite c. eats less than the recommended daily servings, especially from milk products and meat and alternatives food groups, resulting in not getting enough fat d. a and b only e. all of the above

•

Dieting or restricting food: a. can produce a vicious cycle of unhealthy eating patterns b. is appropriate for adults but not for children c. contributes to a lowered basal metabolic rate, slowing down bodily functions d. a and c only e. a and b only

•

One caution with regard to young children’s consumption of foods from the grains and fruits and vegetables food groups is: __________________________________. (answer: balance their fibre needs with their need to take in enough calories)

•

Concern about the link between heart disease and some forms of cancer with certain types of fats has prompted Health Canada to recommend monitoring intake of ____________________. (answer: saturated fats)

6-25

•

A message that is true of all aspects of healthy active living is very evident when it comes to carbonated drinks: _____________________________________________ ____________________________________________________________________. (answer: prevent children’s daily intake of carbonated and other low-nutritive drinks at an early age; it is much more difficult to change unhealthy habits than to form healthy ones)

•

Healthy drinks for children include _______________ and ______________. (answer: milk products (whether cow based or soy); tap water)

•

What is the primary benefit of administering a nutrition screening tool with preschoolers? (answer: determine parental control over feeding; identify children who should be further assessed and treated by a dietitian before they have problems; refer to text page 356)

•

Elaborate on “how” pop is a leading contributor to poor oral health. (answer: high acidity–phosphoric acid causes tooth decay (even from sugar-free drinks), and drinks with sugar (high-fructose corn syrup) make the impact even more severe. The acid in regular or diet pop starts to dissolve tooth enamel in only 20 minutes.)

•

Elaborate on the impact pop and other low-nutritive beverages can have on bone health. (answer: calcium needs are very high in childhood and adolescence, building bone density before adulthood, when bone mass begins to deteriorate. Children and youth often replace calcium-rich beverages such as milk with pop, affecting bone mass and increasing the risk of future osteoporosis. Replacing milk with pop also means that children may be losing out on much-needed vitamins A and D and riboflavin.)

•

Give two (2) reasons why dieting is not a healthy practice. (answer: doesn’t provide body with daily nutrient requirements; doesn’t contribute to positive self-esteem; lowers basal metabolic rate; child feels deprived and centred out)

•

List and describe two (2) reasons why children may be temporarily eating a lot of food. (answer: growth spurt; enjoy eating at a particular time of day; don’t have access to a lot of food at home; refer to Concern about Amounts of Food Eaten, text page 357)

Impact of Screen Time on Healthy Active Living Objectives: To describe the range of concerns regarding children’s excessive screen time. (LO 2, 3) To identify the link between screen time and sleep. (LO 3) To identify the link between screen time and eating. (LO 3) 6-26

To discuss the educator’s role and list strategies with regard to screen time for children. (LO 3)

•

Answer true or false to each of the following statements about screen time: o (T or F) Having a TV in the children’s bedrooms is a strong predictor of being overweight, even for preschoolers. o (T or F) Unlike adults, children are not at risk of developing carpal tunnel damage from using computers. o (T or F) The role of parents and educators in supporting children to become media literate is very important. o (T or F) Activating parental controls on computers and TVs replaces the need for adults to be involved with what the children are viewing. o (T or F) A child’s use of instant messaging, blogging, and chat rooms on the Internet supports the child’s connection with others.

•

Identify whether each statement below is true or false with regard to Active Healthy Kids Canada’s (2013) official position on active video games (also called exergames): o (T or F) Active Healthy Kids Canada recommends active video games as a strategy to help kids be more physically active. o (T or F) Playing active video games does not lead to increased overall daily physical activity levels. o (T or F) Active video games may get heart rates up, but they are not significantly helping kids get to the 60 minutes of MVPA required each day. o (T or F) Active video games do not offer the fresh air, vitamin D, connection with nature, and quality of social interactions that come with outdoor active play. o (T or F) Kids find active video games appealing, and the appeal does not wear off over time, so children stick with these games.

•

The Canadian Paediatric Society’s (2012) recommendations on screen time include which of the following? o (T or F) Children’s cognitive and psychosocial development is negatively impacted by too much screen time.

6-27

o (T or F) Children 0–4 years old should be limited to less than one hour per day of screen time. o (T or F) The Canadian Paediatric Society supports Canada’s activity guidelines for children 5 and older, limiting screen time to less than two (2) hours a day, including their smart phones. o (T or F) Encourage children whose screen time exceeds two (2) hours a day to progressively increase that time. •

Studies on TV viewing habits found the following: a. Children who watched more than one (1) hour of TV each day were five (5) times more likely to be overweight than those who did not watch TV. b. Having a TV in the bedroom is not a predictor of being overweight. c. Children can develop musculoskeletal problems from extended time watching TV and using the computer. d. None of the above statements are true.

•

When the ECLC program is going to show children an appropriate and relevant movie or TV show, what is not a good practice? a. To help the children focus on what they are watching, make the room dark. b. Set up the TV or monitor in an area where children can move in and away from what is being viewed. c. Provide children with other quiet activities nearby that will not disrupt those watching. d. Provide opportunities during a longer show for children to get up and stretch. e. All of the above are recommended practices.

•

Which of the following suggestions should not be considered when offering TV and computers in a preschool or school-age curriculum? a. Educators observe which children tend to choose computer time over more physical activities and, as a result, encourage those to be more active during the day. b. Avoid programming movies and TV shows into the weekly schedule. c. Have a separate area available where the computer is set up. d. All of the above suggestions are appropriate. 6-28

•

Children under the age of ________ should not have access to computers or TVs in the ECLC program. (answer: two)

•

List three (3) concerns about Canadian children having excessive screen time. (answer: increase in obesity; less physical activity; negative effects on postural development; undeveloped social skills; early screen time results in an increase in screen time/day as the child ages; more likely consumption of high-fat, high-energy snack foods)

•

List three (3) of the Canadian Paediatric Society’s recommendations to parents regarding screen time. (answer: refer to text page 367)

•

List two (2) recommendations made by Active Healthy Kids Canada (2013) regarding the use of active video games (also called exergames) by children. (answer: active video games are a good way to break up sedentary time (e.g., sitting on the couch) but not as good as playing real active games or sports; while parents can certainly play active video games with their kids and let them enjoy playing these games with their friends, they should understand that the games are not a replacement for real physical activity; if money is spent on active video games as a means of exercise, it might be better spent on skipping ropes, balls, ice skates, or other sporting equipment; in kids with developmental delays, movement challenges, or injuries, active video games can be used to help teach motor skills, improve movement, and rehabilitate.)

6-29

HERE’S THE ANSWER—WHAT’S THE QUESTION? Here’s the answer. body mass index (BMI) moving the body in one place, such as bending, stretching, twisting, swinging, rolling, and balancing release tension, have fun, learn social skills, build self-esteem, develop skills healthy eating and physical activity

What’s the question? What tool is often used to assess the prevalence of overweight and obesity? What are examples of nonlocomotor skills? What are some benefits of physical activity? What does the term “healthy active living” mean? What are examples of manipulative skills?

throwing, catching, kicking, trapping, striking, volleying, dribbling, bouncing, rolling (object), and punting individuals who move with competence and What does it mean to be “physically confidence in a wide variety of physical literate”? activities in multiple environments that benefit the healthy development of the whole person time spent at the computer should be limited; What are two (2) suggestions that educators exclude programming movies and TV should consider when providing watching into the weekly schedule preschoolers and school-agers with access to screen time in an ECLC program? any form of “human-powered” What does the term “active transportation” transportation mean? promote and support healthy habits from an What are opportunities for educators to early age; participate in advocating for contribute positively to children’s health? change from the local to global level 0–4 years old and 5–11 years old What are the age ranges for the children in the Canadian Physical Activity Guidelines? develop their endurance, flexibility, and What are three (3) components of physical strength activity for children? encompasses all the physical structures and What does a “built environment” mean? elements of the human-made environments in which we live, work, travel, and play divide the total grams of carbohydrates by 4 How do you calculate how many teaspoons of sugar are in a beverage? a variety of different practices and habits What does it mean to have good “sleep that are necessary to have good nighttime hygiene”? sleep quality and full daytime alertness 1 to 2 hours each day What is the maximum recommended number of screen time hours/day for preschoolers? exploring nature is a joy that should be a What does greening the outdoor right in childhood; there is a societal need to environment mean? make this right a reality 6-30

the rapidly expanding science that may have What does the term “epigenetics” mean? a key to one of the complex factors involved in the quick rise of obesity over the past 30 years

6-31

BENEFITS OF OUTDOOR PLAY

6-32

Questions related to the Risky Play presentation on NELSONstudy. Outdoor Play in Early Childhood Settings in the Provinces and Territories (SLIDE DECK) Questions A. OUTDOOR PLAY DEFINED: (SLIDE 3) 1. The main purpose of outdoor play is to allow for: louder and bigger actions, greater sensory stimulation, risk taking, testing of physical limits, and exploration in a more meaningful way than in a controlled indoor setting.” Which 2 of the 5 purposes listed above would you consider most important and why? 2. Outdoor play Includes “running, climbing and imaginative and creative play including constructive, symbolic, self-focused/looking on, and talking. REFERENCE: (Peterborough Public Health, Outdoor Playspaces: An Evidence Review, 2017)

With regard to outdoor ‘imaginative and creative play’, give one specific example for each of the following age groups: AGE

EXAMPLE OF OUTDOOR ‘IMAGINATIVE AND CREATIVE PLAY’

2 and 3 year olds: 4 and 5 year olds: 6 and 7 year olds: 8 to 10 year olds:

B. TYPES OF OUTDOOR PLAY (SLIDE 6) (1) Nature play: (2) Unfettered play (3) Risky play:

(4) Structured play

6-33

_________ “Organized activities including sport”. (Peterborough Public Health, 2017) (4) _________Excitement, exhilaration, a desire to overcome fear and to feel “out of control”. (3) _________Play within the diversity of the natural environment offering biodiversity, topographical diversity, and playscape habitat diversity. (Louv, 2005) (1) _________Free outdoor or unstructured play: (2)

C. ELEMENTS OF RISKY PLAY (SLIDE 7) •

Great heights

•

Great speed

•

With tools

•

Near dangerous elements

•

Rough and tumble

•

Where a child could ‘get lost”

In order to have more info about the 6 elements of risky play, take 5 minutes to go through the link below, including a 2-minute video with Dr. Mariana Brussoni, renowned for knowledge and research regarding risky play. Which of the 6 elements do you think of as most relevant for educators and why? https://outsideplay.ca/

RISKY PLAY VERSUS HAZARDOUS PLAY: (SLIDE 7) Adults manage ______________ (the hazards) ____________ (the risks)

Children manage

(Sandseter 2007)

D. PROMISING PRACTICES (SLIDE 38) identifies the following 4 statements. For each statement, give a specific example: PROMISING PRACTICE

6-34

SPECIFIC EXAMPLE

1. Increase amount of time outside – anything done inside can be done outside. 2. Schedules are made to change. 3. Add loose parts and natural elements ** 4. Identify and use resources, to support engagement in active outdoor play.

6-35

UNIT

Safety Promotion

CONTENTS CLASSROOM ACTIVITIES AND DISCUSSIONS..........................................................................2 Critical Thinking...................................................................................................................................... 5 First (refer to text page 404) ...................................................................................................................... 5 Second (refer to text page 415) ................................................................................................................. 5 Third (refer to text page 419) .................................................................................................................... 5 Assess Your Learning .............................................................................................................................. 6 Resource Materials for Teaching............................................................................................................. 9

ANCILLARY MATERIAL ..........................................................................................................10 Tips for Stroller Safety .......................................................................................................................... 10

ASSIGNMENT IDEAS .............................................................................................................10 TEST QUESTIONS ..................................................................................................................12 The Five W’s of Safety .......................................................................................................................... 12 How Can We Promote Children’s Safety? ............................................................................................. 16 What’s the Rest of the Story? ............................................................................................................... 21

HERE’S THE ANSWER—WHAT’S THE QUESTION? ...............................................................28 WHAT WOULD YOU DO IF …? ..............................................................................................30 COMMON CAUSES OF INJURY OR DEATH ...........................................................................31 PROTECTIVE SURFACES ........................................................................................................32 ENVIRONMENTAL CONTAMINANTS: CONSEQUENCES AND HEALTH PROMOTION ACTION PLAN .....................................................................................................................................33

7-1

Classroom Activities and Discussions Here’s the Answer—What’s the Question? (see handout, page 7-27) Anticipating injuries: Since anticipating injuries is an important skill in injury prevention, set up scenarios for small-group discussions, which students can then come back to the larger group and share. You can create them or ask students to write scenarios and pass them on to you (see What Would You Do If …? handout, page 7-29). Riding toy safety: Create a checklist for educators to use when children are using riding toys. Have them consider supervision and design issues, and how these two factors can reduce the need for rules. Protective surfaces: •

Provide students with a copy of Protective Surfaces (see handout, page 7-31).

•

In pairs, have one student select one surfacing material, and the other student a different surfacing material.

•

Have them complete the advantages and disadvantages for their choice.

•

Have the pair select, if possible, the best choice based on the material’s qualities and your geographic location.

•

The students would need to have full access to the current edition of Children’s Playspaces and Equipment by the Canadian Standards Association (see Resource Materials for Teaching, page 7-9). Unfortunately, this document is no longer provided free of charge.

Stroller safety: Create a checklist for educators to use to inspect the strollers used in the program (see Tips for Stroller Safety handout, page 7-10). Environmental contaminants: •

Provide copies of Environmental Contaminants: Consequences and Health Promotion Action Plan to small groups of students (see handout, page 7-32).

•

Students use text on pages 444–459.

•

15 minutes: Complete the handout, and then discuss in class.

Common causes of injury or death:

7-2

•

Provide students with a copy of Common Causes of Injury or Death (see handout, page 7-30).

•

Divide the class into groups of three or six.

•

Each student in the group will take one of the six (2 of 6) causes of injury or death.

•

Select two common risks for their assigned cause. For each risk, include the age group(s) that are most impacted by the risk, and include two prevention strategies that are applicable for the identified age group(s). This should take approximately 10–15 minutes.

•

You will determine how you want the members of each group to share their findings with one another in the small group.

•

Objectives: To list and describe injury prevention strategies for each of the main causes of injury. (Another objective is for the students to become more familiar with Tables 7.1–7.7.)

Supplement your lecture with: •

Table 5.4 Materials for Arts and Crafts in Well Beings (2015), page 69.

•

Environmental contaminants: o The user-friendly “Checklist for Creating Healthier, Greener Child Care Settings” (page 9) in Advancing Environmental Health in Child Care Settings: A Checklist for Child Care Practitioners and Public Health Inspectors (see Resource Materials for Teaching, page 7-9) is an excellent checklist for discussion about promoting environmental safety of children in ECLC settings. Sections in the checklist include indoor and outdoor air quality, cleaning and disinfecting, and activity, learning, and play areas. Each section has interesting items for discussion, which would help students understand the “why” of specific practices. In preparation for this class, you may want to read the additional information about each section later in the document. For example, for the section “Kitchen and Food Preparation Areas” (pages 46–52), here are some of the items listed and backed up with information on “why” and resources: G1 a. We flush water pipes each morning (or less frequently as specified by local/ provincial authorities) to reduce lead levels in drinking water. b. For drinking and/or to prepare food or drinks, use water from cold water tap. G2 We do not heat food or drinks in, or put hot food or drinks into, plastic containers. G3 We serve low-mercury fish. G5 We avoid cooking at very high temperatures when using non-stick cookware coated with perfluorinated chemicals (PFCs).

7-3

G7 a. We run the dishwasher only when children are not in the kitchen. b. There is good ventilation in the room when the dishwasher is running. c. We avoid opening the dishwasher until the dishes are cool to the touch. G8 a. We employ strategies to reduce the likelihood of pest problems. b. If a pest problem occurs, we select the least toxic method of eradication. These and many other areas and items have lots of potential for in-class discussion—for example, Do they see benefits of the practices to children’s (and their own) health? What may be some considerations (e.g., time, costs, etc.)? Research shows that helmets have been proven effective in preventing head injury from all types of falls and crashes. With this information, what is your opinion on whether and how to translate that important safety information into ECLC programs? Are there particular activities that warrant helmet use? What are potential challenges, and how can they be solved to create safer programs and start young children on lifetime safety practices? Suggestions: Research the helmet regulations in your province/territory; school-age programs where children ride their bicycles between the school and ECLC programs enforce the use of helmets; ideally all children on wheeled toys will wear helmets at all times as recommended by the Canadian Paediatric Society (possible fundraising opportunity to have a helmet for each child in the program); support families with gaining access to information and helmets for their children to wear at home; organize a family education session on helmet use and possibly have an expert who can evaluate the proper fitting of the helmets on the children and parents; advocate for a discount at a local business to purchase a quantity of helmets; visit Parachute’s website at http://www.parachutecanada.org/; refer to Well Beings (2015) for additional recommendations on riding toys and tricycles (pages 74–76), sledding (page 80); activities that merit helmet use are all wheeled toys including skateboards, scooters, and inline skates, along with sledding, skating, ice sports, and skiing; potential challenges: cost of helmets, supervising the younger children who are moving off and on riding toys frequently, plus helmets are unsafe on playground equipment. School-agers on the playground are inundated with a long list of rules and often feel that they have no autonomy. Many children are trying to feel more powerful by deliberately breaking rules when educators’ backs are turned. Suggestions: Recognize that their program is not child-centred and identify needed changes; school-agers will enjoy and benefit from their involvement in the program review and will gain a real sense of control; review rules, referring to Whose Need for Control? (text page 420) and Guidelines for Safety Rules (text page 421); educators should be provided with books and resources specifically on school-age curriculum and program development, and opportunities to attend workshops on school-age child care; network with other school-age programs. 7-4

Critical Thinking First (refer to text page 404) Ten-month-old Jared is learning to climb. He is particularly fond of climbing on the box that covers the heat radiator in the playroom. On one attempt, he falls backward onto his bottom and bangs his head on the floor. How could you have prevented this injury? Suggestions: The child needs opportunities to practise and increase his skill, and for some time this love for climbing will be the focus of his day; keep in mind that we must always assume that a child can do something today that she or he couldn’t do yesterday; educators need to incorporate child development into the planning of the play environment; if they had done so in this scenario, the injury could have been anticipated and possibly prevented by redirecting him to safe climbing materials in the play area (e.g., soft foam blocks, low ladder-slide apparatus with a mat for the impact-absorbing surface). Second (refer to text page 415) One winter day, eight-year-old Joanna is playing on the climber in the school playground. The protective surface under the climber is covered with ice. Her hands slip from the rungs, and she falls to the ground. She is admitted to the hospital’s emergency department with a broken arm. Her friend Michael had to run to tell an educator that Joanna was lying on the ground. What risks should have been identified? How could Joanna’s injury, and other injuries, have been prevented? Suggestions: The daily outdoor safety check should have identified the ice as a risk and should do so in the future; the climber should be closed until the ice can be broken up and removed, and the sand underneath worked up to be an effective cushioning material (frozen sand is a hazard), or the climber should have been closed until the spring thaw; since a child had to run to get an educator after the injury, it is apparent that the children using climbing equipment weren’t adequately supervised; in the future, an educator must be assigned to supervise the climber during use. Third (refer to text page 419) On a field trip to the zoo, a group of 24 preschoolers and 3 educators take time out to use the small playground. While there, 2 children crash into each other and another child is hit by someone on the swing. What can you learn from this scenario? What would you do differently next time to prevent injuries? Suggestions: There were not enough adults for this field trip; a 1:8 ratio is inadequate when preschoolers are in unfamiliar surroundings, both from a safety and education perspective; all 24 children should not have been using the playground at the same time; instead have one small group use it while the others have a rest and snack, and then rotate; question of whether the educators conducted a safety check of this new playground first to determine if it was developmentally appropriate and well maintained; in writing, educators need to notify the party responsible for this Copyright © 2019 by Nelson Education Ltd.

7-5

playground as soon as possible to make them aware of the situation, which should prevent further injuries of other children; in the review of the field trip, these injuries should be noted in order for staff to determine what will need to be done on future field trips, if any, to this destination.

Assess Your Learning Evaluate your options in each situation. 1.

