Health & Safety Hazards for Preschoolers

Originally published 08 March 2009.

Preschool-age children are so exciting to watch exploring their environment. As toddlers they finally gained some mastery of basic physical abilities and can now move on with confidence to learn new things. Unfortunately, new skills and a sense of invulnerability and confidence create a number of safety hazards! Here are five situations that preschoolers can find themselves in, and ways in which their care-giving adults can minimize the risks so their children can develop healthily in every area.

• Preschoolers have learned that they can run and jump and be active. They have not yet learned to discern limits, and so may decide to jump off of something too high or run into areas that may be unprotected, such as parking lots. Set ground rules against dangerous areas as well as consequences for breaking them. Talk to the children about what is real and pretend, and that what they see done on television or comic books does not mean that it's okay for them. If you are able to influence the design of play areas, be sure that they are placed well away from dangerous areas and are developmentally appropriate - meaning, play equipment that is proper for a child of their age and abilities. Safety documents such as SAFE outline ways in which you can make an environment a safer place through supervision, appropriate play areas, looking out for falls, and properly dealing with equipment. Parents and teachers should be consistent in working together to support the rules of the home and classroom, and need to support each other in carrying out consequences for rules broken.
• Preschoolers have not yet fully developed the area of their brain that helps them control their emotions. This means that if they are angry or upset they may lash out physically against others. Teach and model some anger management tools like taking deep breaths or counting to ten. When you see a preschooler getting angry, help them walk through the steps to resolve the problem in a healthy way. Help them name their feelings so that they are able to recognize them in the future. Curriculum is available for classrooms and families to help children develop healthy social and emotional lives. Many school policies require fully rounded attention to this area in the classroom as well. Parents and teachers should be in respectful communication regarding the emotions of a preschooler, as emotions can be aggravated by stress at home and school, and other factors such as blood sugar level that may need a physician's input. Like the teamwork needed in supporting class and home rules and consequences, parents and teachers should work together to consistently reflect healthy emotion management.
  
• Preschoolers are at the age where they are beginning to learn how to do things that are a little more dangerous and require supervision, such as cutting with scissors or helping in the kitchen. Making an environment as safe as possible for those kind of situations allow the best way for the child to learn without getting hurt. Provide age-appropriate safety scissors for use only at specific times, and set ground rules such as 'only cut paper from this drawer unless asking first'. In areas like the kitchen, provide a work space away from the stove for the preschooler to sit and help. Have unbreakable bowls and utensils for them to use and give the child tasks that fit what they are able to accomplish. Always pay attention to what your child is doing when they are using potentially dangerous tools. Because children in the preschool range may be at a wide range of skill levels, it could be helpful for teachers (or parents) to send a quick note when a preschooler has successfully explored and used a new tool for the first time. Teachers can also invite parents to come work with their children during projects in which new tools are introduced, and work together to communicate and enforce safety rules for those new skills.
• Preschoolers are just beginning the process of understanding sequence. This means that many times they can not remember the entire sequence of "first do this, then do that; finally, do that other thing." Their brains are still developing the neuron processes to understand that sometimes certain things must happen before (or after) other things in order to create the desired effect. Many of our health and safety routines, such as a school's fire drill policy or how to brush teeth, depend upon sequential actions, making practice and direct teaching essential for this age level. Make directions simple and focus on rules that open the way to other rules. (In the case of fire drills, for example, the rule of 'no talking' allows the teacher or fire fighter opportunity to provide other rules as needed.) Teach preschoolers how to think in sequence with fun activities such as making a sandwich (bread first, peanut butter on the bread, jam on the bread, top bread last), and remember that it will take time and repetition to help their brains develop into independent thinking. Parents and teachers can work together with preschoolers during drop-off and pick-up times by going through sequential routines. Parents can help children understand sequence in a school setting by talking with their child about their day using words such as "before" and "after", "first" and "next". Teachers can help children understand sequence in a home setting by talking with students about their afternoons and evenings at home and the process of getting prepared for the school day.
• Along with not understanding sequence, preschoolers are just beginning to understand cause-and-effect. They may not understand the danger of leaving toys in the middle of the pathway until they have run and tripped over them. Adults should keep an eye out on the environment and teach the children how to be neat and to identify problem areas. Preschoolers may also be unaware of basic health concerns like spreading germs, another cause-and-effect scenario. Teach preschoolers about good health practices and hand washing, finding ways to make it fun. Most school policies give teachers guidelines on how to implement this in the classroom and school setting. Parents can teach children to cover their mouths when sneezing and coughing, sing with the child as they wash hands for dinner, and model good health behaviors. Through communication with one another, acknowledgment of the rules both at home and school, and through role modeling both home and classroom standards of cleanliness, parents and teachers work together to keep the environment safe.
  

