G.2. Health Policies

Health Appraisals and Immunizations

Licensing regulations require an initial health appraisal, including an immunization record, for all children.  You are then required to provide updated health appraisals periodically as your child has regular check-ups and immunizations.  In most cases, this will be annually.  Please ask for a form to take with you to the doctor on your child’s annual well check-up.  Failure to provide the required health documentation is grounds for terminating enrollment.  Special regulations for families joining us from out of state and from another country allow for more time to obtain up to date information.  Please notify the director prior to enrollment if this applies to your child.

Medical Home

It is recommended that all families be connected with a “medical home”, meaning families have a pediatrician and pediatric dentist that their children can go to on a regular basis for well check-ups and illness diagnosis and medication. Please speak with your program coordinator or the administration if you would like assistance locating a medical home to fit your child’s medical needs within your local vicinity.

Emergency Preparedness

Policies and procedures are in place as required by both State Licensing and the National Association of the Education of Young Children (NAEYC).  Plans and training for the emergency preparedness plan was developed with the assistance and in coordination with the Princeton University Department of Public Safety.  All staff have been trained in the policy and procedures as required with initial and annual orientation.  Fire drills occur monthly and there is annual evacuation drill all in coordination with public safety.

  • Emergency procedures are in place for the following:
    • Accident and Medical Emergencies
      • All Regular UNOW staff are required to maintain current First Aid and CPR certification.  Annual training is provided.
    • Emergency Evacuation to Onsite Location (fire, Chemical Spill, Bomb Threat, etc.)
      • Fire drills occur monthly
    • Emergency to an Off-Site Location (natural or human caused event which deems current location unsafe).
      • Offsite evacuation drill will occur once annually
    • Emergencies requiring shelter in place (natural disaster’s including tornados, earth quakes or lock downs for intruder alerts.)
      • Shelter in place/lock down drill will occur once annually
    • Emergency Phone numbers are strategically placed in all required areas of the building
    • Locations and contents of emergency supplies is monitored and maintained at all times.
    • Chain of Command is established for emergency call and decisions.
    • Communication and reunification procedures.

Additional Health and Safety requirements in place as mandated by NJ State Licensing and NAEYC

  • Health and Requirements for Staff
    • Physical and TB upon hire
    • Background and fingerprint upon hire
    • Current Certification in CPR and First Aid – renewal offered on site annually
    • Health and Safety Policies Reviewed and trained at new staff orientation and annually
      • Illness and Communicable Disease Policy
      • Child Abuse and Neglect Awareness and Reporting Policy
      • Administration and control of prescription and non-prescription medicines.
      • Accident and Medical Emergencies and Injury Reporting forms and procedures
      • Hand washing, food service, Blood Bourne Pathogen training and diapering policy and procedures.
      • Sanitation and infection control policies and procedures
      • Authorization for pick up and procedures
      • Infant care procedures for diapering, feeding, sleep including storage and labeling practices.
  • Health Requirements for enrolled children
    • Physical and immunizations required at enrollment
    • Allergy information, authorization and communication
    • Protocol for children with special care plans

Other programmatic Health and Safety policies and procedures in place

  • Illness and communicable disease policy
  • Reporting illnesses and reportable diseases
  • Authorization and Release of children
  • Ratio and group size and transition of children policies and procedures
  • Partnership with local Health Consultant
  • Menu and food prep and delivery is monitored by the CACFP food program and USDA regulations
  • Health, Safety and Nutrition is intentionally webbed in to the classroom daily routine and in the curriculum with children.
  • Furniture, equipment, materials, foods and food storage meet all safety requirements and maintained.
  • Outdoor play and temperature and weather exposure guidelines.
  • Emergency closing policies

Childcare Accident and Medical Emergencies

All UNOW Staff are required to maintain their CPR and First Aid certification.  The following procedures are presented to staff at orientation and trained annually thereafter.

  1. While remaining calm, the witnessing staff member assesses whether emergency action is required immediately and if so, alert the Department of Public Safety at 609-258-3333 (or 911 via a landline) or by using the blue light emergency notification phone on the playground. The witnessing staff member will send another staff member to alert the Director/Associate Director. The child will not be moved unless the location is potentially dangerous. The child will be reassured that someone is there to help them and keep them as calm as possible. Staff will Begin First Aid or CPR as necessary and as trained.

In the case of any accident that is not an emergency but requires more attention than a single Band-Aid, the Director or Associate Director will be notified immediately and told the location of the accident and a description of the injury. The Director/Associate Director will decide if the parent should be notified immediately.