The daily routine usually ends with outdoor play, and parents pick up their children from the playground. Children need active supervision on equipment, but parents also need the opportunity to speak with an educator about their child’s day. Suggestions: It’s important for the educators to talk with the director about the difficulty in time management at pickup time; both effective communication between parents and educators and adequate supervision should be program priorities and, as such, the following options can be considered: hire an extra staff member for additional supervision at the end of the day, which frees up educators to talk with parents, or arrange for a volunteer or ECE student to be part of the program, but remember that the student needs to receive as much as he or she gives, since the individual is there to learn and must not be used, and that nonstaff can’t be left alone with children; if only one educator is in the centre near closing, then she or he will have to be able to keep an eye on the volunteer/student while talking with the parents.

A new climber on the playground is designed for safe use by preschoolers and school-agers, and the sand underneath is regularly maintained. In addition, there is always adequate staffing to follow regulations. Safety rules for children are developed to foster safety and respect for themselves, property, and peers. Using the criteria discussed in the unit, consider examples of rules that could be appropriate for (a) preschoolers [Pre] and (b) school-agers [SA]. Suggestions: There should be no more than three (3) rules for each of the age groups; some are repeated here to illustrate their appropriateness for rule-setting criteria. •

Consider children’s development. Pre: Remember to keep your legs in front of you when you slide. SA: You may climb up the slide when only the school-agers are on the playground.

•

State rules in positive terms. They should focus on what children can do rather than what they can’t do. Pre: Remember to keep your legs in front of you when you slide. SA: When you slide down the firefighter pole, it is safer for everyone, instead of jumping from the slide platform. Then you can also shimmy up the pole again!

7-6

•

State rules in clear and simple language, especially those for younger children. Pre: Go up the ladder one preschooler at a time. SA: Jumping from the slide platform is dangerous. You can slide down the firefighter pole.

•

Make sure rules are realistic, with enough freedom to encourage creative play, but enough restrictiveness to prevent unsafe behaviour. Pre: The monkey bars are great to hang and jump from. Just look down before you jump to make sure no one is underneath. SA: You may climb up the slide when only the school-agers are on the playground (i.e., the restriction is when preschoolers are also outside, climbing up the slide can result in a “collision” with preschoolers coming down).

•

Enforce rules consistently using gentle reminders and positive acknowledgment when children follow them. Pre: Last time you jumped from the monkey bars, I reminded you that you didn’t look down to check first. This time you did check! That makes it safer for you and your friends. SA: I am reminding you that jumping from the platform at the top is dangerous. You can slide down the firefighter pole. (If a child continues to jump from the platform, remind her or him: If you jump from the platform again, you will need to leave the climber for the remainder of playground time.)

3. The winter has been extremely cold and windy, yet a number of the school-agers are not wearing their boots and hats because “it’s just not the thing to do.” Before and after school, the children have a choice between staying in and going out to the playground. These same children choose to stay indoors. Some haven’t played outside all month. Suggestions: Consider the following: if these children go outside during recess and lunchtime, then going out again may not be a priority; if educators wear appropriate winter apparel, it is developmentally appropriate for school-agers to want to be “in” with their peers and define themselves as members of a group, but they are also ready to accept responsibility for some aspects of self-care and don’t want to be treated like babies; with the popularity of snowboarding has come trendy hats that are worn, so perhaps these children will be more willing to wear a hat that is popular with their peers than “old-fashioned toques”; plan some outdoor activities where everyone is expected to participate, which may encourage children to dress warmly; if they won’t wear them, they are to carry their gloves/hats with them so that if they finally get too cold, they can put them on; as for boots, many children and adults will only wear shoes or athletic shoes—try an extra pair of socks; if an activity is planned where there is going to be deep snow, insist on winter boots (e.g., a sleigh ride). Copyright © 2019 by Nelson Education Ltd.

7-7

4. You are on a long summer walk with the preschoolers before lunch and suddenly you remember that none of you are wearing sunscreen. Suggestions: At the very least, you and the children are wearing hats and clothing that cover a good portion of skin; choose a route that has shade from trees or buildings; try to find a shortcut back to the centre; educators should develop a system to ensure that sunscreen is not forgotten again; for example, review the “things to do before walks checklist” by the door, and routinely keep a bottle of sunscreen in the knapsack taken on walks so you can reapply as needed, along with the first-aid kit. 5. The carpeting in the play area of the infant room needs a good cleaning, and your director wants to have it professionally cleaned. You and your room partner are aware of the environmental toxins, not only from the chemical cleaners but also from the carpet. The infants crawl around on it daily, with ongoing exposure. Suggestions: •

Carpet cleaners can contain o known human carcinogens (e.g., perchloroethylene), which can have immediate central nervous system (CNS) effects including dizziness, sleepiness, nausea, tremors, and disorientation, as well as long-term CNS effects. o CNS toxins (e.g., butyl cellosolve). o eye, skin, and respiratory irritants such as propylene glycol methyl ether. o detergents that can irritate skin, as well as ammonia and fragrances.

•

Is a deodorizer used to cover odours? Most deodorizers rely on chemicals to cover up, overpower (heavy fragrance), or deactivate odours. Some deodorizers block the nerves in people’s nasal passages so that they cannot smell the odour. Instead of relying on chemicals, the key to dealing with odours is to remove the source of the odour or to dilute it.

Other points to consider with the use of carpets in infant rooms:

7-8

•

Educators, parents, and walking infants change to indoor footwear (or shoe covers) before entering the room. Many substances, such as pesticides and animal droppings, are tracked into indoor spaces on shoes and boots.

•

Damp areas that do not dry within 24 hours may grow mould.

•

Although other floor coverings that are low-emitting and easy-cleaning may be a better option, carpeting may still be the best alternative for a number of reasons (promotes child safety by protecting against slips and falls; resilient padding when infants do tumble; a warm, cozy surface for playing on the floor; and can improve room acoustics). If there is a decision to replace the old carpeting, ensure that new carpeting has the green IAQ (indoor air quality) testing label. This label indicates that the product is low-emitting.

Resource Materials for Teaching Advancing Environmental Health in Child Care Settings: A Checklist for Child Care Practitioners and Public Health Inspectors (2010), Canadian Partnership for Children’s Health and Environment. To download the PDF, visit http://www.healthyenvironmentforkids.ca/sites/healthyenvironmentforkids.ca/files/CPCH E-AdvEnvHealthChildCare-lowres.pdf Best Start Resource Centre: http://en.beststart.org/ (Resources—Environmental health) Canadian Partnership for Children’s Health and Environment (search “child care sector”): http://www.healthyenvironmentforkids.ca/ Children’s Playspaces and Equipment (2014), Canadian Standards Association CAN/CSA-Z614-14: https://store.csagroup.org/ccrz__ProductDetails?viewState=DetailView&cartID=&sku=C AN/CSA-Z61414&isCSRFlow=true&portalUser=&store=&cclcl=en_US&gclid=EAIaIQobChMIpobbte yI3QIVirbACh0_UA-KEAAYASAAEgJhUvD_BwE Field Trip and Activities off Premises Policy for Lab Schools (June 2017), George Brown College, School of Early Childhood: https://www.georgebrown.ca/childcare/field-trippolicy.pdf Outdoor Playscapes: Breaking New Ground (2014) by Lynn Wilson. Toronto: Nelson Education Ltd. Parachute: Preventing Injuries. Saving Lives website: http://www.parachutecanada.org/ Radon: What You Can Do—Reduce the Risk of the #1 Cause of Lung Cancer in Nonsmokers (March 2017), by CPCHE & CCCF (for child care professionals): http://www.healthyenvironmentforkids.ca/sites/healthyenvironmentforkids.ca/files/Radon forChildCareProfessionalsEnglish.pdf Radon: What Child Care Professionals Can Do, by CPCHE: http://www.healthyenvironmentforkids.ca/collections/radon-what-child-careprofessionals-can-do Copyright © 2019 by Nelson Education Ltd.

7-9

Ancillary Material Tips for Stroller Safety •

Never leave a child unattended in a stroller.

•

Always use the safety harness and crotch strap.

•

Always use the brake when putting a child into the stroller or taking him or her out.

•

Never park a stroller on a sloping surface, such as a driveway or hill.

•

Before adjusting the stroller (e.g., reversing the handle), make sure a child’s hands and feet are clear.

•

Do not carry more than one child unless the stroller is specifically designed for it.

•

Some strollers have baskets underneath for extra storage. Follow the manufacturer’s guidelines for maximum weight.

•

Do not hang bags or other items from a stroller. The extra weight can cause it to tip over.

•

Make sure children don’t overheat inside a stroller with a canopy and sides. If your facility’s multi-seat stroller has no sun canopy, choose a shady route and have children wear their sun hats. Consider purchasing a sun canopy for a multi-seat stroller, provided it is made by the same manufacturer.

•

Remove a child before carrying a stroller up/down stairs and when using an escalator.

•

Don’t tip the stroller backward and prop the handles (e.g., on a chair) to create a napping spot. A serious head injury can occur.

•

Don’t use pillows, folded quilts, or blankets to cushion a carriage or stroller.

•

Don’t allow other children to play with or on a stroller.

•

Check your facility stroller periodically to make sure that the lap belt remains solidly attached and that all stroller parts are working and in good repair.

Courtesy of the Canadian Paediatric Society. From Well Beings: A Guide to Health in Child Care (Ottawa: Author, 2015), 123–124.

Assignment Ideas 1. Riding equipment: Create safety rules for biking and climbing equipment for all age groups. 7-10

2. Safety rules: Write a list of safety rules for children, stated in either a positive or negative way. Ask students to identify and then rewrite those rules that are stated in a negative way. 3. Field trip planning: Assign each group of students with a field trip destination in their community and have them provide a written plan for the field trip. They could then present their particular field trip plan to the rest of the class. Students should be asked to consider the following: •

what age group the activity is developmentally appropriate for

•

how they are going to get there

•

the adult–child ratio required

•

the length of time they will be away from the centre

•

what they will need to bring with them, for example, food, beverages, and the routine care needs of the children (e.g., diapers and changing supplies, first-aid kit, phone numbers, sunscreen, access to running water, etc.). If food is being taken, then food safety will need to be addressed.

Provide students with the field trips URLs or use resources from your area (see Resource Materials for Teaching, page 7-9). 4. Safety checklist and playground awareness: The purpose of this assignment is for students to develop their safety awareness and observation skills, not to criticize the placement. Note: Students will need a carpenter’s measuring tape during their inspections. •

Access or create an outdoor safety checklist that would be used daily by an ECLC program.

•

Provide students with this checklist.

•

During a practicum placement, have each student complete the checklist for two (or more) days.

•

Answer the following questions: o What is one of the items in the checklist that you find particularly significant? Explain why. o Does this checklist clearly itemize all the safety considerations in the playground you are evaluating? If not, what is one item that needs to be added, and why?

7-11

o Are there aspects of the checklist that could be improved upon? If so, what are your suggestions? 5. Environmental contamination: In addition to information on text pages 444–459, Advancing Environmental Health in Child Care Settings: A Checklist for Child Care Practitioners and Public Health Inspectors (see Resource Materials for Teaching, page 7-9) includes a user-friendly “Checklist for Creating Healthier, Greener Child Care Settings” (starting on page 9). This checklist provides an excellent learning experience for ECE students in promoting safety of children by addressing environmental health issues, including the reduction of potential exposures to toxic chemicals and pollutants known or suspected to pose health risks. Sections in the checklist include indoor and outdoor air quality; sun safety; cleaning and disinfecting the kitchen and food preparation area; activity, learning, play areas; and other issues. It can be used as an assignment if the ECLC programs agree to permit the student (with the supervisor’s knowledge) to go through the checklist and share it with the program’s educators. It also makes for interesting class discussions after students have completed it. 6. Climate change: For each of the seven signs of climate change listed in the text (pages 450–451), provide an example (not in the text) that illustrates each sign of change. 7. Radon: •

In addition to the information on radon in the text (pages 452–454), provide the students with radon resources (see Resource Materials for Teaching, page 7-9).

•

What would you do as the director of an ECLC program when the concern about radon in the facility is raised? o Long-term exposure to high levels of radon causes lung cancer. o Schools and child care environments can have high levels of radon. o Children and staff should be protected from this preventable risk.

Test Questions The Five W’s of Safety Objectives: To describe the nature of childhood injuries and factors that increase risk. (LO 1, 4) To list and describe injury prevention strategies for each of the main injury categories. (LO 4, 5, 6)

7-12

•

(T or F) The term “accident” is used rather than “injuries” because most of the time they are due to fate.

•

(T or F) Injuries are the leading cause of death for Canadian children.

•

(T or F) ECLC settings are designed to be risk-free environments for children.

•

(T or F) Suffocation is the number one cause of injury-related deaths for children under one year old in Canada.

•

Which of the following statements is not a reason why infants, toddlers, and preschoolers are at risk of injury? a. They have yet to learn how to control impulses and so they may be unaware of the danger they are putting themselves in. b. They are usually concerned about others’ safety rather than their own. c. They can go through rapid growth spurts and are likely to misjudge how tall they are. d. They often learn through trial and error.

•

Childhood injuries in ECLC programs (i.e., centres) are more likely to happen a. when children are tired or hungry b. due to changes in children’s social development c. in the winter, caused by ice and snow d. when the daily routine causes boredom

•

From the types of injuries that kill or permanently disable children in Canada every year, identify which combination includes the two (2) most relevant to the day-to-day life in ECLC programs: a. motor vehicle collisions; falls b. drowning; falls c. burns; drowning d. threats to breathing; falls e. falls; bicycle-related injuries

7-13

f. threats to breathing; burns •

The leading cause of injury-related death of children over one year old in Canada is a. threats to breathing b. poisoning c. motor vehicle collisions d. burns e. drowning f. none of the above

•

The term “threats to breathing” includes the following types of injuries: a. choking b. suffocation or strangulation c. entrapment d. all of the above

• In ECLC settings, children’s burns do not usually result from a. scalding by hot tap water b. soups or beverages (including burn injuries to the mouth from microwaving bottles) c. matches or lighters d. contact burns from hot metal, such as slides •

If children are understimulated, the following consequences can happen: a. They stop seeking challenges, which affects their development and self-esteem. b. They turn to their peers for stimulation, or they turn against them, which, either way, often results in antisocial and hurtful behaviour. c. They direct their natural desire for trial-and-error learning to riskier behaviour, which helps them feel invincible. d. all of the above e. a and b only

7-14

•

Children are more likely to be injured in ECLC settings when a. children are tired or hungry, or the daily routine is disrupted b. children are not fully aware of the environment, don’t know how to use play equipment safely, are excited about a new piece of play equipment, or don’t follow safety rules c. educators relax their level of supervision (e.g., while talking among themselves in the playground) d. educator–child ratios are not adequate for the activity (e.g., cooking with children, woodworking, or going for a walk or field trip) e. all of the above

•

__________ are the leading cause of injuries in ECLC programs. (answer: falls)

•

The site of the highest number of injuries in ECLC programs is the _____________. (answer: playground)

•

Children who are not physically challenged are understimulated. List the consequences that this understimulation can have. (answer: refer to text page 383)

•

Why do we not use the word “accident” when talking about children’s safety? (answer: accident implies fate, bad luck, unavoidable; most injuries, including children’s, can be prevented)

•

List three (3) situations where injuries are more likely to happen in the ECLC program. (answer: refer to When, text page 399)

•

List three (3) particular times and/or situations when injuries in ECLC programs (i.e., centres) are more common. (answer: children are tired or hungry, children are new or don’t know how to use equipment safely, educators relax supervision/don’t supervise competently, inadequate ratios, daily routine disrupted, new piece of equipment, field trips)

•

List three (3) practices of educators that can prevent situations that cause threats to breathing in ECLC programs. (answer: serve age-appropriate food; ensure safe eating behaviour; avoid having toys with pieces that can cause choking; avoid (policy) or secure clothes that can get caught on slides/climbers; either ban skipping ropes on playgrounds or ensure that they are never tied to playground equipment; ensure that children’s heads or clothing don’t get trapped in play equipment or infant equipment; students may offer other relevant examples; refer to Table 7.4, text page 389)

7-15

How Can We Promote Children’s Safety? Objectives: To identify the role of public policy in safety promotion. (LO 3) To describe the importance of education and training, including emergency training, in safety promotion. (LO 2) To identify strategies in an ongoing evaluation of the indoor and outdoor environment as primary in safety promotion. (LO 6) To view active supervision as an essential component in injury prevention and to identify the various factors that affect the level of supervision. (LO 2, 4) To clarify the limited role that safety rules play in injury prevention and describe the essential considerations in developing and adapting rules for each age group. (LO 4, 6)

•

(T or F) An appropriately designed indoor play area for preschoolers minimizes the need for safety rules.

•

(T or F) Educators should increase the number of adults supervising an activity when it is developmentally inappropriate.

•

(T or F) If educators are able to find time, they may wish to conduct a playground safety check before the children go outside.

•

(T or F) Because neither preschoolers nor school-agers are at a formal-operational level of thinking, they are not able to have a role in developing safety rules.

•

(T or F) Having four or more rules for an activity decreases the level of supervision required for children.

•

(T or F) Power struggles with children often result when they lack autonomy.

•

(T or F) Rules are the #1 way to ensure children’s safety.

•

(T or F) When an activity is developmentally inappropriate for a group of children, rules will play a significant role in preventing injuries.

•

(T or F) It’s better to have fewer rather than more rules.

•

(T or F) The sale and use of walkers is illegal in Canada.

7-16

•

Give two (2) reasons why the playground is the site of the highest number of injuries in ECLC programs. (answer: most vigorous activity and physically challenging; larger pieces of equipment; poorly maintained impact-absorbing material; insufficient encroachment areas; unmarked or unused pathways; inadequate supervision, etc.)

•

Answer true or false to each of the following statements about the role of public policy in promoting safety: o (T or F) Successful public policy makes environments safer for all children. o (T or F) Canada Consumer Product Safety Act has improved product safety for Canadians. o (T or F) Over the past 10 years, the primary reason for the reduction of childhood injury-related hospitalizations and deaths is successful public policy changes.

•

Identify which of the following is not an important component in injury prevention: a. designing a safe, physical environment b. adequate supervision of children c. developing a minimum of three (3) safety rules for each activity d. ECLC and safety training

•

Educators decide on how much supervision is necessary by considering a. the possible risks in the activity b. how developmentally inappropriate the activity is c. if they develop several rules, it will decrease the need for staff available for supervision d. all of the above

•

A positive design feature of an outdoor playground is a. a layout that provides an adequate amount of space for a large group of children to be in one spot, which makes supervision easier b. shaded areas for quieter activities c. undefined pathways d. the swings, slide, and climbing equipment are close enough together so one educator can supervise all three pieces of equipment at the same time

7-17

•

Effective safety rules a. are stated clearly, simply, and in positive terms b. limit the children’s ability to be creative in play c. are regularly reviewed, revised, and some may be eliminated d. a and c only e. a, b, and c

•

An encroachment area a. is the ground space extending under and around each piece of play equipment b. is designed primarily for the safety of those walking past the equipment c. is the depth of cushioning covering the area under playground equipment d. is the total perimeter of the playground e. none of the above

•

Which of the following is a serious occurrence in an ECLC program? a. A child goes missing for 5 minutes. b. There is a fire in a pot on the stove. c. There is an allegation that a volunteer has slapped a child. d. all of the above e. none of the above

•

Write in the number (1, 2, or 3) to reorder the following three (3) safety components according to the most to the least amount of attention educators should pay to them: Develop safety rules. Design a safe and appropriate physical layout in the play area. Provide supervision. (answer: 3; 1; 2)

•

7-18

Define the term “precautionary approach.” (answer: refer to text page 402)

•

Maintaining the playground equipment’s ____________________ will reduce the severity of children’s injuries. (answer: protective surface)

•

When children are playing outside, educators must actively _____________ the children. (answer: supervise)

•

The following four (4) components are interconnected in either causing or preventing injuries: training, _____________, _____________, and ____________. (answer: environment; supervision; rules)

•

Rather than talking among themselves in the playground, educators need to be _____________ supervising children. (answer: actively)

•

How can educators prevent children under four years old from threats to breathing? In each category listed below, provide two (2) examples of potentially hazardous items: (answer: also refer to Table 7.4, text page 389) o Food: (answer: popcorn; hard candies; gum; raisins; peanuts, seeds, nuts; fish with bones; food with toothpicks/skewers; whole wieners and grapes; hard-dried fruit; fruit with pits; chunks of raw carrots) o Toys: (answer: latex balloons; deflated helium balloons; accessories and pieces < 4 cm [1½ in.] in diameter; pull toy cords > 20 cm [8 in.] long); ensure that ropes or cords are not attached to play equipment) o Clothing: (answers: scarves; hoods; drawstrings) o Infant equipment: (answer: soother string > 20 cm [8 in.] long; bottle propping; cribs: insecure bumper pads, mattress too small, plastic wrap in mattress, crib slats too wide apart, cutouts on head and food boards, finials; accordion-style baby safety gates; playpens with side down, netting that catches clothing, torn pieces of vinyl; mobiles and drapery cords hanging too low over or in crib/playpen)

•

For each of the following pieces of equipment, list three (3) safety practices: (answer: also refer to Table 7.8, text page 406) o cribs (answer: put railing up when children are in it; remove bumper pads and large stuffed toys once child can stand; no pillows for those under 12 months old; secure drapery/blind cords out of reach; no mobiles/gyms with strings within reach when laying or standing) o high chairs (answer: never leave unsupervised; fasten safety belt; caution when sliding tray on and off not to catch fingers/hands/head; help learn that they sit in chair; secure all locking mechanisms; keep chair away from walls, appliances, etc., that the children can use their feet to push up against and rock or tip chair; keep out of reach when not in use to prevent child climbing on empty chair)

7-19

o strollers (answer: never leave unsupervised; secure all locking mechanisms; check brakes; use brakes when parked and when child is getting in and out; watch hands when reversing the handle; use safety belt; don’t overload handles with parcels; help children learn that they sit in stroller) •

Describe how the layout and furnishing of the indoor play area can prevent injuries. (answer: appropriate-sized furnishings in good condition; keep messy activities in an area that is easy to clean up to prevent slipping/falls; room arranged to discourage running and congestion; equipment is changed and added to meet the changing developmental abilities and interests of children, thus reducing the opportunities to be used inappropriately; storage areas are accessible for children to help with cleanup; quiet and exploration areas are in a place that others aren’t continually walking through; secured shelving; etc.)