Emergency Preparedness

Originally published 15 March 2009.

Disasters or emergencies happen to all of us at some point in our lives; as adults we have the wisdom and power available to understand appropriate reactions to them. Children, however, look to us for guidance and safety. I live on the coast in the suburb of a harbor town, which means occasionally unique things can go wrong that were not issues in my Midwest home town. Sometimes these things are human error and sometimes they're naturally occurring events, but the moment at which they're upon us is the wrong time to begin thinking of how to deal with them. It is essential to be prepared beforehand, to have a plan before it's needed; especially so when acting as a caregiver to children. In this post, I'll directly address two emergency situations that the city of North Charleston, SC, has as their highest priority in their document "Emergency Operations Plan": transportation of hazardous materials, and hurricanes.

Although most people often think hurricanes would be the highest predictable disaster for a South-Eastern coastal town, North Charleston's chart on severity and frequency found at the link above actually places hazardous materials risk at "highly likely" and "catastrophic" levels, whereas hurricanes fall slightly below it at "likely". Charleston is not only a port town with a lot of its trade in the shipping industry, but it is also the home to a Navy nuclear training base. When accidents occur in transportation of hazardous materials, everybody within a certain radius of the accident site is at risk of anything from toxic air or water to fires or explosions depending on the material. These accidents also affect traffic flow, which is no easy thing in a large city with only three major thoroughfares; creating potential for a lengthier response from emergency personnel and a longer time with children waiting for their caregivers to retrieve them from school. In the event of this kind of accident, the city enacts a certain plan including notification of what steps to take, and evacuation if necessary, as stated in the link above.

Hurricanes most often give a few days warning before arriving here in Charleston. The two biggest concerns of a hurricane, no matter what severity, are damage from winds and from flooding. Before a hurricane arrives, parents and school maintenance can secure any loose items around the yard or grounds, trim trees and shrubs, shutter windows, and review the emergency plan (see below). When a hurricane is expected to arrive, school most often is already canceled; thus, schools have obvious policies on the tornadoes and flood effects. Dangers from winds seem obvious: things can fly around and break other things or people can be hurt by them. Dangers from flooding are not as obvious, as much of the risk is under the surface of the water. Flood waters flow quickly and are mixed with bacteria-rich sewage. Floods are also strong enough to break things and leave solid objects floating in it that can hit or injure whatever body part is in the water. The water can also conduct any electricity from downed power lines. In the case of flooding for whatever reason, do not allow yourself or children in your care to walk or play in the water.

Many emergencies require similar responses; as previously mentioned, flooding occurs often with a good hard rain but is also a major contributor to danger before and after a hurricane. Here are three essential general tips for preparing for local emergencies or disasters:

• Know how and where to stay informed. In the case of a disaster, police and other safety officials will be hard at work getting the word out with instructions. They may be as simple as boiling your drinking water and as complicated as evacuating the city. Understanding who is responsible for keeping you informed and the methods used to do so is vital - that responsible person may just be you! Teachers and school staff must be thoroughly familiar with their school's emergency response plan, which should identify potential emergency situations, provide guidelines on how to properly prepare students, a procedure for acting on immediate health needs, and the stated method for contacting families. Families should be sure to have battery-operated or wind-up radios in their emergency kits to receive information, and teachers keep the school's communication tools in their classroom functional and well-maintained. Remember that in many types of emergencies, cell phone towers may be overloaded and phones unreliable sources of communication.
  

