Prenatal and Well-Child Care Visits

Talk with families about child care:

• Help families weigh their child care considerations.
• Underscore the importance of quality child care.
• Explain the different types of child care; their characteristics, advantages, and disadvantages.
• Provide information on finding child care.
• Remind parents to consider back-up child care arrangements for when their child is ill.

Help families create partnership with their child’s caregiver:

• Document the child care program in the child’s medical chart.
• Complete the admission requirements. Complete the admission requirements. Make sure the child is up-to-date on immunizations and health screenings.
• Develop individual care plans for children with special needs.
• Ask families about their concerns and their plans for the transition to child care.
• Remind families of the importance of good communication with the caregiver.

Follow up and support child care programs:

• Address questions and concerns about child care.
• Update records of the child care situation.
• Provide anticipatory guidance.
• Promote a 3-way partnership among pediatrician, families, and caregivers.

Children with Acute Conditions

• Review the information on child’s signs and symptoms from the parents and the child care provider.
• Ask the family about contributing factors at home and child care.
• Simplify treatment recommendations and medications.
• Discuss when the child can return to child care.
• Document the child’s condition for the caregiver.
• Report specified conditions to the necessary authorities.

Children with Chronic Conditions and Developmental/Behavioral Issues

• Ask the family about contributing factors at home and child care.
• Offer to speak with the child care provider.
• Consider doing an on-site observation at the child care program.
• Develop a written plan for the child.
• Simplify treatment recommendations and medications.
• Report specified conditions to the necessary authorities.

Click here to find resources you can share with families.

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Health and safety issues in out-of-home child care settings can range from simple to complex. Early education and child care programs can handle certain health matters on their own, such as responding to a minor injury or developing materials and procedures based on their state’s child care regulations. However, when programs face more complex health concerns, such as determining a “safe sleep” policy, developing a care plan for children with chronic medical conditions, or responding to an infectious disease outbreak, they can benefit greatly from expert health consultation.

The National Association for the Education of Young Children (an association for early childhood educators and child care professionals with more than 100,000 members) has revised its criteria for accrediting licensed child care centers, and now recommends that child care centers contract and form an ongoing relationship with a health care professional to improve the health and safety of the children enrolled in that center.

Currently, a majority of child care health consultants (CCHCs) are nurses, mental health professionals, nutritionists, or other health and safety experts. Yet, there is an increasing number of pediatricians who serve as CCHCs or medical directors for local child care programs.

CCHC Job Description

Recommendations for Pediatric Involvement:

• Build relationships with child care providers
• Conduct a needs assessment
• Visit the program and observe practices and facilities
• Promote effective communication
• Develop and review child care health policies
• Ensure medical homes and preventive care
• Develop plans to care for children with chronic conditions
• Provide health education for staff, families, and children
• Review illness and injury logs
• Provide ongoing health consultation

Other Issues to Remember:

• Laws and regulations
• Consent and confidentiality
• Liability

The Pediatrician’s Role in Promoting Health and Safety in Child Care
Details of the above information can be found in this manual and is a valuable resource for pediatricians in supporting their involvement in early education and child care. In particular, Chapter 2 discusses pediatricians as health consultants.

Tips and Resources to Help You Partner With an Early Education and Child Care Program
In 2005, the NAEYC revised its process and standards for “accrediting” center-based child care programs and included health-related standards and criteria for programs (all criteria are currently undergoing revision). To learn how best to support all programs to achieve the health-related criteria, the AAP coordinated a 6-month pilot program to offer pediatric health professional consultation services to child care centers. Visit the project Web page for tips and resources that can help other early education and child care professionals and health care professionals engage in similar partnerships.

The Healthy Child Care Consultant Network Support Center (NSC)
The NSC ended in August 2009, however, some of their publications, research articles, and other resources specific to child care health consultation are still available.

Pediatricians who provide health consultation to child care programs may choose to donate or charge for their services. The February 2007 issue of the NSC Focus newsletter features information on funding issues for CCHCs.

The NSC also provides a comprehensive literature review titled, The Influence of Child Care Health Consultants in Promoting Children's Health and Well-being: A Report on Selected Resources .

The National Training Institute for Child Care Health Consultants (NTI)
The NTI works in partnership with the AAP to support the health and safety of young children in child care settings through the coordination of a national Child Care Health Consultant Train-the-Trainers program that mobilizes and supports states to maintain statewide networks and training of CCHCs. Watch video: "Building Better Child Care Through Health Consultation"

Online Curriculum for Pediatricians
Healthy Child Care Texas has created an online curriculum that can be accessed by anyone, even out of state physicians. This online training will provide you with a certificate towards CME credit.

Health and Safety Consultation in Child Care Video Series or DVD Set
This multi-media training is available as a 2 disc interactive DVD set and as a five part videotape box set. The 5 programs include:

The DVD set includes PDF files of many useful documents. These include Caring for Our Children, the National Health and Safety Performance Standards, Guidelines for Out-of-Home Child Care, 2nd edition, forms and lists for health consultation activities, as well as instructions for completion of documentation for CME/CEU credit. Each Part has submenus for the viewer to choose the whole video, individual segments within each video, or questions to be answered to complete a self-assessment.

*Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care, 2nd Edition, 2002.

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After learning about early education and child care, you can take the important next step–advocating for improvements in the quality of child care in your community!

Provide Assistance to a Local Child Care Program

• Serve on an advisory board
• Conduct workshops on child development, health, and safety
• Donating or advocating for additional services, supplies, or funding

Promote Early Childhood Professional Development

• Participate in early childhood professional organizations and conferences
• Write articles on health for child care publications
• Provide consultation to agencies that offer child care technical assistance

Advocate for Improved Supply, Financing, and Regulation of Child Care

• Serve on child care planning committees
• Work with child care and child health advocacy organizations
• Contact local media to gain interest in and exposure for promoting quality child care
• Act as a legislative advocate

Develop a Health and Safety Initiative in Child Care

• Conduct research on health and safety in child care
• Sponsor a community-based health promotion project

Increase the Involvement of Health Professionals in Child Care

• Teach pediatric residents about child care
• Participate in continuing medical education on child care

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