•

Define an encroachment area. (answer: the amount of space extending under and beyond each individual piece of equipment; ensures safety of those using and walking past the equipment; depending on the design of the playground, each piece of equipment’s area is bordered, creating a pathway)

•

Define an encroachment area and who it is meant to protect. (answer: the ground space under and around each piece of playground equipment; it helps protect both the children using the equipment and those walking by)

•

Define protective surfacing materials. (answer: the depth of cushioning material covering the entire encroachment area; prevents or reduces the severity of injuries when someone lands on it; variety of materials used and vary in depth; must be well maintained to provide adequate cushioning)

•

Encroachment areas commonly have sand as the protective surfacing material. Describe some maintenance issues. (answer: rain-soaked sand is fairly solid to land on; packs down during use; worn tracks under swing seats; sand spills over borders onto pathways causing slipping; needles/syringes/cat feces can be found; without regular maintenance and being worked up, the sand becomes as hard as the ground, and thus the cushioning quality is compromised)

•

Involving children in the development of safety rules for activities provides them with the opportunity to develop observation skills. List two (2) other benefits to children when they participate in developing rules. (answer: learn to anticipate possible risks and consequences; understand the rationale for rules; increase their level of confidence in themselves; build decision-making skills; see the bigger picture around safety)

•

List three (3) examples of incidents that are considered serious occurrences in an ECLC program. (answer: refer to text page 403)

7-20

Call for Action: On Radon In Child Care Settings After reading the article: Call for Action: On Radon In Child Care Settings ( https://pubs.ciphi.ca/doi/full/10.5864/d2017-020 ), answer the following questions: 1. Although radon poses little risk when it is diluted in outdoor air, especially since radon is odourless, when is it a powerful form of radiation? 2. A considerable proportion of child care centres in Canada are at ground level or in basements where radon levels tend to be higher (Health Canada, 2012). Does this mean that almost all child care centres are being tested for radon levels? Why or why not? 3. “General health and safety requirements in laws governing child care licensing arguably could be used to require radon testing, and remediation where warranted, as proposed by environmental and health organizations” (Canadian Environmental Law Association et al., 2015). Do you think this is being carried through? Why or why not? 4. Future directions: “A mandatory approach is imperative to ensure child care facilities and other early learning environments are not a source of preventable lung cancer risk for both children and staff.” List the processes that can ensure safety for children and staff in child care centres across the country: (note: all answers are included in the article)

What’s the Rest of the Story? Objectives: To describe safety issues related to seasonal changes. (LO 4, 6) To discuss the principles and practices in planning and conducting field trips. (LO 6) To list the reasons why children are more vulnerable to environmental contaminants than adults. (LO 4, 6) To identify environmental concerns known to affect children’s health. (LO 1, 3, 4, 6) To be aware of situations in which child protection is a concern. (LO 2, 6)

•

(T or F) Both the sun and tanning machines have the same wavelength of light and cause the same skin damage.

7-21

•

(T or F) Pesticides are regulated by the federal government and are therefore not a concern re: toxicity for humans.

•

(T or F) Children’s skin will be protected by a sunscreen with an SPF of at least 15.

•

(T or F) Someone arrives to pick up the child from the centre, but she is not on the parent’s written list. Educators can release the child to her if the child appears happy to see her.

•

(T or F) Canada was the first country to designate bisphenol A (BPA) as a toxin.

•

Answer true or false to each of the following statements about plastics: o (T or F) There is evidence that hormone-disrupting chemicals used in the manufacturing of plastics can leak into foods and beverages. o (T or F) All plastic products intended for children’s use have undergone stringent testing before being put into the Canadian marketplace. o (T or F) PVCs used to produce plastics are difficult to destroy and are adding to our overflowing landfills. o (T or F) Burning plastics with PVCs is a better alternative than putting them in the landfills.

•

Answer true or false to each of the following statements about radon: o (T or F) Radon is a radioactive gas that comes from rock and soil. o (T or F) Radon is an outdoor air pollutant. o (T or F) Radon is invisible, tasteless, and odourless and easily seeps into buildings. o (T or F) Long-term exposure to high levels of radon is the second leading cause of lung cancer for non-smokers. o (T or F) Testing for radon levels in our homes and workplaces is expensive and difficult to carry out.

•

First-aid training equips educators with a. the necessary knowledge and skills to assist ambulance attendants b. knowing when to call 911 c. the ability to remain calm while administering basic first aid d. all of the above

7-22

e. b and c only •

Exposure to lead a. can affect a child’s brain development and nervous system, but not at low lead levels b. is almost never from paint because lead-based paint has been banned for decades c. can be reduced by using warm water from the tap rather than cold d. can be a concern many years after contamination because it can remain in the soil for decades and contaminate vegetables grown in that soil e. None of the above statements are true.

•

Educators can help children develop lifelong health habits in sun protection by a. applying sunscreen recommended for children b. wearing hats c. avoiding being outside between approximately 11 a.m. and 3 p.m. d. asking parents to provide sunglasses for children e. all of the above

•

Safety measures that can be put into place to prevent children from wandering away from the facility or a group can include a. daily attendance and regular head counts b. security system for entrance c. intact playground fence and locked gate d. developing and regularly reviewing procedures for missing children e. all of the above

•

Which of the following substances is not an indoor air pollutant? a. tobacco smoke b. carbon dioxide c. formaldehyde

7-23

d. radon e. asbestos •

Safety considerations when planning a field trip would not include a. ensuring that there is quick access to a phone when offsite b. ensuring that children know how to safely hold on to a walking rope c. ensuring that you bring the emergency contact numbers for each child coming on the trip d. bringing enough adults to ensure safety: more than the legislated minimum number of adults for the age group e. You would include all the considerations listed above.

•

Injury reports a. serve as a tool for staff in developing injury prevention strategies b. serve as a legal document to report the injury as objectively as possible c. should only be completed when a child is injured, not an adult d. need to be signed and dated e. a, b, and d

•

Another adult other than the parent arrives to pick up the child at the centre, and the staff have never met this person. You check whether this person is on the list authorized by the parent. The following statement is true: a. If the person is on the list, you will ask for identification before releasing the child. b. If the person is on the list, you don’t have to ask for identification before releasing the child. c. If the person is not on the list, but the child seems happy to see him or her, you will ask him or her for identification, write down the name, and ask the parent to add this person to the list. d. Whether the person is on the list or not, you will go with your “gut” feeling and decide whether to ask for identification or not. e. A and c are true.

7-24

•

The following health concerns have possible associations with pesticides: a. allergies b. development neurotoxicity c. indigestion d. a and b only e. a, b, and c

•

It is recommended that children and adults apply sunscreen with a minimum of at least an SPF of ______. (answer: 15)

•

Being outside in the sunlight, even in the winter, provides us with the best source of vitamin ______. (answer: D)

•

Because of the high risk of frostbite, the Canadian Paediatric Society suggests that children should not go outdoors when the temperature is below ________________, regardless of the wind chill. (answer: –27°C or –16°F)

•

The key to having safe field trips is educators’ careful _________. (answer: planning)

•

Parents provide the centre with a written list of individuals whom they have _______________ to take their children from the centre. (answer: authorized)

•

Using the health promotion action plan, identify which level applies to each of four (4) examples related to radon: A) individual problem solving and self-reliance B) community action C) societal change Encourage families to test their homes for radon seepage and share the radon testing results with others. Test your ECLC facility to protect the children in your care and yourself. Meet with parents and staff in your ECLC program to discuss the issue of radon and plan how to proceed at your facility. Advocate for mandatory testing, helping to protect all children. Policies for radon testing are starting to emerge in Canada. Conduct radon testing in your home. (answer: B, A, A, C, A)

7-25

•

For educators to know where children are at all times, what are three (3) safety measures that can be put into place to keep children from wandering away from the centre or a group? (answer: daily attendance; secure exits that are difficult for young children to open; security system for entrances; intact playground fence and locked gate; conduct regular head counts indoors and outdoors; develop and regularly review procedures for a missing child; method of ID for field trips; additional supervision on field trips; etc.)

•

List five (5) practices that educators can implement to help protect themselves and children from the sun. (answer: apply sunscreen with SPF of 15 about 15–30 minutes before going outside; wear hats; provide shade; wear sunglasses; offer water before, during, and after playing outside; wear T-shirts during water play; limit or avoid time outside between 11 a.m. and 3 p.m.; perhaps wear clothing with loose, long sleeves and legs; know if anyone is taking medication that can cause photosensitivity)

•

What are six (6) points to keep in mind about using sunscreen products? (answer: use sunscreen with SPF of at least 15; select lotions recommended for children; apply above where the bottom of sleeves and shorts end, to back of ears and neck; supervise older preschoolers during application; school-agers should be able to apply lotion; reapply after being in the water; don’t apply to children under six months)

•

List the five (5) safety questions listed in the textbook, in any order, that educators should ask themselves when planning winter sporting activities. (answer: developmentally appropriate activity; location designed for age of children using it; potential dangers and can staff reduce or eliminate risks; applicable safety equipment and quantity; enough supervision)

•

Explain what kind of centre identification is appropriate for children to wear on field trips and provide the rationale (the why). (answer: use something [hat/smock/T-shirt or a coloured ID tag] with the program’s name and phone number; don’t have tags with the children’s names as they could be used by someone trying to lure a child away from the group; use one brightly coloured smock/T-shirt, which helps them stand out in the group and to do head counts; students may raise the one drawback around wearing hats as ID is that children have a tendency to take them off from time to time, so they won’t be as visible)

•

Provide three (3) reasons identified in the text why children are more vulnerable than adults to environmental toxins. (answer: refer to the Canadian Partnership for Children’s Health and Environment’s list, text pages 447–448)

•

Why are children living in poverty at even higher risk of effects from environmental toxins than children in general? Give two (2) reasons. (answer: more likely to live in industrial areas; home environments more likely to be improperly designed and poorly maintained buildings, with poor indoor air quality, old paint and plumbing [possible lead exposure], parking lots backing onto apartment buildings)

•

List two (2) ways you can tell that a toy contains lead. (answer: refer to text page 455)

7-26

•

Using the three (3) levels of the health promotion action plan, give one suggestion at each level to reduce exposure to and production of environmental contaminants. (answer: refer to text pages 464–465)

•

Describe two (2) ways that injury reports can be used to prevent similar injuries in the future. (answer: can evaluate the 5 W’s of safety promotion; identify cause(s) of the injury; implement necessary changes)

•

List two (2) tips for safer use of plastics around food. (answer: refer to text page 458)

7-27

HERE’S THE ANSWER—WHAT’S THE QUESTION? Here’s the answer. exploration and practice loose or dangling hoods and scarves, ropes tied to playground equipment the most common cause of program injuries for children to provide educators with the knowledge, attitudes, and skills to promote safety by designing and maintaining a safe indoor and outdoor environment the quality of the protective surfaces and the height the child falls from formally identify hazardous items and faulty equipment 5 cm (2 in.) of water

What’s the question? How do children learn? What are some common serious strangulation hazards? How common are falls in ECLC programs? Why is safety training important for educators? How can educators reduce the inherent physical risks in the ECLC setting? What are two characteristics of the environment that have the most influence on the severity of playground injuries? What is the role of safety checks?

How little water could drown a young child? depends on the inherent risks of the activity In addition to legislated adult–child ratios, or equipment, ages of children, and how do you determine the level of applicable rules supervision? environment, supervision, safety rules, and What are the four (4) components of safety training promotion? when the temperature is below –27ºC, When should children remain indoors in the regardless of the wind chill winter? to learn to behave responsibly and to What is the ultimate goal of rules? develop self-control wear hats and sunglasses, apply sunscreen, What are ways we can protect ourselves limit time outside during peak sunshine outside in the summer? hours, seek shade, drink fluids list of persons who can pick up children What is an authorization list? from the program careful planning What is the key to safe field trips? being exposed to toxins at a younger age What is meant by the latent effect? gives more time for health-related problems to develop air pollution, lead, pesticides, and plastics What are four (4) environmental issues of concern to children’s health and safety? in other words, “better safe than sorry” with What is a precautionary approach? regard to the absence of full scientific certainty children’s outer layer of skin is thinner and Why are children more sensitive than adults they spend more time outdoors than adults to UV exposure? sand, pea gravel, and wood/bark mulch What are three (3) protective surfaces for playgrounds? 7-28

Do not walk between parked cars. refers to periods of fetal development or other sensitive stages of childhood when safe doses are not necessarily safe for children

What is an example of a road rule? What are windows of vulnerability?

7-29

WHAT WOULD YOU DO IF …? Scenario 1—You’re on a field trip and one of the three toddlers you are responsible for runs into an elevator. The doors close before you can reach her. Scenario 2—Three of the school-agers have begun to cross the busy intersection as the light turns red. They had run ahead of you, even though you were the educator at the front of the group. Scenario 3—You are on a walk with the infants in strollers along a tree-lined boulevard when thunder starts. Some of the infants are upset and you are still 15 minutes from the centre. Scenario 4—When you conduct your weekly safety checklist, you find that the ladder on the wooden climber has two large splinters where children place their hands as they climb. The director tells you that the maintenance person is on vacation and it will be two weeks before it’s repaired. Scenario 5—An older sibling (high school) comes to pick up a preschooler. Their parents had not listed the older sister on the authorized list, but she tells you that their mother asked her to pick up her brother today.

7-30

COMMON CAUSES OF INJURY OR DEATH Causes of Injury or Death Falls

Common Risk for Age Group(s)

Two Prevention Strategies for the Risk

Common Risk for Age Group(s)

Threats to breathing

Drowning

Motor vehicle collisions and bicycle-related injuries Poisonings

Burns

7-31

Two Prevention Strategies for the Risk

PROTECTIVE SURFACES 1. Select two of the following surfaces: •

sand

•

pea gravel

•

wood/bark mulch

•

engineered wood fibre

•

gravel

•

shredded tire crumb

•

tiles

•

pour-in-place

2. Complete the advantages and disadvantages of each surfacing material. Type of Surface: Advantages: Disadvantages: Type of Surface: Advantages: Disadvantages: Compare and contrast the two surfaces:

7-32

•

Do you agree that one of the two is a better choice?

•

If so, which one, and why?

•

If not, why not?

ENVIRONMENTAL CONTAMINANTS: CONSEQUENCES AND HEALTH PROMOTION ACTION PLAN

Air pollution Examples:

Identify Potential Developmental and Health Consequences

Identify One Strategy for Each Component

List:

Individual problem solving and self-reliance: Community action: Societal health:

Lead Examples:

List:

Individual problem solving and self-reliance: Community action: Societal health:

Pesticides Examples:

List:

Individual problem solving and self-reliance: Community action: Societal health:

Plastics Examples:

List:

Individual problem solving and self-reliance: Community action: Societal health:

7-33

UNIT

Preventing Child Maltreatment

CONTENTS

PREAMBLE ..............................................................................................................................3 CLASSROOM ACTIVITIES AND DISCUSSIONS..........................................................................4 Critical Thinking...................................................................................................................................... 7 First (refer to text page 485) ...................................................................................................................... 7 Second (refer to text page 503) ................................................................................................................. 7 Third (refer to text page 509) .................................................................................................................... 8 Fourth (refer to text page 521) .................................................................................................................. 8 Assess Your Learning .............................................................................................................................. 9 Resource Materials for Teaching........................................................................................................... 11

ANCILLARY MATERIAL ..........................................................................................................12 The Range of Emotional Reactions to Child Sexual Abuse ..................................................................... 12

ASSIGNMENT IDEAS .............................................................................................................17 TEST QUESTIONS ..................................................................................................................17 Exploring Your Feelings ........................................................................................................................ 17 Child Maltreatment .............................................................................................................................. 18 Preventing Child Maltreatment ............................................................................................................ 20

HERE’S THE ANSWER—WHAT’S THE QUESTION? ...............................................................29 CASE STUDY—JU-LONG........................................................................................................31 CASE STUDY—CAROLINE ......................................................................................................32 CASE STUDY—RAYYAN .........................................................................................................33 Copyright © 2019 by Nelson Education Ltd.

8-1

CASE STUDY—LAUREN .........................................................................................................34

8-2

Preamble Child maltreatment is a very difficult topic. It goes without saying that the utmost caution must be taken by the instructor to create a climate of trust and outlets for the sometimes confusing feelings that some or all students may experience. Instructors must find a balance between having a climate where students can begin to deal effectively with this issue and recognizing that there are limits on what should be discussed in the group. Setting a tone and ground rules when child maltreatment is first introduced as a topic is essential—it is also worthwhile to spend a few minutes reviewing these at the beginning of every subsequent class on this subject. For example: •

Acknowledge that this will be a challenging subject to read, think, and talk about.

•

Child maltreatment can’t be discussed as if it is “out there” without acknowledging that it’s also “in here”—in other words, probably one in four of us in this room are survivors of child maltreatment (or other forms of violence). You may want to use The Range of Emotional Reactions to Child Sexual Abuse for students to read on their own (see handout, page 8-12). We acknowledge that this is a dated reference and the Institute for the Prevention of Child Abuse has been replaced by Boost Child & Youth Advocacy Centre. However, Boost has not produced a resource that could replace this document. Within your own province/territory, such resources may be available.

•

Provide students with the following information: o Name, phone number, and/or email of the counsellor at the college. It is a good idea to let her or him know that you are about to talk about child maltreatment in class, and that you will be letting students know about counselling services. o Resources available for anyone who wants to talk about maltreatment (e.g., disclosure). This list could include your own office hours, as well as counsellors or agencies in the community that would be relevant. o Relevant resources from the child protection agency, public health agency, and agencies serving victims of violence (e.g., rape crisis centre, helplines, women’s shelters).

•

Be very clear about confidentiality both in terms of the classroom and their work in programs now and after graduation. Discuss what confidentiality means, and how they can discuss observations and concerns appropriately with professionals without jeopardizing confidentiality. Although you will discourage students from disclosing to the group, it may happen and everyone needs to know that personal information and other information of a confidential nature must not leave the room.

8-3

•

Remind students that someone’s opinion is to be respected, and that comments or body language that make fun and demeaning or dismissive facial expressions at another’s opinion are not acceptable.* * The exception is a stated opinion that indicates discrimination of any kind. This behaviour cannot be tolerated, and the instructor needs to call it and take appropriate action to ensure safety in the learning environment.

Classroom Activities and Discussions Here’s the Answer—What’s the Question? (see handout, page 8-29) Emotional reactions to sexual abuse (see The Range of Emotional Reactions to Child Sexual Abuse handout, page 8-12): •

Ask students to review the handout; it is probably more appropriate to do this on their own.