• Know where to go. During disasters, he city keeps residents updated as to the severity and whether or not they wish to evacuate your area. Many of the emergencies listed by North Charleston could have the potential for evacuation in extreme situations, so have a copy of driving routes and a plan for where you will head if evacuation is required, as well as your contact numbers with someone else in the area. Don't forget to have a full gas tank! School emergency response plans will conduct drills with the students for many kinds of emergencies, both man-made and weather related, such as fire drills or drills for tornado, hurricane, earthquake or dangerous intruders.
  

• Know what extra supplies you'll need. Emergencies of all kinds may take out power, water, or sewage, or close down grocery stores and gas stations. Having an emergency supply of a first aid kit, food, water, money, batteries, soap, and toilet paper. Also, copies of important documents like birth certificates, medical records and bank account numbers will help in any number of emergency situations. Be sure to have a contact number on a land-line, as cell-phone communication may become difficult. This emergency kit can go with you if your family must evacuate. The American Red Cross provides a great list near the bottom of their article for families preparing for a hurricane. Teachers can also prepare emergency kits for their class that families help to stock with items a class may need in a power outage or evacuation. While schools will have their own policies on this topic, students may feel more secure in an emergency knowing they participated in providing extra tissues or hand sanitizer, an extra set of clothing, emergency procedures at their appropriate age level, and contact information for their families. Teachers or school officials should also have contact information and medical records (and medication, if appropriate) with them when leaving the building with the students.

Not preparing ahead for disasters and emergencies exposes you and the children in your care to physical injury or sickness during the time of the disaster and in the recovery time following. Do some research on the major emergencies in your area to be aware of what may happen in each situation. Be sure to check with your city and state officials on how they communicate with residents and businesses and use that information when you make your emergency plan. The Department of Education provides a crisis planning guide for assisting schools and communities in creating an emergency response plan. Parents and teachers should work together in preparing children both in physical needs, such as the emergency kit, and in emotional needs by talking together about the emergency plan and going through drills both at school and at home. In both settings, involve the children in planning in age-appropriate ways. At home for example, the children may help choose a family meet-up spot down the street in case of a home fire. Also, parents or family friends who are public safety or health officials can come speak to classroom students about emergencies and disasters, and school staff can provide further information on preparedness both at home and school for school families.

CPR and Choking

Originally published 22 March 2009.

Many health hazards exist in a child's world that require immediate treatment when a child is in danger. While care is taken to create a developmentally appropriate learning environment, an early childhood education center may have a number of developmental stages within one classroom. This is also often the case in a home with more than one child. This means that while older children may be prepared to interact appropriately with items such as scissors or very small objects, younger children in the home or classroom may not be. In many cases, this mixed-development environment results in items dangerous for younger children being accessible to them. Caregivers must be prepared to deal with potential emergencies resulting from these circumstances.

In the 2-3 toddler classroom, young Amy has just moved up from the infant room. She is still unsteady on her feet and chooses to crawl around her new environment. Still in the oral learning stage, her first instinct when she encounters a button on the floor during her explorations is to put it in her mouth. The button had fallen from the table where her not-quite-four year old classmate is working on a button sorting project. The lead teacher is sitting on the floor with another child in her lap, and the aide is returning from the bathroom with a potty-training child. They both scramble towards Amy as she pops the button in her mouth and begins to choke on it. One teacher moves to intervene with Amy while the other tends to the rest of the class.

As long as Amy is coughing well, the teacher encourages her by demonstrating good coughs, and lending assistance if necessary. The button does not appear, however; Amy begins having weaker coughs and the teacher must perform the Heimlich Maneuver, or abdominal thrusts. Because Amy is two years old, the teacher will do this in the method used on children, and not the one used on infants. This should force the button out of Amy's airway. Cigna Healthcare provides good pictures of the Heimlich Maneuver on their website.