•

Depending on available class time and how supportive your group is to one another, it may be possible to discuss some of the reactions to possible effects on the child or how to try to work through some of our emotions.

Children’s rights: Discuss children’s rights in reference to child maltreatment provincially/territorially, nationally, and internationally (refer to Appendix 8.1, text page 529). Child protection agency: •

Invite one of their workers who is familiar with ECLC programs to talk about the reporting process.

•

Child maltreatment prevention programs for children: o Present one or more examples of prevention programs that are currently being used in the field. o In small groups, students could discuss the list of questions used to evaluate such programs (refer to text page 502).

Case study—Ju-long (see handout, page 8-31): •

This case study is misleading since the dark bluish mark is a common birthmark in non-Caucasian babies, known as a Mongolian spot, which disappears over time.

•

It illustrates how easy it is to be suspicious of everything: o Many students will automatically think the mark is a bruise.

8-4

o The infant room staff are suspicious of Mrs. Liu’s fears, lack of eye contact, etc. •

Based on an actual situation, the director recognized the birthmark and was compassionate for the mother’s stress and for the baby’s: o Refugee experience—fleeing their country, husband’s death, a new country with a new language and customs, uncertain of her rights o Many babies take much longer than three weeks to develop trust in a new environment, along with hearing a language, music, and voices; food odours and tastes; toys, etc., that are completely unfamiliar to the baby. o Mother needs support, not suspicion. o Educators need to show sensitivity, as well as needing to get help (e.g., learn sounds and words familiar to Ju-long to help him feel more secure and comforted).

Case study—Caroline (see handout, page 8-32) Case study—Rayyan (see handout, page 8-33) Case study—Lauren (see handout, page 8-34) Stress in the family: Class discussion on how ECLC programs can help prevent child maltreatment by reducing stress experienced by families. (answer: being a support system; students may provide examples of ways that illustrate their role in reducing stress) Female genital mutilation/cutting (FGM/C): Due to the diversity of population in your community, FGM/C may or may not be an issue in your community. Contact your public health and/or child protection agency to determine what is being done, as well as to obtain up-to-date resources (videos, literature). Remember how crucial it is to be sensitive to the fact that some of your students may be survivors of this practice. Refer to Through a New Lens: Seeing Woman Abuse in the Life of a Young Child—A Learning Module for Early Childhood Education Programs. This module provides instructors with all the material required for either a two-hour lecture or an all-day workshop (see Resource Materials for Teaching, page 8-11). Documenting your suspicions: 10 guidelines for educators who may be part of a child abuse investigation (refer to text page 516). In small groups, ask the students to go through the guidelines and note which are more challenging to understand. One member in each group will write down any questions that need further clarity. At the end of their discussion, ensure that you answer their questions and follow up with a case study example. The small group will go through the 10 guidelines again, using the case study information to answer each question. Copyright © 2019 by Nelson Education Ltd.

8-5

Disclosure of family violence: •

Use Table 8.2 (refer to text page 508).

•

In pairs, ask students to develop a role-play scenario involving a parent who tells an educator that she or he is being abused.

•

Then bring two sets of pairs together, and as one pair runs through their role-play, the other pair compares the strategies used with Table 8.2; then switch.

Note: This activity can also be done using the list in Responding Effectively to Disclosures (refer to text starting on page 511). Reporting family violence: The examples of when to call a child protection agency regarding suspicions of family violence are a long list (refer to text page 507). For class discussion, small groups of students would have three examples per group to discuss. The examples and their discussion would likely broaden their awareness of types of scenarios they may be faced with as future educators (or even possibly students in ECLC practicum placements). Each small group will report back to the class including information such as identifying one of the three examples they believed would be most likely to happen and how they would go about calling the child protection agency. The term “child rearing” is commonly used to mean bringing up children. Some child advocates would argue that this term perpetuates the use of corporal punishment, whereas a term such as “child raising” would be better suited to positive parenting and the respect to which all children are entitled. Do you think that language is powerful in this regard? Back up your opinion. Suggestions: Punishment has a negative connotation; effective discipline more appropriately means to teach rather than to punish; to “rear” is to bring up; to “raise” is to elevate. Family diversity varies on a wide range of topics (e.g., religion, politics, discipline, eating habits). After reading the section Discipline versus Punishment (refer to text page 482), divide students into small groups, asking them to share their childhood experiences around discipline. Keep in mind some students may not feel comfortable participating, or they may feel they must leave the classroom, or they may disclose. This type of discussion is based on the instructor’s read of the students and their readiness for such a discussion. This may be an opportunity where a student may have observed punishment of a childhood peer and now as an ECE student can reflect on a positive discipline approach that the adult could have used as an alternative to the punishment the child did receive.

8-6

Critical Thinking First (refer to text page 485) As of 2018, Canada has not yet joined the countries that have abolished corporal punishment, including spanking. Identify how the parameters discussed (a) support or (b) do not support a child’s rights according to the UN Convention of the Rights of the Child (see Appendix 8.1, page 529) and the Global Initiative to End All Corporal Punishment of Children’s website. Suggestions: Have a class debate on this UN position (refer to the list of justifications in text pages 483‒484): •

Support the abolishment of corporal punishment

•

Do not support the abolishment of corporal punishment

Second (refer to text page 503) After half an hour, Shelly is still unable to comfort a toddler. She is becoming increasingly frustrated and has said, “I just want to leave him in the crib until he stops crying.” You can see that she is handling the child less and less gently. How could you manage this situation to reduce Shelly’s stress, and the stress experienced by the child, and reduce the risk of physical abuse? What steps might prevent these types of situations in the future? Suggestions: Acknowledge Shelly’s feelings: “I can see that you’re really frustrated. It’s hard when you are really trying to comfort a child but nothing you do seems to help”; suggest that she needs a break and that you will try; the toddler may stop crying; if so, it may be due to you starting fresh and his sensing your calmness and patience, which Shelly had lost some time ago; if you can’t comfort him either, consider it a possible sign of illness; soon afterward, you and Shelly should talk about the situation; teamwork and cooperation may need to be stressed and that all of you are there to support each other; upon her own reflection, she may consider whether there was an earlier point when she should have asked for relief, which may have prevented the child’s continued stress and her rougher handling; if Shelly tells you that she is often frustrated with the children, discuss why this may be and suggest that she may need some help because children can’t be treated inappropriately; the two of you may be able to develop some strategies for working more effectively as a team in these situations; the director may be able to provide additional support in the room when one child is particularly upset to help care for the others; as a last resort, if Shelly is continually frustrated with the children, perhaps she will have to evaluate if she would have a better fit with another age group or even leave the ECLC profession.

8-7

Third (refer to text page 509) The next-door neighbour notices that the children are playing outdoors without coats on in cold weather and does not realize that the mother has sent them outside to prevent them from witnessing her impending assault. This example is not meant to underplay the children’s needs for proper clothing but to highlight the mother’s assessment of risk and her strategy to protect her children from the greater risk. Consider all players in this scenario: children, the non-offending mother, and the offending partner. Identify each player’s issue and decide what the neighbour’s next step should be. Suggestions: (This list is a small sampling of what students may suggest during the discussion.) •

From the children’s perspective: While the children may be cold, it is likely less distressing than watching their mother’s assault.

•

From the mother’s perspective: She is relieved that the children aren’t witnessing the assault; eliminates the possibility that if the children were in the house, they would be assaulted (directly or indirectly) as well; the mother has some sense of power in that she is protecting her children.

•

From the offender’s perspective: His sense of power may be reduced because the children are not there to witness the assault or to be under his control.

•

The neighbour’s response: Ask the children if they want to come into her house; possibly the children will tell her what is going on and she would call 911.

Fourth (refer to text page 521) Maltreatment by educators may be identified through the child’s disclosure or by parents who approach the director with their concerns and perhaps their suspicion of a particular educator. How does the director proceed? Suggestions: Regardless of how the director is made aware of the alleged abuse, the director notifies the child protection agency and proceeds accordingly. As in the case of suspected maltreatment of children in the home, the educator is not confronted. In the interim, if the alleged offender is known, the director takes the following action:

8-8

•

removes the educator from any possibility of being alone with children

•

notifies the child care licensing office

•

informs the program’s board of directors immediately

•

It may be appropriate to remove the accused staff from the program until the investigation has been completed or to assign that person to administrative duties. The accused staff should seek legal advice.

Assess Your Learning Evaluate your options in each situation. 1. A coworker remarks that there are probably a lot of children in your program who are maltreated because most are part of single-parent families. Suggestions: The message that you want to convey to your coworker is that this is a stereotypical remark, which is not in the children’s or families’ best interests; this is another example of a situation where possessing effective communication skills is essential to avoid alienating or putting off your coworker; search out books, videos, and workshops that send the message that abuse is widespread and is not concentrated in a certain type of family; within the ECLC program, you all can provide support to parents, which reduces isolation and stress, thereby contributing to abuse prevention; seek additional child maltreatment prevention training for your team. 2. A month after you reported a case of suspected maltreatment to the child protection agency, there has been no news. The child continues to come to the program each day and is demonstrating the same behaviour that led you to make the report in the first place. You are angry and confused with the lack of response from the agency. Suggestions: Whoever reported the suspected maltreatment should call and ask about the status of the case; although the child protection agency may not be able to fully disclose the status of the investigation, they may be able to give you enough information to indicate that they have indeed followed up or are in the process of handling the case. Remember that the outcome of the investigation may result in the agency’s inability to act further at this time, but reporting will probably make a difference in the long term. If there is no response, ask the director if she or he has heard from the agency and you were not told. (Refer to text page 519 for the agency’s two possible findings.) 3. A coworker who spanks her children starts a conversation at lunchtime about repealing section 43 of the Criminal Code. She suggests that doing so would mean that parents would be charged for “a little slap.” Suggestions: There are a number of ways to approach this topic with your coworker. You could begin with focusing on her situation, which may provide some insight into why she holds this belief. For example, you could ask, “Why do you spank your children?” Her answer may reflect her frustration with the demands of parenting, or she may talk about her fears of spoiling her children if they don’t learn right from wrong and respect for authority, etc. (there are a host of reasons cited by parents who use corporal punishment—refer to text page 484). Copyright © 2019 by Nelson Education Ltd.

8-9

Depending on her answer to that question, you may be able to discuss the similarities and differences between discipline and punishment, and the ultimate goal of children’s self-control, which isn’t role modelled when adults lash out with hitting and other forms of corporal punishment (connect to Boost Child & Youth Advocacy Centre website for excellent information on the difference between discipline and punishment, why children misbehave, and positive ways to guide children’s behaviour: https://boostforkids.org/). In addition, another argument may be noting that it is against the law to hit any adult (i.e., charges are often laid when a virtual stranger pushes or hits another adult). Don’t children deserve the same rights? One would assume that an educator in an ECLC position would uphold children’s rights. There may be several other discussion points for this scenario. Ultimately, your coworker’s fear that parents could be charged for a little slap has not been borne out in countries where corporal punishment is against the law. Repealing Section 43 of the Criminal Code would be an important public policy acknowledgment that corporal punishment is not in the best interests of children. It is a remote possibility that, in reality, the law would push it to the extreme that your coworker suggests. On the contrary, the present reality is that the majority of reported physical abuse cases are due to parents who stated they were only disciplining their child (consult Trocme’s article “Child Maltreatment and Its Impact on Psychosocial Child Development: Epidemiology” (February 2012); to download the PDF, visit http://www.child-encyclopedia.com/sites/default/files/textesexperts/en/779/child-maltreatment-and-its-impact-on-psychosocial-childdevelopment-epidemiology-.pdf). Having Section 43 of the Criminal Code covertly gives parents permission to hurt their children. Note: Changes do not allow corporal punishment for children under two years of age. 4. Lily, one of the five-year-old children who attends the program in the mornings and school kindergarten in the afternoon, is quiet and listless this morning. When you sit with her for a while, she tells you that she’s scared to go home tonight. Lily says that last night her dad was really mad and hit her mom. She comments that she is going to be a good girl tonight so it won’t happen again. Suggestions: Lily believes that she is responsible for the abuse or can stop it. Lily is also exhibiting symptoms of emotional distress because of exposure to family violence. She is concerned for her mother’s safety and possibly her own. These two indicators justify, and actually necessitate, calling the child protection agency for their advice. Depending on provincial/territorial legislation, as well as other mitigating factors, the child protection agency may require filing a report. If not, they will advise or require other action (such as continued documentation and/or the mother’s referral to a women’s shelter). Educators in these situations often struggle with the best way to support children exposed to family violence because they are also concerned about the non-offending parent. However, ultimately the educator needs to consider whether not reporting may place the child at further risk (an interesting class discussion). 8-10

5. The director meets with the educators to inform everyone that the child protection agency has requested that a child who has been maltreated be enrolled in your program as part of his treatment. He requires a caring, consistent environment to help reduce developmental delays and build self-confidence. Although you are flattered, and the director obviously wants to say yes, you are concerned because you and the other educators are already feeling stretched meeting the needs of the present children. Suggestions: Educators who would be working with the child need to develop a list of pros and cons, which considers the best interests of all parties (i.e., the child who has been abused, the family, the other children and families in your program, and you, the educators); try to consider all the possible questions, such as the following: •

What are our feelings about a child who has been abused and his family?

•

Will these feelings help or provide a barrier?

•

What are our feelings about taking this on?

•

If led simply by wanting to help, is it helpful in the long term if it doesn’t work out and the child has another transition?

•

Do we know what this child’s particular needs are, and do we have the expertise to work with him?

•

If not, do we have guaranteed ongoing support from community professionals/agencies to provide the direction we need?

•

Can we handle the needs of one more child and family without jeopardizing those already in the program?

When the ECLC team has thought through these and other concerns, a decision may seem more evident, and speaking with the director will be helpful.

Resource Materials for Teaching Aboriginal Domestic Violence in Canada (2003), prepared for the Aboriginal Healing Foundation by Four Worlds Centre for Development Learning. Published by Aboriginal Healing Foundation: http://www.ahf.ca/. To download the PDF, visit http://www.ahf.ca/downloads/domestic-violence.pdf Boost Child & Youth Advocacy Centre: https://boostforkids.org/ London Family Court Clinic: http://www.lfcc.on.ca/ Making a Difference: The Community Responds to Child Abuse program, designed to train individuals who provide frontline services to children and families in early Copyright © 2019 by Nelson Education Ltd.

8-11

identification of child maltreatment and effective intervention in situations where children are at risk of being abused. To access the online training, visit https://boostforkids.org/training/making-a-difference/. The centre also publishes a resource on the educator’s response to family violence. Visit https://boostforkids.org/ Through a New Lens: Seeing Woman Abuse in the Life of a Young Child—a Learning Module for Early Childhood Education Programs (2005) by L. Baker and A. Cunningham. Available through the Centre for Children and Families in the Justice System: http://www.lfcc.on.ca/. To download, visit http://www.lfcc.on.ca/wpcontent/uploads/2017/02/Through-a-New-Lens-Seeing-Woman-Abuse-in-the-Life-of-aYoung-Child-_-A-Learning-Module-for-Early-Childhood-Education-Programs-1.pdf

Ancillary Material The Range of Emotional Reactions to Child Sexual Abuse When educators are aware of their personal reactions to sexual abuse, their emotions can be constructively controlled or channelled. This, in turn, likely has a positive impact on their objectivity, sensitivity to the child, ability to increase the child’s level of comfort, and general effectiveness in relating to and working with colleagues and sexually abused children and their families. How do you feel when you learn of incidents of sexual abuse? Following are some of the possible emotional reactions one might experience and the possible effects on the child. Anger •

at the offender for using a child to meet his or her selfish needs, violating the law and his or her trust as an adult or parent

•

at the other parent or siblings for not protecting the child

•

at the child for not stopping/resisting the abuse or for not telling someone about it

•

at other professionals for their involvement/lack of involvement, lack of knowledge or cooperation Possible effects on the child:

8-12

increased guilt

increased blame

may not view the offence as that negative, especially if a young child is involved in minor sexual activity

may not view his or her family or parents as bad, awful, etc.

may feel positive toward them or may feel ambivalent, confused, or overwhelmed by the reaction

Disgust •

with the offender’s behaviour (e.g., How could he do such a thing)?

•

with the child’s behaviour (e.g., How could she let him do it again?)

•

with the family’s behaviour (e.g., They must have known about it.)

•

at this sinful, depraved behaviour

•

over the curiosity of others to know more about the incident Possible effects on the child: §

reduced self-respect

increased view of her- or himself as bad, awful, or sinful

sense of being unworthy of love or help

Embarrassment/Discomfort •

about discussing intimate sexual behaviour with the child, your spouse, your family, social workers, or other professionals

•

with the child’s public exposure

•

about naming and discussing sexual parts of the body Possible effects on the child: §

This is too awful to talk about.

may increase guilt and shame: If adults can’t handle it, how am I expected to discuss it?

Disbelief/Doubt •

that this type of behaviour could occur

•

that this could occur in your community

•

that this could go on in families

8-13

•

that a parent would do such a thing

•

that it could be as much as they told me

•

that it could happen to a child like this Possible effects on the child: §

Doesn’t anyone believe my story?

Do they think I’m lying or dreaming?

increased anger and distrust

Curiosity/Fascination •

about deviant, forbidden behaviour

•

about the details involved

•

about what kind of child and family would be involved in this Possible effects on the child: §

Some of this is none of their business.

They have no right to ask me about some things.

They seem to be on a fishing expedition, trying to find out more about me and my family.

They think I’m a freak and my family is really weird.

Revenge/Retribution •

Someone is to blame and should be severely punished.

•

Those responsible don’t deserve to care for children.

•

The offender should be separated from the family and the community (e.g., jail, because it may happen again; perhaps he should be castrated so he doesn’t hurt other children).

•

The child should be disciplined for participating, not telling, or provoking the event.

•

The family members should be punished for collusion or failure to protect the child.

•

Other professionals should be reprimanded:

8-14

o for not preventing o for not knowing o for not intervening o for not punishing o for not providing treatment Possible effects on the child: §

I’m afraid for myself.

I’m afraid for my family.

I feel responsible for the trouble I’m causing, and for what will happen to my family now that I’ve told.

You don’t know my family; they are not bad all the time.

I don’t know if I can trust you.

Ambivalence •

about helping or punishing the offender and/or family member

•

about being able to help the child

•

about rescuing the child or preserving the family unit

•

belief versus denial that such things happen

•

about whether the child has been harmed

•

approach and avoidance toward the event Possible effects on the child: §

I don’t know if they like me or want to help me.

I don’t know if they like my family, or want to help them, or will even let me return home.

I’m not sure they believe me or know what I’ve been through.

Fear/Anxiety •

about the child recovering

8-15

•

for the safety of the victim’s siblings

•

of the offender’s possible aggressive behaviour

•

of inadequacy in handling the situation

•

of the expectation others have of me in caring for, or helping, this child and family

•

about future court hearings

•

about the child going home Possible effects on the child: §

increased fear and anxiety

I don’t know if they are able to help me with my problems or what’s ahead.

It didn’t happen to them; why are they so anxious and fearful? Do they know something I don’t know?

Empathy/Concern •

for the child’s situation, condition

•

for the family’s predicament (e.g., separation, public censure, criminal charges, etc.) Possible effects on the child: §

They care about me.

They don’t blame me.

They understand.

They care about my family.

Some techniques for positively managing your responses to the topic of sexual abuse: •

talking it over with others (e.g., partner/spouse, colleagues, friends)

•

talking about sex and sexual activity with others to help sensitize oneself to certain words and activities

•

writing down feelings or reactions to help one vent in a non-harmful way

•

deep-breathing exercises

8-16

•

listening to music for its calming effect

•

physical activity discharges strong emotions without directing them toward others

Not everyone can work effectively with children and families involved in sexual abuse. For some, the issues are too intense, the problem too emotionally upsetting. Professional counselling may be beneficial to those who are working through this emotional issue. Adapted from TRUST II: Instructor’s Manual (Toronto: Institute for the Prevention of Child Abuse, 1994), 50–54.

Assignment Ideas Children’s rights: Independently or in small groups, students could choose one of the rights depicted in the video or by the UN Convention on the Rights of the Child and research what is being done and what should be done to ensure that children in the community, province/territory, Canada, and globally have their rights honoured (refer to Appendix 8.1: UN Convention on the Rights of the Child, text page 529).

Test Questions Exploring Your Feelings Objectives: To identify your feelings about child maltreatment and how you can deal with them. (LO 2) To identify your level of openness to family diversity. (LO 2)

•

What are two (2) important questions you should ask yourself before managing suspicions of child maltreatment in ECLC programs? (answer: What are some of the feelings I’m experiencing about child maltreatment? How open am I to others’ values and practices that are different from mine?)