Little Tommy is playing on the playground with his friend from the older class. They get along very well; however, sometimes his friend forgets that Tommy is younger and still much smaller and lighter than he is. Tommy and his friend decide to play on the teeter totter in the older grade playground. Suddenly, his friend drops his end of the teeter totter and smacks it on the ground when Tommy isn't holding on. Tommy flies off the teeter totter, knocks his head on the ground, and stops breathing.

When the recess teacher arrives, Tommy is unconscious. The teacher checks carefully for breath by watching his chest, listening, and feeling for air. She also sends two older children to get the other recess teacher on the ball field, who calls 9-1-1 when informed of the accident. The teacher treating Tommy looks in his mouth to be sure that there is nothing in the airway that she can see. If a child is unconscious and the airway needs to be cleared, the teacher can tip his head back; but this teacher knows that Tommy hit his head from falling and is afraid there might be damage to his spine, so she will have to use her best judgment on whether or not to tip his head to clear the airway. Tommy's airway seems clear but he's not breathing, so she plugs his nose with one hand, and breathes lightly twice through his mouth.

Giving Tommy air to breathe doesn't start him breathing on his own, so the teacher checks for a pulse. Tommy has no pulse, so she must administer CPR, or Cardio Pulminary Resuscitation. Following the steps she learned in training, she locates his sternum and presses down five times, performs rescue breathing, and alternates the two until Tommy begins breathing or emergency help arrives. First Aid Web has great information on child CPR with pictures.

As shown in both Amy's and Tommy's cases, some advanced planning could have prevented both of these accidents. Better choices of play material, organization, clean-up practices, fences for keeping crawlers away from certain areas, or only allowing small object games for older children while the younger ones had an extra nap could have all helped prevent Amy from swallowing the button. Enforcing playground rules or having older child playground equipment in a separate area from the younger equipment could have prevented Tommy's accident. Paying attention to keeping the environment developmentally appropriate can prevent a large number of accidents. For many accidents that do occur, teachers can prevent them from becoming life-threatening emergencies by being trained in infant and child CPR, first aid, and the use of a defibrillator if one is available to them. Planning ahead can make a vital difference even in something as seemingly small as choosing to carry a cell phone when outside the school building so that another teacher or emergency personnel can be called if necessary.

Teachers and parents must work together to prepare children and adults for the possibility of an accident or medical emergency. Both the home and the classroom should have a first aid kit available to them. The home kit may include medications, bandages, creams, tweezers, and a thermometer, among other things. KidsHealth from Nemours has a more complete list on their website. The first aid kit for the classroom should be designed in accordance with school health policy and the school nurse, but may contain band aids and bandages, a thermometer, and tweezers, among other things. In many schools, classroom kits may not include medications unless it is specifically written into a student's health plan that these medications are available in the classroom. Teachers should also keep family emergency contact information and hospital plan, any unique student health plans such as an asthma care plan, and even picture flashcards of emergency procedures just in case. If a student is on regular medication and a prescription is on file, a copy (labeled as "copy") may be useful to have available if emergency personnel respond to the scene. All of these documents should be kept with the first aid kit so they are readily available if needed.

A final thing that parents and teachers must do is prepare their children. Teaching children that there are plans in place for emergencies, that accidents happen and adults are ready to handle them, and allowing the children to participate in preparing if developmentally appropriate can help them be calm and assured during an emergency. Both the Red Cross and the American Heart Association, as well as other organizations, have school curriculum and family activities geared towards preparing children of all ages for health emergencies. Teach children what to do in any personal emergency that may happen to an adult while they are in their care, such as how to dial emergency numbers on the phone and where they can find the next nearest adult. Provide a plan for the children and role play emergencies in both the home and the school setting so that they can practice what to do. Parents should encourage the children to share school procedures with them and role play them at home; likewise, teachers should encourage and lead role play on home procedures as reasonably appropriate.