•

Identify whether each statement below is true or false regarding family diversity: o (T or F) You have to adopt other families’ beliefs and values. o (T or F) You need to develop a level of understanding and respect for others’ values and beliefs. o (T or F) Many practices are not harmful to children, even if they are different from your experience.

8-17

o (T or F) It is easy to know mostly everything about a person’s values and beliefs from their race, skin colour, gender, and age.

Child Maltreatment Objectives: To define and describe each category of child maltreatment: physical abuse, emotional abuse, sexual abuse, neglect, and exposing children to family violence. (LO 1) To develop a heightened awareness of the complex consequences of maltreatment on children. (LO 1, 3)

•

(T or F) Categories of child maltreatment are not interrelated.

•

(T or F) In Canada, female genital mutilation/cutting is against the law.

•

(T or F) A child who witnesses her or his mother’s abuse is being emotionally abused.

•

(T or F) Most children who have been sexually abused have physical indicators of the sexual abuse when examined by a physician.

•

(T or F) The vast majority of sexual abuse offenders are men, but women can also be offenders.

•

(T or F) Violence in our North American society is not accepted.

•

(T or F) The most common form of investigated neglect is related to inadequate food and clothing.

•

Sexual abuse includes a. only incidents involving actual sexual intercourse b. any sexual involvement between an adult and child c. only sexual acts to which a child did not consent d. rape and incest only e. none of the above

•

The following could be significant indicators of suspected physical abuse: a. several new bruises on different parts of the body

8-18

b. injuries that are not consistent with explanations c. injuries that are in various stages of healing d. child is extremely aggressive or extremely withdrawn e. all of the above f. a, b, and c only •

The following is not one of the six (6) forms of physical abuse: a. shake, push, grab, or throw b. hit with object c. hit with hand d. belittle child in front of his friends e. punch, kick, or bite

•

List the five (5) types of child maltreatment. (answer: physical abuse, emotional abuse, sexual abuse, neglect, witnessing family violence)

•

What is female genital mutilation/cutting? (answer: extreme form of physical abuse against girls, ranging from removing the hood of the clitoris to cutting away all the external sexual organs)

•

Make two (2) statements about sexual abuse offenders listed in the unit. (answer: the vast majority are men, a few are women; pedophiles make up a small unknown percentage; most are heterosexual; offenders put a great deal of thought into how they will manipulate children; vast majority are known to the child [i.e., father, brother, mother’s boyfriend, babysitter, friend, friend of family])

•

What is failure to thrive? (answer: extreme consequences of neglecting infants and very young children; due to inadequate emotional and physical stimulation and malnutrition; gains little weight with no medical explanation; experiences developmental delays during second year of life, particularly in language)

•

In your own words, list and define the five (5) types of child maltreatment. (answer: physical abuse—suffered injuries that were deliberately inflicted either once or over a period of time, abuse usually becomes more severe over time, abuser often justifies actions in terms of discipline; emotional abuse—most widespread, most difficult to prove, verbal expressions that demean, belittle, threaten, ridicule or use sarcasm, harsh criticism or make inappropriate demands; sexual abuse—involvement of children in sexual activities where they are used for sexual purposes, exploitation, prostitution, or sexually arousing children; neglect—parents do not provide for the

8-19

children’s physical, emotional, and social needs that nurture growth and development; witnessing family violence—the child is in psychological and physical danger, living with threats, fear, and feeling powerless •

Generally, what are behavioural indicators of abuse? (answer: any kind of signs, symptoms, or clues seen in a child or the adult in the child’s life that lead educators to suspect maltreatment)

•

List four (4) behavioural indicators that may be exhibited by a child who is being abused in any way. (answer: refer to text page 493)

•

Two essential components of effective parenting skills are ________________ and _____________. (answer: responsiveness; discipline)

•

Corporal punishment is a. the use of physical force on children in order to discipline them, and it is against the law in Canada b. the use of physical force on children in order to discipline them, and it is never against the law in Canada c. the use of physical force on children in order to discipline them and it is not against the law in Canada unless it is considered excessive d. the use of emotional abuse on children, including sarcasm and put-downs

•

The primary objective of discipline is _____________________________________ ________________________________________________. (answer: to help children develop the ability to use their own judgment and to cultivate self-control)

•

What are two (2) lessons that anti-spanking advocates believe children learn from being hit? (answer: It’s okay to hurt and humiliate someone because my parents do it; the reason to obey rules is to avoid being hit; when I get bigger, I will have power over my parents; violence is an acceptable way of expressing anger.)

Preventing Child Maltreatment Objectives: To describe the function of child protection agencies with regard to child maltreatment. (LO 5) To define primary prevention and outline the educators’ role in the ECLC environment and beyond. (LO 1, 2, 4, 6)

8-20

To define secondary prevention and discuss the educators’ role in identifying suspected child maltreatment and in documenting and reporting it to a child protection agency. (LO 1, 2, 4, 5, 6) To define tertiary prevention and discuss the educators’ role in working with children, families, and agencies. (LO 1, 2, 4, 5, 6) To identify individual, community, and societal levels of child maltreatment prevention. (LO 1, 2, 4, 5, 6)

•

(T or F) Educators can help reduce the incidence of parental spanking and other forms of punishment by lecturing to parents about the negative aspects of spanking.

•

(T or F) Educators can help reduce the incidence of parental spanking by modelling positive guidance with children.

•

(T or F) Factors that contribute to maltreatment in families are usually very different from those in programs.

•

(T or F) Maltreatment is always a violation of power.

•

(T or F) It is an educator’s legal responsibility to report suspected child maltreatment.

•

(T or F) A child witnessing his mother’s abuse by her partner is not reportable because the child is not directly involved.

•

(T or F) Upon investigation by the child protection agency, if the maltreatment cannot be proven, the staff or student who reported it will be held accountable.

•

(T or F) It is the staff’s responsibility to report and investigate suspected child maltreatment.

•

(T or F) When victims of family violence decide to leave the offender, there is no further risk to the victim and her or his children.

•

If an educator is unsure about whether a situation should be reported to the child protection agency, the following is an appropriate option: a. Refer the parents to community services, which can help them with specific concerns before they become too serious. b. Continue to document all observations/concerns in the child’s file. If the situation is obviously continuing to be of concern, report to the child protection agency. c. Call the child protection agency and ask them to advise you about whether a report should be made based on the information you have so far.

8-21

d. none of the above •

Identify the question not in the list of those to ask when examining the appropriateness of a prevention program for children in your care: a. Are the materials comprehensive, socio-culturally relevant, and include information for staff, parents/caregivers, and children/youth? b. Is the information in the program accurate and up-to-date? c. Does it give children the message that there are no people who will help? d. Does it empower children/youth, supporting development of communication and problem-solving skills in a variety of situations? e. All of the above questions are in the list.

•

If an educator is wondering about a child’s physical injury, a possible question(s) to the child would be: a. What happened to your arm? b. Who did this to you? c. Why did your mother hurt you like that? d. Why didn’t you tell us about this?

•

Which of the following guidelines are part of the documentation process? Circle YES or NO for each of the following guidelines: o complete the correct form identified in the child abuse policy of your agency: YES or NO o include the full name of the child, the date and time of recording, and the date and time of your observations: YES or NO o describe clearly whatever you observed that is of concern (i.e., the child’s physical injury or behaviour): YES or NO o write down everything that was said in direct quotations, including the child’s response to questions such as, “When did your dad hit you so hard?”: YES or NO o do not write down anything that someone else has said: YES or NO o complete the documentation as soon as possible after you become aware of the physical or behavioural indicators or after a child’s disclosure: YES or NO

8-22

o type in your signature and the date that you have completed the form: YES or NO (answer: refer to text page 516) •

When an educator is concerned about a child’s injury or behavioural indicator(s), the following statement is appropriate: a. Your tone of voice, body language, and the way your questions are phrased convey to the parent that you are suspicious. b. Start with a question and follow with an observation (e.g., “Is Daniel uncooperative at home? We’ve noticed that he doesn’t want to follow routines lately.”). c. Take the parents’ lead while being careful not to put them on the defensive (e.g., making an observation first and then following with a question). d. Always approach parents for clarification, even if you have documented indicators before and have not been completely sure whether the explanation has been true. e. None of the above statements are appropriate.

•

The following statement is true about reporting suspected child maltreatment: a. The director will make the initial call to the child protection agency. b. The educator who suspects maltreatment will make the initial call to the child protection agency. c. The director will make the initial call to the police. d. The educator who suspects maltreatment will make the initial call to the police. e. The educator and director will call the public health agency.

•

In the investigation of suspected child maltreatment a. child protection workers conduct the investigation alone b. child protection workers may investigate with police and/or professionals from other social service and health agencies c. child protection workers always investigate with the police d. child protection workers always investigate with other social service/health professionals

8-23

•

One of the most important consequences of reporting suspected child maltreatment is that a. the offender always appears in court and is prosecuted b. the child and family always receive the support and help they need for the maltreatment to stop c. children who are being maltreated learn that someone significant in their life is telling them that this should not be happening to them d. the offender is put in jail

•

The following statement(s) is/are true about maltreatment by educators: a. Educators never maltreat children. b. When an educator is suspected of sexual abuse, she or he must not be left alone with children. c. If you have strong suspicions that a coworker is abusing children in the program, the most responsible reaction is for you to quit your job and work elsewhere. d. Educators who are emotionally abusing children typically belittle all the children under their care.

•

If a parent discloses family violence to you, ensure that you keep three (3) of the following strategies in mind when responding to the parent (choose a or b for each of the 3 strategies): (answer: 1b, 2b, 3a) ONE a. Control your emotions (e.g., encourage the parent to leave her or his partner, by saying, “I would never have stayed so long if I were you.”) b. Control your emotions (e.g., try to stay calm and relaxed; the parent needs to sense that you are able to help) TWO a. Offer a respectful perspective (e.g., suggest that family violence is not a crime) b. Offer a respectful perspective (e.g., acknowledge any steps the parent has taken toward safety and change, no matter how small, including disclosure to you) THREE

8-24

a. Present options (e.g., strongly encourage the parent to seek medical treatment if the parent [and/or the children] have sustained any injuries) b. Present options (e.g., give advice and try to help the parent make decisions) •

When educators suspect child maltreatment, it is their responsibility to _________ their suspicions to the child protection agency (CPA), and then the CPA will _______________ the report. (answer: report; investigate)

•

Write in the letter (A, B, or C) for the term that best describes the following statements: A) primary prevention B) secondary prevention C) tertiary prevention Educators have ongoing communication with the child protection and other agencies involved with the child who has been maltreated. Educators provide a secure and developmentally stimulating environment for the child and support change in parents who have been abusive. Educators can contribute to the prevention of child maltreatment by providing a positive environment for children, and support for parents in their parenting rights and responsibilities. Educators document observations and possible indicators, and the person who suspected child maltreatment reports to the child protection agency. (answer: C; A; B)

•

List three (3) of the reasons that educators or directors may hesitate to report suspected child maltreatment to the child protection agency. (answer: feels the agency won’t do anything; parents may ask them to keep it a secret; emotional/difficult experience for educator and/or director; uncertain about what information is needed to report; may not be aware of legal responsibility; parents may withdraw child from the program—financial loss)

•

List two (2) opportunities that educators have to help prevent child maltreatment in families. (answer: supporting each child in developing positive self-esteem; providing a positive role model and support for parents; supporting parents in their parenting rights and responsibilities)

•

List four (4) program policies that can contribute to a maltreatment-free ECLC program. (answer: open-door policy for parents; hire and screen all new employees and volunteers and performance appraisals during probation period; hire ECE-trained staff; implement positive child guidance practices; maintain and exceed minimum educator–child ratios and group size standards; ensure staffing permits at least two staff with children as much as possible; supervise staff and conduct yearly

8-25

performance evaluations; provide administrative support—approachability, staff meetings, accessing and offering resources, in-service training; ensure adequate physical working environment, professional salaries and benefits; encourage peer support) •

Identifying children who may be victims of maltreatment is one role of educators with respect to secondary prevention. What are the other two (2) roles? (answer: documentation of observations; report to child protection agency)

•

Provide two (2) reasons why it is very difficult for children to disclose sexual abuse. (answer: just starting to realize something is not right; child has been threatened; feels it is his or her fault and will be blamed; feels that no one will believe her or him)

•

If a child is disclosing maltreatment to you, what are three (3) reassuring statements that you can offer to the child? (answer: refer to text page 511)

•

Educators may hesitate to document their suspicions in children’s files. State two (2) possible reasons why. (answer: they don’t fully understand the importance of documentation in supporting the investigation of child maltreatment; they believe that they don’t have time to document suspicions; they are concerned that their report may be made public)

•

List and describe three (3) elements that help to make documentation clear, concise, and complete. (answer: refer to text page 516)

•

What are two (2) educator roles in tertiary prevention? (answer: ongoing communication with the child protection agency and other agencies; providing a secure and developmentally stimulating environment for the child; supporting change in parents)

•

What are three (3) aspects of your everyday work that can help to provide a secure ECLC program for children who have been maltreated? (answer: provide predictability and security in the day’s routine; help children learn appropriate ways to have their needs met; provide clear, firm, but kind limits; model and guide children to help them learn age-appropriate behaviour; be an active listener; recognize that a child’s behaviour can have different meanings)

•

Give two (2) examples of how educators can play a role in the treatment of parents who have been abusive. (answer: respite for parents; model appropriate and positive ways of interacting with children)

•

List three (3) of Perry’s six (6) social–emotional core strengths for children described in the textbook. (answer: refer to text page 495)

•

Read the following case study and then answer the questions that follow below.

8-26

Jason W. is a five-year-old (born January 20, ______) who attends kindergarten and your licensed after-school program. He lives with his mother, father, and uncle Tom (mother’s brother), who moved in with them three months ago. On February 15, the kindergarten teacher phones you to ask if any of the staff have noticed any changes in Jason’s behaviour since returning from the holidays. She has observed Jason withdrawing from play with other children, often sitting in the book area blankly staring at a book. This was very different from his usual energetic and social interactions with a number of his peers. You and your coworker, too, have been wondering about Jason’s apparent sadness much of the time. Fortunately, you have a close working relationship with the family and so you will talk with Jason’s parents about what they may have observed. At the end of the day, you share your observations with Doreen (Jason’s mom). She mentions that she and Jason’s father have been wondering if Jason is anxious about being “replaced” when she gives birth in two months. Doreen adds that Jason has been waking with nightmares about being chased by monsters. You and Doreen plan how to try to help Jason sort out his feelings, and you suggest that Doreen talk with the kindergarten teacher as well. Over the next two months, Jason has some days where he is more involved with his friends, but he still lacks his usual level of confidence. He refuses to try anything new and withdraws from play whenever a conflict starts. At lunchtime, he often complains about stomachaches, and he has vomited three afternoons in one week. Doreen assures you that Jason is seeing a doctor about this, but she hasn’t made a diagnosis yet. On Wednesday, April 20, at 4:30 p.m., Jason urinates in his pants while playing with the blocks with friends. He becomes very upset, and although you try to console him, he cries for over 30 minutes. When you offer to help him change, he refuses and insists on wearing his wet pants for the rest of the afternoon. You ae torn between wanting him to change to be more comfortable and wanting to respect his strong wish not to change his pants. You know Jason’s uncle Tom lives in the same house and he does not work during the day. You ask Jason if he’d like you to call Uncle Tom to pick him up now. Jason answers, “No! Don’t make Uncle Tom come. He wants to touch my penis.” Part A. Identify indicators that you may have documented before Wednesday, April 20: •

Behavioural Indicators of the Child: (answer: withdrawal from play, especially when conflict starts; often sits staring blankly at a book; apparent sadness much of the time; lack of confidence; refuses to try anything new; his mother reports that he wakes up with nightmares)

•

Physical Indicators of the Child:

8-27

(answer: complaints of stomachaches; vomited three afternoons in one week) Part B. What are two (2) important messages that you want Jason to hear after he says to you, “No! Don’t make Uncle Tom come. He wants to touch my penis.” (answer: see text page 511—“It’s not your fault”; “You are very brave to tell”; “I’m glad you told me what happened”; “I’m sorry that has happened to you”; “You are not alone — this happens to other children too”; “I will do everything I can to help”) Part C. Do you believe that there are grounds to suspect possible child maltreatment? (answer: yes) If yes, what should be done? (answer: complete the report and notify the child protection agency) Part D. Would someone from the program (director/supervisor or educator) call the parents if there was intention to report? Why, or why not? (answer: no. In the case of sexual abuse, educators/directors do not clarify their observations with the parents. This would increase the chance of putting the child in danger of further maltreatment or manipulation of the child’s story; the offender fleeing or convincing others of his or her innocence; or the parents retaliating on the alleged offender)

8-28

HERE’S THE ANSWER—WHAT’S THE QUESTION? Here’s the answer. emotional abuse physical abuse, emotional abuse, sexual abuse, neglect, and exposing children to family violence occurs when caregivers fail to meet the child’s physical, emotional, and social needs the child is often aggressive or acts out the child sets unreasonably high expectations for her- or himself the child has an unusual level of sexual knowledge or sexual play for his or her developmental level the child continues to ask for helpings of food at lunch beyond what seems like a reasonable amount the child is in psychological and physical danger, often living with threats, fear, and feeling powerless we can’t predict the outcomes that children will or won’t experience as a result of maltreatment firm but not excessively restrictive, and does not involve humiliating or shaming responsiveness and discipline

What’s the question? Exposing children to family violence is what category of maltreatment? What are the categories of maltreatment? What is neglect? What is a possible behavioural indicator of physical abuse? What is a possible behavioural indicator of emotional abuse? What is a possible behavioural indicator of sexual abuse? What is a possible behavioural indicator of neglect? What is a possible behavioural indicator of witnessing family violence? What is an important statement about the consequences of maltreatment on a child? What is appropriate discipline?

What are two components of effective parenting skills? spanking (corporal punishment) that is not What form of discipline is not against the considered “excessive” law? prevention and community support services What is the child protection agency’s priority? listen to and support the child; consult with What is the role of the educator when a the local CPA child discloses maltreatment to her or him? educators provide a secure environment for What is a role of educators in tertiary the child and support for change in parents prevention? who are known to be abusive an educator’s professional role in secondary Why do educators need to document prevention, to be used by CPA in observations and possible indicators of investigation child maltreatment?

8-29

ensure that educators have ECE training, implement positive child guidance practices and consistent implementation by staff the fear that maltreatment has not occurred or cannot be proved

How can program policies and procedures play a role in primary prevention?

Why may educators hesitate to report their suspicions of child maltreatment to the child protection agency? it is ultimately the educator’s legal What action must educators take if the responsibility to call the local CPA director discourages them from reporting suspicions of child maltreatment to the child protection agency? an infant or young child is shaken violently, What is abusive head trauma? usually by a parent or a caregiver (e.g., babysitter) a range of feelings that may impact a child What are emotional indicators for children who has been maltreated, such as fear, self- who have been maltreated? blame, and hopelessness short- and long-term health effects of this What does female genital mutilation/cutting practice can be physically, emotionally, and result in? socially devastating to the girls and women subjected to it

8-30

CASE STUDY—JU-LONG Ju-long, six months old, has been in your infant room for three weeks now. He still cries for most of the day, especially when anyone puts him down. Your attempts to talk to the parent about helping him settle in the morning haven’t worked. His mother rushes in, seems very anxious, and leaves, avoiding eye contact with anyone. Mrs. Liu has come to Vancouver as a refugee from China and is working part time in a factory while she attends full-time English classes. She is living in one room of a house with three other people who fled their country together. Ju-long’s father died during the voyage. Finally, you realize that requesting a translator is an absolute must so that you can communicate with the mom about Ju-long. There doesn’t seem to be a relationship developing between him and any of the three educators in the room, and you are concerned about his emotional well-being. Mrs. Liu agrees to meet with you and the translator, but her look of terror has you puzzled. When you meet, she explains through the translator that she is terrified that Ju-long will be taken from her by the authorities because they are refugees. You try to assure her that you are simply asking her to help Julong in transition to the ECLC program. The next day, upon changing Ju-long’s soiled diaper, you need to wash higher up his back and notice a dark bluish area at the base of his spine. Neither you nor other educators had seen it before.

8-31

CASE STUDY—CAROLINE After a week’s absence, Caroline returned to the program today at 9:30 a.m. She entered the room quietly, rather than with her usual energetic bounce. She didn’t respond when you welcomed her back or to her friends’ happy greetings. Clutching her teddy bear, she retreated into the dramatic play area by herself. At 9:35 a.m. you approached Caroline and overheard her talking loudly to the bear: “If you cry any more, I’ll give you something to cry about.” She looked afraid when she noticed you standing next to her. As you were talking with Caroline, you placed your hand on her arm, and she winced with pain and said, “Ow! My arms hurt!” When you lifted up the sleeves of her T-shirt, you saw several oval-shaped green-yellow bruises on both the front and back of the upper arms. When you asked her if she hurt anywhere else, she complained that her legs were sore. You and Caroline went to visit your director. Caroline agreed to show you her legs and you saw six more similarly sized, shaped, and coloured bruises on the back of the thighs. When you asked Caroline what happened, she replied, “Mommy used the ‘hurting brush’ when I wouldn’t go to sleep. I was bad.” You and your director recalled similar behaviour from Caroline twice before. Both times, she had healing bruises on various parts of her body. For a number of reasons, you have been concerned about the possibility of physical abuse. While trying to maintain your objectivity, you had wondered about the mother’s ability to cope lately. For example: •

Several times Caroline had not been picked up by closing time, and when you reached the alternative adult, Caroline’s mother hadn’t told her that she may be late.

•

Whenever you or the director asked the mother if there was anything you could do to help, you were told by her to mind your own business.

Group Discussion: 1. Do you think that you would have documented any information before today? And if so, specify. 2. How would you proceed today?

8-32

CASE STUDY—RAYYAN Rayyan’s mother, Nabila, attends the morning ESL classes in the adult learning centre, where there is also a Community Health Centre in the building. The Community Health Centre supports students who are parents by having a morning program available for the children while the parent is in class. As the manager of Family Programs, you ensure that you are there to greet the families (with the staff) when they come every morning. You have met both parents, as all three (Nabila, Anwar, and Rayyan) came in for the initial interview. Although there was an interpreter present, Anwar did all the talking, and you thought that was because he is much more confident in English than is Nabila. Nabila drops Rayyan (18 months old) off each day before ESL class. One morning, after being in your program for two months and seeming settled and content, Rayyan came in with red marks around both his wrists. After a friendly hello to both mom and son, you noticed the marks and asked Nabila about them. Nabila did not hesitate when she stated that Rayyan loves putting elastic bands around his wrists, and neither she nor Anwar had seen those before Rayyan went to bed in his crib. Nabila continued to say that when he woke up, Rayyan showed them to Nabila, indicating with his body language that he wanted them off. You wished Nabila good luck in her test that morning and thought about the conversation. You thought that it sounded like a reasonable explanation. For the next two weeks, Rayyan often would cry for an extended period of time after his mother left in the morning. The ECLC staff needed to call Rayyan’s mother out of her class periodically to calm Rayyan down. Nabila said that Rayyan was having sleeping difficulties and was waking up in the middle of the night and getting out of his crib. It was affecting everyone’s sleep, and Anwar needed to be up at 5 a.m. for work. The ECLC staff invited Nabila to stay after class so they could discuss some strategies that might help Rayyan sleep more soundly. Nabila said she could not stay today, but maybe another day. The educator said that any morning after class would be fine. One morning (March 15th), Nabila came in late and was in a hurry to get to class. She looked visibly upset with tears in her eyes, and when you asked if she was feeling okay, she said, “Okay, just late.” You offered to change Rayyan’s diaper. When Rayyan was on the change table and you were about to put on the new diaper, he began to cry and wince in pain. You noticed that Rayyan had red braided marks on both thighs, front and back.

1. Identify step-by-step all of the actions that you would take in the process, and when. Be specific. 2. Document indicators. 3. Would you discuss your concerns with the child’s mother? Why, or why not? 4. What strategies might you use to seek guidance or support for yourself?

8-33

CASE STUDY—LAUREN Lauren is a delightful four-year-old child with excellent verbal skills. She tends to “mother” the other children in the playgroup. Lately, you’ve noticed that Lauren frequently expresses worry about her baby brother and her mother, Joy. Mom and baby brother are in the adjoining room of the OEYC, where caregivers and infants/toddlers can meet and watch their children while the preschoolers are in the next room with the educators and an emergent curriculum program. For the last two weeks, Lauren has been asking to go to the other room to see her baby brother, Paul. If she is not with Paul, she is peering over the half door of the preschool room, observing Paul. It is becoming increasingly harder to encourage her to rejoin her group in the preschooler room. If you attempt to redirect her, she begins to cry and physically resists moving. When you meet with Joy, you describe her daughter’s behaviour and express your concern. You ask if she has noticed similar behaviour. Joy indicates that Lauren is like a little mother to Paul and has started to sleep in Paul’s room. Lauren makes a fuss if Joy tries to get Lauren to return to her own bedroom. You inquire about possible changes or events in Lauren’s life that might explain her seeming concern about Paul and her mother. Joy says everything is fine but that things have been a little rough between Lauren’s father and herself. You ask if Joy or the children are being hurt when it gets rough. Joy describes her husband as a good father who is going through a difficult time after losing his job. She explains that his nerves aren’t very good because she spends so much money on diapers and baby formula. Joy suggests this may be why Lauren is worried about Paul, but she is adamant that her husband has never and would never really hurt a child. You reply that it is good her husband has never hurt the children. You ask her if he sometimes gets physically rough with her when he really gets upset and worried. Joy indicates that this does not happen often. When you mention the local shelter, Joy quickly says she knows all that.

1. Document any indicators of suspected child abuse or family violence. 2. Document the facts without personal judgments, opinions, conclusions, or medical/emotional diagnosis: • • • •

Give a clear description of the situation—what was actually seen or heard, and not what you think might be happening. Include what you did or said, and why. Describe any gestures made by a child (e.g., hitting motions, sound effects). Make sure the entry is complete, then sign and date it.

3. What action would you take, if any? Why, or why not? Be specific. 8-34

UNIT

Supporting Children’s Development

CONTENTS CLASSROOM ACTIVITIES AND DISCUSSIONS..........................................................................2 Critical Thinking.................................................................................................................................... 10 First (refer to text page 541) .................................................................................................................... 10 Second (refer to text page 552) ............................................................................................................... 10 Third (refer to text page 554) .................................................................................................................. 11 Fourth (refer to text page 565) ................................................................................................................ 11 Assess Your Learning ............................................................................................................................ 12 Resource Materials for Teaching........................................................................................................... 14

ANCILLARY MATERIAL ..........................................................................................................15 Bread ................................................................................................................................................... 15 Bannock (early Canadian, originally Scottish) ....................................................................................... 15 Chapatis (Indian) .................................................................................................................................. 16 Tortillas (Mexican)................................................................................................................................ 16 Very Hungry Caterpillar Veggie Dip ....................................................................................................... 17

HERE’S THE ANSWER—WHAT’S THE QUESTION? ...............................................................32 SEXUAL DEVELOPMENT IN YOUNG CHILDREN ....................................................................34 Copyright © 2019 by Nelson Education Ltd.

9-1

Classroom Activities and Discussions Here’s the Answer—What’s the Question? (see handout, page 9-32) Healthy brain development, self-regulation, and relating to others: This unit only touches on these critical emotional–social aspects of healthy development, and so it is important that students know that this is introductory and that they need a much more comprehensive study of these and other aspects of emotional–social health, which will be covered in other courses in the ECE program (e.g., Child Development, Role of the Teacher, Principles of Curriculum, etc.). Obviously, if you have time in class, it would be beneficial for students to discuss how physical, social, and emotional well-being are interconnected in developmental health. Helping children cope with stress: In class, have discussions around Identifying Children Who Are Experiencing Stress (refer to text page 541), and Suggestions for Reducing Children’s Stress (refer to text page 542). Some very helpful resources are •

Kids Have Stress Too!® by the Psychology Foundation of Canada: https://psychologyfoundation.org/Public/Public/Programs/Kids_Have_Stress_Too /Kids_Have_Stress_Too_.aspx This website has a range of information on indicators, strategies, books for children, and books for adults, as well as information on their training.

•

Canadian Mental Health Association: https://cmha.ca/

•

Handle with Care: Strategies for Promoting the Mental Health of Young Children in Community-Based Child Care (2004), by the Canadian Mental Health Association and Hincks-Dellcrest Centre. To download the PDF, visit https://www.sickkidscmh.ca/getmedia/5032842b-627e-4c88-b511f0f9eee9ed79/Handle-With-CareENGLISHBooklet.aspx

Sexuality:

9-2

•

To help students to relax and to lighten things up at the beginning of the class on sexuality, have students list all the slang words for male and female genitals and ask them if there is a difference between those used for males and females (e.g., often the males’ are powerful words versus females’, which may be derogatory and overtly sexual).

•

Using a blank overhead or the blackboard, have students list the ways we learn about sexuality (e.g., magazines, teachers, parents, stores, TV, videos, books, family, street, school, peers, TV ads, soap operas, toys, relatives, songs, children’s programs, cartoons, talk shows, sitcoms, home, news coverage, newspapers, music).

•

Distribute Sexual Development in Young Children (see handout, page 9-34). Ask students to take five minutes to answer the questions with: True, False, or It depends. Have a group discussion about each of the questions. Answer key to the handout: 1. False

8. It depends

2. True

9. False

3. True

10. True

4. False

11. False

5. False

12. It depends

6. True

13. False

7. True •

Present the following situation to the class, who is divided into smaller groups. Ask them to develop a response to the parents. Then have the class discussion. There are three slides: this scenario, a question, and some possible responses (listed below). As well, this is a Critical Thinking question (refer to text page 552). As an educator, how would you respond to the following scenario? A mother asks you to tell her four-year-old son that he is “bad” whenever you see him touch his penis. She tells you that the behaviour is morally wrong. Here are some possible responses: o Listen to and acknowledge the parent’s concern for her child, with assurance that it is a normal, natural behaviour for four-year-olds. o Let the parent know that guidelines for touching genitals or self-pleasuring are related to privacy. o Let the parent know the centre behaviour guidance policy—no child is ever told they are “bad.” o If the parent responds with, “No matter what anyone else says, this behaviour is against our beliefs,” you may be able to compromise—e.g., you redirect the child to another activity without giving the message that he is “bad.” o Ensure that resources are available, such as printed materials, parent phone line, etc., regarding children’s sexual health.

9-3

•

Welcoming and Celebrating Sexual Orientation and Gender Diversity in Families: From Preconception to Preschool by the Best Start Resource Centre (2012). To download the PDF, visit https://www.beststart.org/resources/howto/pdf/LGBTQ_Resource_fnl_online.pdf The entire resource is relevant reading for all of us. However, if there is limited time, have students read from the beginning to page 15, and then the section Early Childhood Education and Care (pages 34–39) before having a classroom discussion (in small or larger groups) on the following questions: o How do assumptions about gender, sexuality, and family composition shape our everyday practice? o How do we embed awareness into the work we do every day in ECLC programs? o How do we create an LGBTQ-positive space? o How do we all benefit from inclusive spaces?

•

Contact your public health agency and inquire if they have a sexual health educator or another staff person who is knowledgeable in this area and would come and speak to your class, which provides students with an opportunity to meet and become familiar with another professional within the community with relevance to early childhood education.

Rhythm of the program—during placement (refer to text page 556): Identify different ways that children are able to rest and relax: •

The most obvious one is nap times, but is this a child-centred routine (e.g., nonsleeping children are expected to rest for half an hour, and then can get up and engage in quiet activities)?

•

Are there places where a child can go to be on his or her own (e.g., stimulus shelters)? Describe these places.

•

What are other ways/times children can relax? (refer to the examples on page 559)

Health curriculum: This may be a topic in the text that you do not have enough time in class to expand on or to discuss specific curriculum areas—you may feel that they will be covered in other courses.

9-4

•

Use Table 9.3 as a reference (refer to text page 567).

•

Small groups in class

•

Create and distribute a list of three or four ideas for health curriculum. Some examples for this exercise: o taking infants on a field trip to the science centre because there is an exhibit on healthy eating—inappropriate, based on the educators’ interests, not the children’s o doing a toothbrushing routine with toddlers, emphasizing that their teeth will get holes (called cavities) in them if they don’t brush for at least two minutes—inappropriate, can create fear in a child, and toddlers do not yet have an understanding of time (i.e., two minutes) o four-step production line for preschoolers making sandwich faces— appropriate, four steps tends to be a manageable recipe for preschoolers o school-agers learning different types of dances weekly in the gym during the winter months. Educators had found that the children weren’t moving around much outdoors. Also, the children were interested in taking turns showing their peers a traditional dance or the latest dance steps they had learned— appropriate, fits most of the guidelines.

•

Ask students to identify if each idea is a developmentally appropriate curriculum: 1. If yes, which of the guidelines in Table 9.3 are being met with this curriculum plan? 2. If not, what are the inappropriate health curriculum practices?

Environmental health education: Depending on your geographic location, climate, etc., particular environmental issues will be more relevant than others. Choose one issue most relevant to your community for a discussion with your students in either small groups or as a class on this topic’s relevance as health curriculum for children and, if so, for what age group(s) is it most appropriate? Discuss how this program would be delivered. There are many national, provincial/territorial, and municipal agencies related to environmental issues that you may decide to refer to. One website link you may be interested in for this classroom discussion is the Canadian Partnership for Children’s Health and Environment (CPCHE). To access their fact sheets and brochures, visit http://www.healthyenvironmentforkids.ca/collections/cpche-fact-sheets-feuilletsdinformation-du-pcsee Nutrition education: •

Bring to class: a large piece of poster board or cardboard, markers, pencils, food magazines and/or coloured grocery flyers for pictures of food, and cookbooks for children.

9-5

•

In small groups, have students create recipe cards for a simple recipe (between four and eight steps), and then share with the class (refer to The Five Ws of Cooking with Children, in text page 579).

•

Provide students with examples of nutrition activities (e.g., food preparation ideas) for a particular age group, and ask the class (either in groups or as a class) what developmental opportunities are involved (i.e., what the primary and secondary objectives are of each activity). Note: This exercise can be done in any areas of health curriculum.

Oral health education: •

Contact your public health agency to see if they offer an oral health education program or other topics for ECLC programs and schools (e.g., often puppet plays), and invite their staff person to conduct it with the students. After the guest leaves, explore with students whether this program was developmentally appropriate for the intended age group, and if not, how can it be modified? Perhaps the instructor can relay constructive feedback to the presenter in the near future.

•

ECTD is an important issue and it includes infants, toddlers, and preschoolers around the consumption of sweet beverages. Bring in pictures from dental/medical texts or journals, or online images and talk about what happens to the child’s teeth.

•

Invite a dentist or dental hygienist to speak to the class about oral health, caries, brushing tips with children, ECTD, etc.

•

See Winnipeg Regional Health Authority’s Early Childhood Tooth Decay in Resource Materials for Teaching, page 9-14.

Hand washing and germs: •

Review some of the ideas for songs, finger plays, dramatic play ideas, etc.

•

With school-agers, use petri dishes and/or Glo Germ (see Unit 3’s Classroom Activities and Discussions, page 3-2).

Toilet learning (refer to text page 569): This topic warrants discussion of toilet-learning issues, such as the following:

9-6

•

cloth versus disposable diapers (children’s awareness and motivation may be affected by wetness—where they do not feel wetness in disposable diapers)

•

the importance of seeing this developmental milestone as “learning” rather than “training”

•

how it is handled by adults (e.g., avoid shame, humiliation) affects the child’s self-esteem

•

how the desire to use the toilet can be affected by peers—when friends are using the toilet or are in transition, the child may be more interested

•

possible fears of the child and how to support the child’s emotions and coping

Food experiences with children: Students may have a challenging time planning, facilitating, and evaluating food experiences with children. A wonderful teaching tool is to ask staff in your lab programs (if applicable) or another community ECLC program whether you can videotape the setup and implementation of one of their experiences with children. Obviously, you will meet with the staff ahead of time and discuss criteria that you will be using in class so that the experience is as positive as possible for the children, staff, and you (as well as your class). You will be ensuring that all necessary permissions are taken care of, and that you view the video with the staff before showing it in class to get feedback and permission for what you would like to say about it. It is ideal if you can get video coverage of food experiences with different age groups. Rainbow Plate delivers evidence-based, interactive food education programs to children, parents, educators, and health practitioners. Put simply, they help people to relax around food. Rainbows of real food (fruit and vegetables) spark imaginations, make healthy eating simple and fun, and cultivate lifelong healthy eating habits. Refer to the website to order the new Rainbow Plate Resource Kit. See Resource Materials for Teaching, page 9-14. Making snacks: If your budget permits, it is worthwhile to demonstrate using recipe cards and real food with students. For example, pick a recipe from Gimme Five! Kid-Friendly Recipes and Tips for Helping Your Child Enjoy Eating Fruits and Vegetables by N. Graimes: •

Set up each card with the designated food in front of each card.

•

Students can make the salad in a production-line format.

•

Although you will bring in a real pineapple as well, to simplify it, use cans of pineapple chunks for this activity.

•

To reduce garbage, ask students to bring in their own reusable cup/bowl and utensils from home.

•

Although you lose authenticity, if you don’t have enough chopsticks, craft sticks can be used.

•

For a more complete experience, have students grow the bean sprouts (keep in your office) before you conduct this activity in class.

Educators have plans to incorporate a doctor/hospital space in the preschool’s dramatic play area. One of the parents provided them with two sterile syringes (without needles) Copyright © 2019 by Nelson Education Ltd.

9-7

for the children to play with. A debate arose about whether providing children with syringes was appropriate. Some educators feel that this would help children work through their anxieties about vaccinations. Others are concerned about discarded syringes and needles frequently picked up in the playground. They regularly tell children that if they find one, they should leave it on the ground and call an educator. These educators feel that play syringes give children a mixed message. Which side of the debate would you join? Suggestions: Pros

Cons

Become familiar with equipment used for While familiarity may reduce anxiety, it vaccinations in the doctor’s office (i.e., can lead to carelessness around discarded syringes and needles in the playground, reduce anxiety). and children will pick them up. Having children in dramatic play provides Having them in dramatic play provides an an opportunity to teach important safety opportunity for children to use them inappropriately (e.g., pretend to give aspects during play. another child a vaccination with one found in the playground). Real objects are the most appropriate way Real objects used in play give the impression that specific objects are not to facilitate learning. potentially dangerous. Talking about these objects increases children’s awareness and safety, and they will be quicker at identifying them, know to leave them alone, and call the educator.

“Out of sight, out of mind”: if they don’t see them outside the doctor’s office, they are less likely to be looking for them in the playground; if used in dramatic play, they will be quicker to identify and pick them up.

You and the other preschool educators at your program are pleased that your toothbrushing routine after lunch seems to be working well for the children. Most of the preschoolers independently follow the routine with some support from the educators, and sometimes make comments such as, “My mouth feels clean” or “Brushing takes the food out of my teeth.” It is quite challenging to ensure that each child’s toothbrush does not touch the next one stored in the container, and a few times the container has toppled to the floor, requiring disinfecting all around. During the annual visit, the public health inspector was concerned about the risk of contamination, particularly because the name labels were coming off the wet brushes. 9-8

You and your colleagues now need to decide: Can you arrive at a more stringent procedure and storage arrangement, or should you discontinue the routine at the program while encouraging the children to brush at home twice a day? Suggestions: To Support Toothbrushing in the Program

Not to Support Toothbrushing in the Program

Children learn early that good oral health habits are part of your routine during the day.

It takes up time in your already busy day with children and adds one more transition (after lunch, before rest time).

It contributes to good dental hygiene and can contribute to prevention of dental caries and bacterial infections in the mouth.

It can spread disease if toothbrushes and containers are not kept clean and separate.

It can provide positive opportunities for interaction between adult and child as well as child and child through active supervision and an enjoyable routine (e.g., singing “Up like a rocket, down like the rain, back and forth like a choochoo train” while children are brushing.

It can be a negative experience for children if adults nag or don’t ensure time needed for children not to rush through the process.

It provides an opportunity for communicating with families (e.g., partnership in children’s oral health).

It can contribute to negative communication with families, if expectations for each partner are unclear (e.g., if parents are expected to bring in toothbrushes and toothpaste often, can add to parents’ stress, etc.).