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The Importance of Healthy Eating

Originally published 29 March 2009.

Healthy nutrition is vital for all of us. Food provides fuel for our bodies to function, and nutrients (including vitamins and minerals) necessary for each part of our bodies to grow and change in healthy ways. Nutrients provided through the food we eat can basically be divided into three categories: what becomes energy, what works together to turn the food into energy, and the "support staff" that provides extra strength and growth to various body parts, organs, and processes such as our eyes, our hearts, or our circulation. Just like a well-run business, the body can't run smoothly with part of the company missing. Company has a goal and motivation, a purpose for existing. The body's statement of purpose comes in the form of food to become energy. People (energy processors) take that purpose and transform it into something useful through the work they do. Finally, everyone understands that the job would be much more difficult if it weren't for the folks who change the light bulbs, fix the toilets, and take out the trash (support staff). Like a company, the body needs all of those functions fully supported through the nutrients in the food we eat. Like a successful company, the body must be in balance.

Children are still in the process of developing, a state which is more dramatic the younger the age of the child. Because of this, good nutrition is vital! For infants, well-balanced nutrients conduct the healthy development of the brain and physical body, as well as the daily learning that occurs at a great speed, forming a foundation for the rest of their life's learning. Toddlers and Preschoolers are also developing some new areas of their brains and abilities as well as solidifying some areas from infancy, and a well-balanced diet gives them what they need to progress independently and for their body to continue fine tuning various areas of their basic physical development. At this age, interactions with food itself are adventures that teach many physical and social skills necessary for successful older life. For most school age children, food loses its thrill and is mostly required to maintain health and energy necessary for doing other things they want (or need) to do. Food becomes more of a social and emotional motivator, and maintaining healthy eating habits can get a lot more difficult because of it.

Children look to their parents for direction on how to life their lives. Parents have a great amount of influence on the eating habits of their children, and should take every opportunity to help them learn how to keep the nutrients in their body in healthy balance. Here are a few suggestions to help you get started:

• Be a good role model. Remember, right now you are your children's hero and they will imitate what you do! If you make choosing healthy food a priority, so will they.

• Give your child the power of choice. If you say, "We're having eggs for breakfast," your child may claim they don't like eggs and begin a power struggle over breakfast. Instead, give your child a choice: "Would you like your eggs scrambled or flipped over?" You may be amazed at the things your child will eat if they have a say in how it's prepared.

• Have patience and have fun. Your child may still be learning about food; what it feels and tastes and smells like, how to coordinate eating properly, how it makes them feel, and ways in which they can use it and manipulate it in social events. These are things that they need to learn, and often it's best learned by experimenting. Sit down with your child to explore food; have them help you with cooking by measuring ingredients into bowls or helping you stir and mix away from the oven; do taste and feel tests with food at times other than meal time. Let your child know that healthy food is fun and good.

• Use MyPyramid.gov in your home. This is the official government site of the new Food Pyramid, called MyPyramid, which shows how much of each kind of food you and your children need in their diet, as well as additional information on why and how to go about it. There are fun things for kids to do, and areas in which you can find special menu plans that fit you and your family.
  

You can find many healthy and balanced meal recipes from the United States Department of Agriculture's Team Nutrition website, organized by topic or culture and free of charge. There are also some great healthy recipes for kids at the National Network for Child Care's Recipe page. These three healthy recipes came from "Delicious Heart Healthy Latino Recipes" and "Heart Healthy Home Cooking African American Style" at the USDA link above. All three recipes are similar in ingredients that provide vitamins and minerals, but should also be accompanied by a side dish to fill out the other areas of fruit and dairy that you may need for your personal recommended daily allowances. I've also added some suggestions in the recipes where you can involve your children in preparing the meal. [My comments will be in brackets and italics.]

Quick Beef Casserole: High in potassium, which helps to regulate heartbeat, water balance, and metabolizing protein and carbohydrates. This casserole includes portions from the Meat, Vegetable, and Grains categories on MyPyramid.