Upon reviewing the above listed pros and cons (you can probably think of others) and talking with parents about it, the educators decided that toothbrushing at the program was definitely worth the commitment. Some of the adjustments they made to ensure that the public health guidelines were followed: •

Individual toothbrush containers were purchased by the program (from a dollar store), which hold one child’s toothbrush and toothpaste. They are available in the child’s cubby. Each child retrieves his or her container at toothbrushing time.

9-9

•

The routine is well supervised by the educators, ensuring that children are enjoying and following the routine—educators see this as an educational opportunity.

•

A new, larger mirror was installed to ensure that children can watch as they are brushing.

•

After brushing, each child wipes his or her wet toothbrush with a paper towel, reducing bacterial growth in the containers.

•

Containers are cleaned and disinfected every Friday as part of the cleaning routine for the staff.

•

A number of parents are interested in having a parent meeting with a guest speaker from public health or a dentist to discuss further oral health issues, such as flossing (to be done at home).

Critical Thinking First (refer to text page 541) Last week, two-year-old Priya, who had just started using the toilet, slipped while seated and almost fell in “bottom first.” She now refuses to use the toilet again and cries and points at it whenever she needs to go but insists on wearing diapers. Priya’s mom has requested to bring in a potty as Priya feels safe with it and uses one at home. However, the public health department has a policy against potties for hygiene reasons. How can you support Priya in coping with her fear? Suggestions: Fear of using the toilet is common for toddlers; as with all children’s fears, it is important to recognize that it is real to the child; many children are not developmentally ready to learn to use the toilet at two years old—suggest that this process can wait until the child indicates readiness (this could be several months); once she is ready to try, ensure that her feet are supported when she is sitting on the toilet, and after standing up, let her have control of flushing. Second (refer to text page 552) A mother asks you to tell her four-year-old son that it is “bad” whenever you see him touch his penis. She tells you that the behaviour is morally wrong. How would your conversation with her proceed? Suggestions: It is important to let the parent know that you won’t be able to carry through with her request; the program’s child-centred philosophy ensures that no child is ever told that they are bad; educators communicate to children that their behaviour is inappropriate when applicable; a four-year-old touching his penis is a normal, natural behaviour, and guidelines for self-pleasuring are related to privacy; you could offer the parent some information on sexuality or suggest that she speak 9-10

with an expert on children’s sexuality (e.g., sexual health educator at the public health agency, family doctor); if she does not wish to do so and responds with, “No matter what anyone else says, this behaviour is against our religious beliefs,” you may be able to find a compromise (e.g., you could try to redirect the boy to another activity without giving him the message she is requesting of you); questions about sexuality from parents are often nerve-racking for educators as you want to respect the family’s values but also maintain respect for the child and the program’s integrity; all of this must be balanced through negotiations. Third (refer to text page 554) An ECE student who is pregnant is approached by an eight-year-old boy, who asks, “How did you get pregnant? Were you raped?” The student responds angrily, “That’s not a very nice question. Do you know you could hurt someone’s feelings by asking that?” How would you respond? Suggestions: Rather than taking this question personally, it is more appropriate to try to find out “where it’s coming from” (i.e., “Why do you think I was raped?”); there is a range of possible reasons that this child may have asked this question. Perhaps: •

He saw a rape on TV or video and the victim subsequently became pregnant.

•

He has heard the word but is confused about its meaning and is trying to check it out.

•

Someone he knows has been a survivor of rape and perhaps became pregnant as a result.

•

He has much more knowledge about sexuality and violence than most of his peers. This could be due to a number of reasons, one of which is sexual abuse.

•

He is trying to shock a new student and he knows that the word “rape” will get a reaction.

It is important to document this occurrence if you have concerns about the child’s knowledge. How the child responds to your question will determine how you proceed. Don’t overreact or alarm the child. In any case, the ECE student must let an educator know about the child’s question and the conversation. The educator has a bigger picture because she or he is much more familiar with the child. Fourth (refer to text page 565) Your partner in the preschool room searches the Internet on a regular basis for finding curriculum ideas. She has found a theme-based set of activities on learning about germs, all of it focusing on children learning that germs are not visible to the naked eye, they are everywhere, and we must kill them all. What feedback will you offer, and what would you suggest as an alternative? Copyright © 2019 by Nelson Education Ltd.

9-11

Suggestions: Eliminating germs or sterilizing one’s environment is an impossible task and not a goal for any ECLC program; eliminating all exposure to germs does not support the development of children’s immune system; developmentally and culturally appropriate ECE curriculum is not theme-based; themes imply a cookiecutter approach that tends to be more adult- than child-directed; use the children’s development skills and interest to plan curriculum; refer to Table 9.3, text page 567.

Assess Your Learning Evaluate your options in each situation. 1. You overhear an ECE student say to a three-year-old, “You have to play with Daniel. We are all friends at daycare.” Suggestions: In peer relationships, it is important to avoid an “I know more than you do” attitude. However, as a learner, it is also important to question practices that seem incongruent with what you have read or what teachers have taught. Find an appropriate time, usually not at that moment, to speak with the other student and say, “I noticed you told Jamie that he has to play with Daniel. From class, I understood that although everyone needs to respect each other, no one should be expected to be friends and play together unless they would like to. Just like adults. Is that what you heard, too?” If the ECE student tells you that she is simply repeating what she’s heard an educator say to children, find an opportunity to discuss your confusion with this educator. It may be that the educator uses that phrase without really thinking about it and would use this opportunity to reevaluate. If not, can the educator offer you reasons for using this phrase? You can evaluate whether or not her reasons are child-centred. 2. A parent approaches you and asks that you do not allow his son to play with his friend Brent, because Brent likes to play with dolls and dress in girls’ clothes. Suggestions: Educators can seek out resources to help build their knowledge and understanding of gender identity and communicate respectfully with all families in their program to best support them. While many adults think that “boys will be boys,” typical male (or female) behaviour isn’t as biologically determined as many of us think. Gender identity is far from being fully formed at birth; it continues to develop throughout early childhood. Many parents challenge their preconceptions and anxieties when preschool children engage in play that may not be considered typical of their gender. This type of exploration is actually healthy and even necessary, although that doesn’t make it any less puzzling to parents. The first few years of life are a time for children to try out different gender roles and explore what it means to be a boy or a girl. Starting around age five, most children experience an intense period of identification with their own sex. “Boys usually become supermacho and girls superfeminine,” explain Galinsky and David, authors of The Preschool Years (see Resource Materials for Teaching, page 9-14). “They can be very unforgiving of a 9-12

child who hasn’t reached that point.” Currently, we may be on the edge of a new children’s culture in which differences won’t exist between what have been considered girls’ and boys’ toys, such as dolls and diesel trucks. With reference to the above content, when the educator has built some knowledge on this issue, two good suggestions to the parent are the following: •

Have a private discussion with the parent and ask why he would not like his son to play with Brent, even though they are close friends. A likely response would be that the parent is concerned that his son will become more like a girl than a boy if he plays with dolls and wears dresses. Be prepared to share information such as gender identity is far from being fully formed at birth and continues to develop throughout early childhood; this type of exploration is actually healthy and even necessary; and starting around age five, most children experience an intense period of identification with their own sex.

•

Offer resources (e.g., specific websites/books) for the parent’s reading if he agrees.

Note that all children need to be shown respect by their peers, and that individuality in children is natural. 3. An eight-year-old in your program is being teased by her peers for being so tall. Katie has been growing quickly lately and is much taller than the rest of the children. She storms off crying, and when you go to comfort her, she asks you, “Will I always be different from everyone else? I hate being tall.” Suggestions: Validate her feelings; because she has grown so quickly, it will take some time for her to feel comfortable in her own skin; assure her that many children are teased about something that makes them unique; help to find ways to see her height as an asset (e.g., what she can do that others who are shorter can’t do); it is natural that some children grow taller more quickly than others of the same age, but eventually, many will be the same height as her; help her develop strategies for positive self-talk. 4. You and a classmate have been asked to plan a curriculum to help preschoolers learn about poison prevention. You agree that it would be a good idea to bring in real objects. Next day, your colleague arrives with a bag of potentially hazardous products, including oven, window, and toilet cleaners used at home. Suggestions: Without making your partner feel incompetent, it is important to acknowledge the effort while identifying the potential hazards. Perhaps starting the conversation with a comment like, “These are great examples of the types of products that children need to learn to avoid. How can we get that message across to them without the children having access to these dangerous products?” (e.g.,

9-13

using empty containers instead, removing labels and pasting them on poster board, instant-camera photographs). 5. The program where you are doing a placement does not promote good nutrition. You are responsible for the weekly after-school cooking club and have submitted your plan to the educator. You would like to begin with simple recipes such as “dippidydoo and vegetables too” and move to more complex recipes, such as soups and breads. The educator discourages you with the comment, “This will never work. The children only want to make cookies and cakes.” Suggestions: Comments such as, “I hear what you’re saying. The children have a taste for sweet foods. I’d really like to try something different, though, to introduce them to a variety of nutritious foods. I’m going to make sure that I have a positive attitude about the foods and really try to involve them. I’ve heard that when children are involved in preparing foods, they’re more likely to try them. It’s worth the effort even though it isn’t as easy as preparing foods they’re more familiar with. I’d really appreciate your support.”

Resource Materials for Teaching Advancing Environmental Health in Child Care Settings: A Checklist for Child Care Practitioners and Public Health Inspectors (January 2010) by the Canadian Partnership for Children’s Health and Environment. To download the PDF, visit http://www.healthyenvironmentforkids.ca/sites/healthyenvironmentforkids.ca/files/CPCH E-AdvEnvHealthChildCare-lowres.pdf Canadian Dental Association: http://www.cda-adc.ca/en/index.asp The Preschool Years: Family Strategies That Work—from Experts and Parents (1991) by Ellen Galinsky and Judy David. New York: First Ballantine Books. Janet Gonzalez-Mena is a respected and prolific author on working and communicating with diverse families. Best Start Resource Centre provides a multitude and range of culturally relevant resources regarding Indigenous child development: https://www.beststart.org/cgibin/commerce.cgi?search=action&category=AB0A&advanced=yes&sortkey=sku&sortor der=descending Parentbooks: http://www.parentbooks.ca/ This Canadian retail bookstore maintains an extensive list of books for parents, educators, and children. Click “Browse Booklists” to display a wide range of subjects and topics that enable you to filter your search. Keep in mind that when you are looking at the list of titles for a subject, scroll to the end to see the titles relevant to children. Rainbow Plate: Healthy Eating Made Simple website: http://www.rainbowplate.com/

9-14

Winnipeg Regional Health Authority’s Early Childhood Tooth Decay website: http://www.wrha.mb.ca/healthinfo/preventill/oral_child.php (includes a range of documents and educational material that you can download as PDFs [e.g., Prevent Early Childhood Tooth Decay: Action Plan Workbook and Toolkit)

Ancillary Material Bread Multicultural snacks need not be exotic and expensive food bought at specialty shops. Start with a basic food such as bread. Avoid the butter-and-cracker trap and put a variety of breads on your snack plate instead. Slice them, stuff them, spread them, dip them, toast them, or cut them with cookie cutters to make interesting shapes. Some of the breads you may want to use are listed below. Bagels (Jewish) Baguette (French) Bannock bread (early Canadian) Bran bread Bread sticks, cheese sticks Buns Buttermilk biscuits Challah (Jewish) Chapati (Indian) Christonomo (Italian) Corn bread Corn tortillas (Central American)

Croissants (French) Date bread Fry bread (Navajo) Gingerbread Injera (Ethiopian) Irish soda bread Kamaj (Palestinian) Klaben (German) Knackbrod (German) Laufabrod (Icelandic) Matzot (Jewish) Muffins Nan (Indian) Pita (Middle Eastern)

Popovers Potato bread Pumpernickel Pumpkin bread Raisin bread Roti (Caribbean/East Indian) Rye bread Scones Steamed buns (Chinese) Taboun (Palestinian) Whole-wheat bread

Show the children photographs of people baking bread. Use Ann Morris’s book Bread, Bread, Bread (published by Lothrop, Lee, and Shepard, 1989) to give a photo tour of world cultures and the breads native to each. Then buy the bread or try your hand at making some. Unleavened bread or bread leavened by an agent other than yeast is best to make with young children because it is so quick. Try these recipes, adjusting quantities to suit the group. Each recipe serves about 20 children.

Bannock (early Canadian, originally Scottish) Ingredients: 750 mL flour

30 mL water

dash of salt

10 mL oil

9-15

1. Use a fork to mix all the dry ingredients. 2. Make a well in the dry ingredients, then pour in the water. 3. Mix the dough by hand, kneading it, then pound it flat. 4. Fry on an oiled griddle until puffy and golden on both sides.

Chapatis (Indian) Ingredients: 500 mL whole-wheat flour

175 mL water

2 mL salt Method: 1. Mix whole-wheat flour, salt, and water to form a stiff dough. Add more water if necessary. 2. Let the dough rest for half an hour, then roll into small balls. 3. Flatten the balls, then fry them on a very hot griddle until brown spots appear on the dough. 4. Take them off the griddle and brush with butter or serve plain.

Tortillas (Mexican) Ingredients: 625 mL corn flour

10 mL oil

250 mL water

10 mL butter

Method: 1. Mix corn flour with enough water to make a stiff dough. 2. Roll into small balls, then flatten with a rolling pin or tortilla press. 3. Fry in a lightly oiled pan, turning until cooked. 4. Brush with butter and serve. Source: Cech, M. (1990). Globalchild: Multicultural resources for young children. Ottawa: Health and Welfare Canada, pp. 43–44. 9-16

Very Hungry Caterpillar Veggie Dip This recipe is thanks to Diane Bergeron, School of Early Childhood, George Brown College. Measure 4 big spoons of yogurt into your bowl.

Now you can eat like a caterpillar!

Add 3 small spoons of mayonnaise.

On Monday she ate 1 broccoli

Use the whisk to stir it all together. Add 1 shake of flavouring.

On Tuesday she ate 2 celery stalks On Wednesday she ate 3 carrots On Thursday she ate 4 red peppers On Friday she ate 5 cucumbers

Ingredients: Depending upon group size: • • • •

1–2 large containers plain Greek yogurt 1 container low-fat mayonnaise flavourings such as Parmesan cheese, garlic powder, steak spice, in clear shaker bottles with large holes carrots, broccoli, cucumbers, red peppers, celery, all washed and pre-cut into servingsize pieces

Note that you will need to adjust the amounts since it is likely you will need less broccoli than cucumbers, since each child will likely have 1 piece of broccoli but 5 pieces of cucumbers. Tools Required Enough bowls for each child, plus a few to spare Tablespoon Teaspoon Whisk Copyright © 2019 by Nelson Education Ltd.

9-17

Scissors: pre-disinfected and child-sized, to cut the chives Shaker jars to contain flavourings (usually available from dollar stores) Tongs for children to use to select their vegetables Notes: • Teach the use of hand tools to achieve a result. • Introduce new vocabulary: “whisk,” “tongs.” • Make meaning of the printed word by expanding the idea presented in The Very Hungry Caterpillar by Eric Carle and reading the chart to imitate the caterpillar’s pattern in choosing vegetables.

Assignment Ideas 1. Individuals or groups of students develop a poster on one health behaviour for preschoolers (e.g., brushing teeth; hand washing; four food groups). 2. Develop recipe cards for preschoolers and school-agers. 3. Stress: This assignment can give students insight into one child’s stress factors, reactions, and ways of coping, and they can compare it with typical developmental stressors listed in the text. •

Ensure that you will not use the child’s name, and this information will be kept confidential.

•

Ask if you could speak to a parent of a preschooler or school-ager about what kinds of things have caused stress for her or his child over the years: o How have these stress factors changed with development and new experiences? o What are the ways to reduce or alleviate the stress? o Has the child learned ways to cope or reduce the stress reaction?

4. Health curriculum. Here are a few ideas:

9-18

•

Choose a topic other than the four discussed in the text and develop integrated health curriculum for infancy through to school-agers.

•

Select three children’s books on the same topic (e.g., toilet learning, rain forest, self-esteem, oral health) to review for age appropriateness and other criteria you provide. You may find it helpful for students to submit the three books with their Copyright © 2019 by Nelson Education Ltd.

assignment; ask students to renew any books from the library just before this assignment’s due date to avoid any overdue book fees. •

Create a curriculum plan for a cooking experience with children, including safety issues and objectives for learning, and if planned for preschoolers and schoolagers, submit recipe cards. Create a curriculum plan around greening your ECLC program that includes involving preschoolers and school-agers. See the “Checklist for Creating Healthier, Greener Child Care Settings” (pages 9–15) in Advancing Environmental Health in Child Care Settings: A Checklist for Child Care Practitioners and Public Health Inspectors (see Resource Materials for Teaching, page 9-14).

Some elements of this assignment include the following: •

Ensure that the student follows the 5 Ws of Cooking with Children (refer to text page 579) (e.g., foods need to be nutritious, adult–child ratio must be low).

•

Include developmental reasons/children’s interests for choosing a particular experience.

•

Show how the experience supports an anti-bias approach.

•

Examine health and safety considerations before, during, and after the experience.

Test Questions Healthy Brain Development Objective: To outline educators’ roles in supporting each child’s emotional well-being in terms of the child’s self-regulation, relationship development, stress levels, and sexuality. (LO 1, 2, 4)

•

(T or F) Three- and four-year-old children explore sexuality through play with dolls and peers.

•

(T or F) Preschool boys do not have erections.

•

(T or F) Children’s sexuality is not important until they reach puberty.

•

(T or F) Early development is linked with susceptibility to later disease.

•

(T or F) The human brain in early life is far less “plastic” than in adulthood.

9-19

•

Identify each of the following statements as true or false with regard to LGBTQ families: o (T or F) An educator who is either subtly or overtly disapproving of a family’s structure is not having a negative effect on a child or family’s emotional wellbeing. o (T or F) Being an LGBTQ-positive professional means being willing to spend some time reflecting on your earliest beliefs about LGBTQ people and, often, to challenge these beliefs. o (T or F) Educators can seek out community resources to help build their knowledge and understanding of LGBTQ families and communicate respectfully with all families in their program to best support them.

•

Identify each of the following statements as true or false with regard to gender independent children: o (T or F) May strongly and consistently identify with a gender role that differs from their natal sex. o (T or F) Gender independent children are not diverse. o (T or F) May be comfortable in their assigned sex but behave in ways that do not conform to social norms, such as preferring clothing and activities associated with the other gender. o (T or F) In the majority of situations, gender independent behaviour is simply a natural expression of the diversity of human experience. o (T or F) If provided the space to explore a range of activities and gender identities, most will grow to feel comfortable in their assigned gender role.

•

Which of the following statement(s) is/are true? a. Adult responses to the child’s sexual behaviour will be important in the child’s feelings of the goodness and badness of sexual matters. b. When children do not have access to the facts about sexuality, they are less likely to worry about it. c. Most young children do not touch their genitals for pleasure. d. We have sexual feelings and responses from the time we are born. e. a, c, and d only f. a and d only

9-20

•

Self-regulation refers to a. the ability to focus attention, control emotional energy, and recover from intense emotions b. rules in the program that foster self-control c. children’s understanding of rules d. the ability to make friends e. none of the above

•

Relating to others refers to a. the child’s relationships with family b. the ability to build relationships c. different age groups playing together d. conflict resolution e. none of the above

•

Self-pleasuring is a. another term for masturbating, and more closely describes the child’s intent b. a healthy behaviour that is done in private c. not appropriate at any time d. a and b only e. a and c only

•

With regard to questions about LGBTQ sexuality, what is important for adults to focus on is a. the sexual act b. the suggestion that people shouldn’t talk about this topic c. the caring part of the relationship d. the negative attitudes that many people hold about LGBTQ sexuality e. none of the above

9-21

•

Which of the following statements about a child’s temperament is false? a. is biologically based, part of the unique wiring of the individual’s nervous system b. is chosen by the child c. shapes the way we experience the world and interact with others d. is the collection of characteristics—emotional intensity, sensory reactivity, activity level, adaptability, persistence—that makes each of us who we are

•

For each statement, indicate which age group is most appropriate: I) infant T) toddler P) preschooler S) school-ager possibly self-pleasure in public, though most of them understand privacy rules have concerns regarding genitals (e.g., boys worry about their penis falling off) activities such as bouncing, swinging, jumping may produce sexual pleasure increased interest in others’ genitals, an interest heightened by learning to use the toilet ask questions like why girls and boys are different, where babies come from ask questions like how do babies get into a uterus or what does “lesbian” mean (answer: S; P; I; T; P; S)

•

Shankar (2013) states that the dynamic nature of self-regulation has five levels operating. Identify one of the five levels not listed below: 1. biological 2. emotional 3. cognitive 4. ___________ (answer: social) 5. reflective thinking skills

9-22

•

___________ stress response refers to when a child experiences strong, repeated/continuing adversity without adequate adult support, which can have lifetime effects on physical and mental health. (answer: Toxic)

•

____________ stress response could have been traumatic or long term but primarily due to support from caring adults to adapt to the event, there is not likely long-term damage to child’s health. (answer: Tolerable)

•

__________________ is normal and healthy stress for children, characterized by brief increases in hormone production and heart rate. (answer: Positive stress)

•

Partnerships between ________________ and educators are essential in supporting children’s well-being. (answer: parent(s) or family)

•

Define the term “self-regulation.” (answer: refer to text page 533)

•

The Best Start Panel on Early Learning identifies that making friends is the dominant social domain skill for preschoolers. List three (3) indicators of a child’s developing skills. (answer: refer to text page 536)

•

List two (2) ways that children are constantly learning about their sexuality from adults. (answer: listen; observe how adults interact with each other, react to events and comments, etc.; absorb attitudes that are communicated in adult conversation and action; interact with adults)

•

What are three (3) ways that educators positively contribute to children’s sexual learning? (answer: help them feel proud and in control of their bodies; help them value their gender; encourage knowledgeable and responsible behaviour; serve as role models; help to protect children from exploitation or sexual abuse)

•

List the three (3) key points when answering children’s questions at any age. (answer: clarify what the child really wants to know; find out what the child already knows; if you can’t answer immediately, be sure to get back to the child soon)

•

List two (2) patterns of normal sexual development in each age group: o Infants-toddlers (answer: early experiences with being held, sucking, etc., foster positive self and relationships; exploring body, including genitals; bouncing, swinging, jumping can produce sexual pleasure; toddlers—learning words for private body parts and toileting, increased interest in others’ genitals) o Preschoolers (answer: concerns regarding genitals [e.g., boys—penis falling off, girls—where is penis]; self-pleasuring; observing each other during washroom routines; sex play; ask educators questions [e.g., how body works, where babies come from])

9-23

o School-agers (answer: sex play; self-pleasure, most likely in private; use slang or profanity for private parts, sexual acts, etc.; ask educators questions [e.g., how babies get into a uterus, what those animals are doing]) •

Give five (5) of the more common signs of possible stress in children. (answer: seems sad, whining a lot, or has frequent temper tantrums; clings to educators/hasn’t connected with at least one educator; constantly worried; complains about physical symptoms [e.g., headaches]; seems to be tired, run-down, often is sick; has nightmares; bodily functions not working properly; self-stimulates constantly; drastic change in behaviour; developmental regression)

•

Identify four (4) strategies that educators can implement in creating a stress-aware environment. (answer: provide secure, calm environment where schedules, routines, and transitions contribute to stability; maintain an emotional climate of trust; be calm and provide security for children; recognize and respond to children’s feelings, taking your cue from the child; create a curriculum that supports the development of children’s learning about self; help children develop coping skills through responding to needs and cues; create developmentally appropriate stimulus shelters; help children broaden their repertoire of coping strategies)

•

List three (3) examples of coping strategies that educators can help children develop. (answer: deep breathing; stretching exercises or relaxation exercises; small-group discussions; helping children identify their own stress releases; helping children identify what causes their stress reactions, and how they can prevent them; conflict resolution)

•

Ekwaamjigenang, a “living document,” includes the principles for the Gaabaagang (gives children a space of their own). List three (3) of those principles. (answer: encourage and support children’s self-control and regulation; foster kindness and respect of children; allow children to take time to calm down until they are ready to act with a clear mind; allow children to be in a better frame of mind, which in turn allows them to be open to discuss what happened and what needs to be done; help children form positive beliefs about themselves, their world, and their behaviour; support children struggling with emotional regulation and help them identify and validate their feelings)

9-24

Rhythm of the Program Objective: To describe essential principles in planning and carrying through with a program that recognizes children’s needs for sleep, rest, and physical activity. (LO 2, 4, 6)

•

Sleep hygiene is a. a variety of different practices and habits necessary to have good nighttime sleep quality and full daytime alertness b. having a bath before going to sleep c. known to have a paramount role in brain and cognitive development of young children, beginning very early in their development d. a and c only e. none of the above

•

Regarding sleep in young children: a. There is a critical maturation period of the nervous system during which sleep plays a key role. b. Adequate sleep helps structure the foundations of language from six to seven months of age. c. Insufficient sleep for young children contributes to emotional and behavioural problems later (at five years old). d. Insufficient sleep contributes to possible weight gain leading to childhood obesity. e. all of the above

•

The rhythm of a program refers to the pace of daily routines and activities. It is influenced by several factors; name three (3). (answer: the ages of the children, group size, ratios, interests of the children, time of day, weather, space available, mood of the group, and individual children)

•

What needs to be balanced when considering the rhythm of the program? (answer: adequate opportunities for physical activity, cognitive stimulation, and nutrition with opportunities for rest and relaxation, safety, and infection control; needs of the individuals with needs of the group)

9-25

Health Curriculum Objectives: To identify and describe four factors that influence children’s understanding of health. (LO 4) To discuss the guidelines in developing an appropriate health curriculum and identifying inappropriate practices. (LO 3, 4) To identify developmental health needs and interests for each age group. (LO 3, 4) To offer suggestions for integrating the health curriculum in each age group on topics such as environmental education, oral health education, and hand washing and germs. (LO 3, 4, 6) To identify the who, what, when, where, and why of cooking with children. (LO 4) To discuss how educators promote oral health with each age group. (LO 1, 4)

•

(T or F) Plaque is a thick, sticky bacterial layer that is constantly on our teeth.

•

(T or F) Toothbrushes only need replacing when lost or used by someone else by mistake.

•

(T or F) Health curriculum around hand washing and dental education is based on an ongoing routine in the program.

•

(T or F) Early childhood tooth decay refers to chronic ear infections that young children can get from drinking from a bottle in bed.

•

(T or F) Consuming more fluoride each day will make your teeth even stronger.

•

Bottle propping: a. can cause early childhood tooth decay b. is an appropriate way to feed babies when educators are busy c. can increase the risk of ear infections d. may cause choking e. all of the above f. a, c, and d only

9-26

•

Bottle propping or putting children to bed with a bottle is not good practice because a. the child could choke b. the liquid, unless it is water, contains sugar, which stays in the mouth and contributes to tooth decay c. young children do not benefit from extra sucking d. a and b only e. b and c only

•

The ideal situation for cooking experiences with preschool children is a. at group time when all children can be involved in a circle b. at group time when all the children can be divided into two groups c. during play time with a small group of interested children in a low-traffic area d. during play time with a small group of interested children in a busy area

•

Identify which of the following statements is not a health curriculum guideline: a. focuses on the children’s developmental needs, interests, and level of understanding b. is based on themes so that a health area is highlighted for a week c. builds self-esteem and competence, moving from the simple to the complex d. has clear and reasonable objectives for children’s learning based on developmental areas e. is flexible so that educators can take advantage of teachable moments or one-toone interactions

•

Fluoride: a. is a mineral that strengths tooth enamel to help prevent cavities b. is added to everyone’s tap water in Canada c. overconsumption can cause discoloration of the teeth d. a and c only e. all of the above

9-27

•

For each statement, write in the letter (A, B, or C) that identifies which factor is most influential in the child’s understanding of health: A) stage of cognitive development B) personality characteristic C) family connection D) peers, their community, and the media “I’m sick—see, I scraped my knee.” Rishma says that illnesses result from an imbalance in the body humours and is given several herbal teas and body oils at home to cure the illness. Hossein likes trying risky stunts on his bike. His friend Marc is constantly reminding Hossein to be careful. Sasha has enough food and adequate shelter. She is confident about her health and safety. Tim tells his mother that the sugar-coated cereal advertised on TV is good for you—“It’s part of a balanced breakfast.” Melissa doesn’t really understand what her father means when he says, “Eat low-fat foods now to prevent heart disease later.” In Jason’s neighbourhood, gangs selling illegal drugs and vandalizing make everyone afraid. (answer: A; C; B; C; D; C; D)

•

Identify which age group of children would more likely be interested in the following health-related topics (for selection and answer: refer to Health Needs and Interests of Children, text page 566) I-T) infants & toddlers P) preschoolers S) school-agers bullies, peace-making health and safety rules (e.g., cover your mouth when you sneeze) coping with stress fear of loud noises grooming and dressing themselves beginning self-feeding

9-28

(answer: S; P; S; I-T; P; I-T) •

When planning a small-group food experience with three-year-olds making fruit salad: o limit the group size to the ideal number: _________ children with one (1) educator. (answer: three) Please explain: (answer: enables each child to participate fully) o two (2) important design features when making the recipe cards are: (answer: maximum of pictures with minimum of words; use dot system [i.e., •, ••, •••] rather than numbers [i.e., 1, 2, 3]; place the applicable whole fruit in front of each card) o provide an example of an aspect of the three-year-old’s physical and cognitive development that would be promoted through this food experience: (answer: physical—smell differentiation, food texture, size, and appearance; small muscle coordination—chopping, stirring, and squeezing; large muscle coordination— mixing, tossing, and kneading; cognitive—counting, tossing, etc.)

•

Dental fluorosis occurs when high amounts of _____________ are consumed in early childhood. In its most common form, fluorosis affects how the child’s teeth _____________, with small white specks appearing on the teeth. (answer: fluoride; look)

•

Toilet learning involves three (3) areas of readiness; name two (2): (answer: physical maturity; awareness; desire)

•

For each of the four (4) factors below, discuss how it can influence children’s understanding of health: (answer: refer to Children’s Understanding of Health, text page 560) o cognitive development o personality characteristics o family connection o peers, their community, and the media

•

The Canadian Paediatric Society recommends that for the child between one and three years of age, the educator checks for ECTD monthly. Explain how this is done. (answer: by gently lifting a child’s upper lip to check for signs of tooth decay) If

9-29

•

there are spots on the child’s teeth, it’s important to inform parents, so that they can ___________________________________ . (answer: take their child to a dentist soon)

•

List three (3) of the thirteen (13) guidelines in the textbook to be considered when planning health curriculum. (answer: refer to Table 9.3, text page 567)

•

Give a specific curriculum example, indicating age group, for each guideline listed (or answer a selected number of the guidelines). (for selection and answer: refer to Table 9.3, text page 567)

•

List three (3) specific practices through which a program models a philosophy of respect for the environment. (answer: refer to Environmental Health Education, text page 571)

•

List four (4) of the ten (10) nutrition concepts that can be appropriately incorporated into children’s nutrition experiences. (answer: refer to Nutrition Education, text page 577)

•

Describe the five Ws of cooking with children: (answer: refer to The Five Ws of Cooking with Children, text page 579) o Who? o What? o Where? o When? o Why?

•

Describe the components of ideal oral health education with preschoolers in programs. (answer: brush teeth after lunch or at least rinse mouth if on field trip; limit amounts of high-sugar foods offered; children have own toothbrush, stored separately; incorporate oral health education in areas of curriculum [e.g., art, music, science, etc.])

•

The Canadian Paediatric Society’s (2013) position statement on oral health care for children in Canada includes five points. List two (2). (answer: dental care for both prevention and treatment should be accessible to all children and youth; the cost of dental care impacts low-income families more due to their income level and less likelihood that they carry dental insurance; public funding of dental care in Canada is decreasing and varies across the country; research shows that preventive dental care improves our oral health later and, in turn, reduces treatment costs; fluoridation does decrease the rate of dental caries, especially in higher-risk populations)

9-30

•

Describe how learning about hand washing and germs can be incorporated in the program with each age group (infants/toddlers, preschoolers, and school-agers). (answer: refer to Hand Washing and Germs, text page 590)

•

Choose one (1) of the following four (4) topics and discuss appropriate curriculum for each age group (infants/toddlers, preschoolers, and school-agers): (answer: refer to text) o environmental health o nutrition education o oral health o personal hygiene

•

List two (2) benefits and two (2) effects of children’s hands on contact with nature as described in the textbook. (answer: refer to Table 9.4, text page 573)

•

List three (3) of the five (5) tips that educators must consider when incorporating toothbrushing into the program. (answer: refer to text page 588)

9-31

HERE’S THE ANSWER—WHAT’S THE QUESTION? Here’s the answer. small numbers of children with an educator promotes safe cooking practices and individual participation helping children develop a realistic belief that they can effect change through their actions stress factors that can be more traumatic or long term, but if the child has support from caring adults to adapt to the event, longterm damage to child’s health not likely a maximum of eight (8) steps in a recipe replace every three (3) months learning this behaviour begins in infancy and is an ongoing routine in all programs the ability to focus our attention, control emotional energy, and recover from intense emotions their role is to design environments and programs that maximize the child’s interactions with other children if an educator doesn’t demonstrate the same respect and support to a family with gay parents as to a family with heterosexual parents a child experiences strong, repeated/continuing adversity without adequate adult support, which can have lifetime effects on physical and mental health deep breathing and stretching exercises 1. 2. 3. 1. 2. 3.

9-32

What’s the question? What are the benefits of fewer rather than more children participating (at one time) in a food experience with an educator? What is the goal of environmental health education for children? What is tolerable stress response?

How many steps are appropriate in recipes used with school-agers’ cooking experiences? How often should toothbrushes be changed? How do you implement hand washing education? What is self-regulation? What is the educators’ role in helping children to make friends? What is an example of discrimination due to sexual orientation? What is toxic stress response?

What are two (2) ways that children and adults can cope with stress? understand what the child wants to know What are three (3) key points when find out what the child already knows answering children’s questions about sex? if you can’t answer immediately, get back to the child as soon as possible stage of cognitive development and What are three (3) influences on children’s temperament understanding of health? family connection peers, their community, and the media

formerly called nursing bottle syndrome, this oral health issue can quickly lead to the painful decay of primary teeth it is integrated into the program in ways that relate to children’s development and interests normal and healthy stress for children; characterized by brief increases in hormone production and heart rate the term may be more “fluid” than once thought it is acquired, often reflecting values, attitudes, and ideologies includes race, ethnicity, gender identity, language, and religion children whose gender identity and/or gender expression differs from what others expect of their assigned (natal) sex a situation whereby educators use their observation skills to identify signs and possible stress factors touching oneself for pleasure, a normal and natural behaviour a variety of different practices and habits necessary to have good nighttime sleep quality and full daytime alertness it is the collection of characteristics— emotional intensity, sensory reactivity, activity level, adaptability, persistence—that makes each of us who we are

What is early childhood tooth decay (ECTD)? How should health curriculum be delivered to children? What is positive stress? How has the term “gender identity” changed recently? What is personal culture? What is inherited culture? Who are “gender independent” children? What is a stress-aware environment? What is self-pleasuring? What does sleep hygiene mean? What is the definition of “temperament”?

9-33

SEXUAL DEVELOPMENT IN YOUNG CHILDREN 1. Males usually do not get erections until they are beginning puberty. 2. It is normal for infants to touch their genitals when they get the chance. 3. Orgasmic-like responses have been observed in infants as young as five months of age. 4. Few young children self-pleasure. 5. Most children are not curious about where babies come from until they are going through puberty. 6. Three- and four-year-old children explore sexuality through play with dolls, siblings, and peers. 7. Four- and five-year-old children enjoy using swear words and bathroom terms, and telling “sex” jokes. 8. It is unusual for a child older than three years of age to touch an adult’s breasts or genitals. 9. If a preschool boy gets an erection, he must be thinking about something sexual. 10. Five- to eight-year-old children are often very set in their thinking about what boys should do and what girls should do, even if their family has tried to teach them differently. 11. A child who engages in sex play with another child of the same sex will be gay. 12. Children today are more knowledgeable about sex than children were in the past. 13. If a child dresses in clothing usually worn by the opposite gender, there is a cause for concern.

9-34

Additional YouTube Videos with Questions Unit 3: Illness Prevention Video Title: Safe Lifting Techniques of Children https://www.youtube.com/watch?v=UjTxgxU7y50&feature=youtu.be

Introduction: The most frequent injuries of child care workers (ECLC staff) are sprains, bruises, back pain, and fractures. The Occupational Health Clinics of Ontario Workers (OHCOW) developed this video, which focuses on child care workers’ ergonomics and identifies many important suggestions on how to prevent injuries by lifting and bending correctly.

Questions: 1. 2. 3. 4. 5.

What does the “BACK” acronym stand for? What are the dos and don’ts for safe lifting? What are the steps for tripod lifts with an infant? (compare with Figure 2.1, page 83) What are the steps for lifting toddlers and objects? (compare with Figure 2.2, page 84) What are the dos and don’ts carrying a child? (refer to page 85)

Unit 4: Illness Management Video Title: Antibiotic-Resistant Bacteria https://www.youtube.com/watch?v=oLPAodRN1b0

Introduction: This video, while from the United States, applies to Canada and reinforces the messages found on antibiotic-resistant bacteria (pages 193–195).

Questions: 1. Could more types of bacteria become resistant to antibiotics? If so, what could happen to people who are sick from these types of bacteria? 2. Could we ever have a perfect antibiotic that bacteria could not develop resistance to? 3. What can each of us do to help fight against more resistance developing?

Unit 6: Healthy Active Living Video Title: Risky Play: Summer https://www.youtube.com/watch?v=-v_cYEv9hYY

Introduction: While this video is from Early Childhood Australia, their message is the same for Canadian ECLC programs. And that message is, that without opportunity for slight risks, children may take on riskier behaviour; for example, without trees to climb, they will try to climb the fence. Copyright © 2019 by Nelson Education Ltd.

A-1

Questions: 1. Although the term “safe risky play” may sound like an oxymoron, how do you think the term can relate to children’s learning opportunities? 2. Policies need to be developed at your centre with respect to outdoor risky play and field trips. Why do you think this is important? 3. Watch the video again and identify one policy that you think would make their activities safer but still include risk, for example, closed shoes, not bare feet or flip flops. Also refer to Risky Play (pages 352–354).

Video Title: Do You Know What’s in Your Soft Drink? https://www.youtube.com/watch?v=7NWUAYyPdag

Introduction: The author of this text was involved in the planning of this video with George Brown College students. It gives you an idea of how much sugar is in a soft drink.

Questions: 1. How much sugar is in your soft drink? 2. What are the health effects of drinking soft drinks? 3. Does diet soda make you gain weight? What’s the alternative?

Unit 7: Safety Promotion Video Title: About CSA Group https://www.youtube.com/watch?v=yK1KOXTzzhg

Introduction: If you have already read Unit 7: Safety Promotion, you will have seen “CSA”

mentioned throughout the unit. This video provides you with a brief introduction to who CSA are and what they do for Canadians. As a leading global testing and certification services and standards development organization, CSA Group is committed to a better, safer, and more sustainable world.

Questions: 1. What do the letters CSA stand for? 2. What are the two main safety considerations regarding outdoor playgrounds at child care centres and schools whereby CSA must be followed? Refer to Outdoor Play Equipment, particularly pages 410 and 413.

A-2

Unit 9: Supporting Children’s Development Video Title: Are Kids Getting Enough Sleep? https://www.youtube.com/watch?v=vIjB-ezPufw

Introduction: This short video highlights the importance of sleep for children of any age.

Questions: 1. What is the obvious consequence for children who don’t get as much night’s sleep as they need? 2. Sleep has a variety of functions. What is the one that Dr. Jose Colon (sleep specialist) identifies in the video? Please note that while there are minor discrepancies in the hours of sleep for children by age group recommended by this video and the National Sleep Foundation in the textbook (page 558), the benefits of sleep remain the same.

Video Title: Early Childhood Tooth Decay (ECTD) https://www.youtube.com/watch?v=jDuR7CEcMus

Introduction: Tooth decay in young children is the most common reason for day surgery in

Canada’s hospitals. ECTD can be prevented with good oral health care. This video gives simple instructions on how babies and toddlers can have healthy smiles.

Questions: 1. 2. 3. 4. 5.

Even before an infant has teeth, how do parents provide good oral care each day? Why is starting good oral care in infancy important? How many times a day should toddlers brush their teeth? What time is the most important time to brush a child’s teeth each day? Typically, how old are children before they can independently brush their own teeth?

Describe what the teeth look like in each of the three stages of tooth decay: 1. Stage 1 (very early decay) 2. Stage 2 (decay) 3. Stage 3 (severe decay)

A-3