½ pound lean ground beef
1 cup onion, chopped
1 cup celery, chopped
1 cup green pepper without seeds, cubed
3½ cups tomatoes, diced
¼ teaspoon salt
½ teaspoon black pepper
¼ teaspoon paprika
1 cup frozen peas
2 small carrots, diced
1 cup uncooked rice
1½ cups water

[Kids love to measure things. With supervision, your child may be able to help you with Step 2 as well, as it will be drained and shouldn't splatter.]

1. In a skillet, brown the ground beef and drain off the fat.
2. Add the rest of the ingredients. Mix well.
3. Cook over medium heat and cover skillet until boiling.
4. Reduce to low heat and simmer for 35 minutes. Serve hot.

Yield: 8 servings Serving size: 11⁄3 cups Calories 201 Total Fat 5 g Saturated Fat 2 g Cholesterol 16 g Sodium 164 mg Total Fiber 3 g Protein 9 g Carbohydrates 31 g Potassium 449 mg

Smothered Greens: This recipe is also high in potassium and contains a combination of meat and vegetables, covering the Meat and Vegetable categories of the MyPyramid. Choosing leafy greens in a dark green color also provides calcium, magnesium, iron, folic acid, niacin, riboflavin, thiamin, and Vitamins C and K. All of these vitamins and minerals help regulate and develop different parts of your body. Because the "Smothered Greens" recipe does not include carbohydrates, be sure that need is met either as a side dish or at another time during your day.

"These healthy greens get their rich flavor from smoked turkey, instead of fatback."
3 cups water
¼ pound smoked turkey breast, skinless
1 tablespoon fresh hot pepper, chopped
¼ teaspoon cayenne pepper
¼ teaspoon cloves, ground
2 cloves garlic, crushed
½ teaspoon thyme
1 scallion, chopped
1 teaspoon ginger, ground
¼ cup onion, chopped
2 pounds greens

1. Place all ingredients except greens into large saucepan and bring to boil. [Let the kids help measure and put the ingredients in the pot before you add the water.]
2. Prepare greens by washing thoroughly and removing stems. [After washing hands, kids can help here!]
3. Tear or slice leaves into bite-size pieces. [And kids can help here!]
4. Add greens to turkey stock. Cook for 20–30 minutes until tender.

Yield: 5 servings Serving size: 1 cup Calories 80 Total Fat 2 g Saturated Fat 0 g Cholesterol 16 mg Sodium 378 mg Total Fiber 4 g Protein 9 g Carbohydrates 9 g Potassium 472 mg

Scrumptious Meat Loaf: A well rounded meal includes a balance of different kinds of healthy foods. This meatloaf offers foods from the Meat, Vegetable and Grain categories on MyPyramid. Using whole grain breadcrumbs will also add more fiber!

"Got the meat loaf blahs? This recipe transforms the ordinary into the extraordinary."
1 pound extra lean ground beef
½ cup tomato paste
4 cups onion, chopped
4 cups green pepper
4 cups red pepper
1 cup fresh tomatoes, blanched, chopped
2 teaspoons mustard, low sodium
4 teaspoons ground black pepper
2 teaspoons hot pepper, chopped
2 cloves garlic, chopped
2 scallions, chopped
2 teaspoons ground ginger
8 teaspoons ground nutmeg
1 teaspoon orange rind, grated
2 teaspoons thyme, crushed
4 cups bread crumbs, finely grated

1. Preheat oven to 350 F.
2. Mix all ingredients together. [After washing hands, kids can help measure and mix!]
3. Place in 1-pound loaf pan (preferably with drip rack) and bake, covered, for 50 minutes.
4. Uncover pan and continue baking for 12 minutes.

Yield: 6 servings Serving size: 1¼-inch thick slice Calories 193 Total Fat 9 g Saturated Fat 3 g Cholesterol 45 mg Sodium 91 mg Total Fiber 2 g Protein 17 g Carbohydrates 11 g Potassium 513 mg


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