  1. If DPS is dialed and an emergency transport is necessary, the Program Coordinator will report to the specified entrance given to DPS and escort the emergency personnel to the scene. The Associate Director will retrieve the Medical Information and Release Form kept on file in student records and accompany the child to the hospital with the form. Once at the hospital, the Associate Director will wait for the child’s family to arrive and support them as needed with information.
  2. The Director will call the parent, notify them of the emergency, and tell them either which hospital the child is being transported to or the need to pick up the child and bring them to their Doctor.
    1. Under most circumstances, the child will be taken to Penn Medical Center of Princeton at Plainsboro
    2. If medical consultation is necessary beyond emergency personnel, UNOW uses the services of Princeton Nassau Pediatrics
  3. The other staff members keep all remaining children calm and away from the accident area.
  4. The Director/Associate Director will notify the Board Chair and Licensing within 24 hours of emergency transport as well as submit all required written documentation to Licensing and appropriate insurance providers within 48 hours of accident.
  5. Once the emergency is under control the witnessing staff member must fill out an accident report form, describing the accident in full. A copy is given to the child’s family and the other copy turned into the office to be filed in the child’s folder.

UNOW Injury reports

Every effort is given to provide a safe and secure environment for all children.  Even with these efforts, in the natural life of young children in a group environment minor injuries are not uncommon.  Children are developing at different rates and they are often trying new skills for the first time.  Bumps and falls may happen as they learn to stand and walk or climb a new piece of equipment.  Also, children are learning to express their feelings and learning how to meet their needs appropriately.  Without the problem solving skill level of much older children and adults, sometimes children may bite, hit or scratch.  Although we do not want anyone to get hurt sometimes it does happen. 

When “boo boos” happen, teachers immediately attend to the injured child first.  Once the injured child is cared for with both first aid and kindness, the teacher will address any other issues contributing to the situation.  Sometimes environmental factors may contribute to the situation such as a fallen tree branch or a broken toy.  The teacher or facilities will be contacted and remove or repair the item of concern.  If it was an altercation with another child, teachers will work with the children to support language and social skill development.

After the incident has been addressed, teachers will complete an injury report form letting families know what happened and what type of care was given.  With any injury above the shoulders, even if minor, parents will receive an immediate phone call.  Any injury leaving the child distraught or visibly injured may warrant the teacher to contact the family prior to pick up.  Most injuries will be followed with a written injury report and provided to the parent for signature of receipt at pick up. It is also useful for the parent/guardian to report any injuries that may have occurred outside of UNOW care so teachers can be on the alert for any unusual delayed reactions. 

Reporting Incidences of Biting

Although biting is an unwanted and upsetting behavior with emotional and physical consequences to all parties, it is a common occurrence during the early years of development when children are still learning language and problem solving skills.  An injury report will be completed if a child was bitten and left with a mark or broken skin.  If the skin was broken, teachers will call the parents of the injured child and the child should be seen by a doctor.  If there is a pattern of biting, teachers will meet with the family of the child who is biting and together they will create a prevention plan. The UNOW Confidentiality policy holds true with biting and other injury incidences.  Teachers will not share names of children involved in any incident with families.  Feel free to speak with teachers at any point you feel your child is being targeted or are alarmed by any incident that may occur in the classroom.  For further information, see article from NAEYC on biting at: 

https://www.naeyc.org/our-work/families/understanding-and-responding-children-who-bite

UNOW ILLNESS POLICY AND MANAGEMENT OF COMMUNICABLE DISEASES

A copy of this policy is provided to new families at the new family orientation and additional copies may be provided upon request.

UNOW Day Nursery promotes the protection of well children by preventing illness and promoting safety and general wellbeing.  We encourage children to develop good health practices including daily handwashing, understanding and encouraging good nutrition, exercise and proper rest for the development of healthy bodies.  In addition, all staff practice proper hand washing, sanitation and safe food service throughout the daily routines of the day.  All adults and children are required to wash their hands upon entry into the classroom.  For families, this also offers a transition and separation activity each day. All full time and regular part time staff maintain certification in Infant/Child/Adult CPR and First Aid.  Health and Safety policies are reviewed and shared with all staff and families annually.

Immunizations and Health Records are required to ensure the safety of staff and children:

In accordance with the State of New Jersey health regulations, families are required to provide a copy of up to date immunizations record, including an annual flu shot for children over 6 months of age to be given between the months of September 1 and December 31.   Along with a copy of the immunization records, families must provide a copy of a completed Universal Health Record based by the child’s first date of attendance and annually thereafter.  Universal Health Records may be based on the child’s most recent physical if it is within the previous year from point of the first day of attendance.  New families enrolling from different states or from out of the country have up to 30 days to submit immunizations records.

All Staff prior to working must provide current TB test results and a Staff Health Record completed by a licensed physician and indicating good health and pose no health risk to persons at the center.  Staff Health records may be completed by a physician based on a previous health wellness exam from no more than one year of hire date. 

Procedures at the onset of illness symptoms at home or at school:

 AT HOME: 

If your child exhibits any of the symptoms listed below at home, keep your child home until your child is well and contamination to others is not a concern. Children should be symptom free (fever free, no vomiting or diarrhea) for a 24 hour period before returning to school.

AT SCHOOL:

When the presence of the child poses a possible risk of spreading a communicable illness to other children, we will isolate the child from the rest of the group as much as possible but still attend to the ill child. The child will remain with an appropriate staff person, until the parent/guardian can be notified and the child is picked up. If a parent/guardian is not reached within a reasonable amount of time, the emergency contact person will be notified and expected to pick-up. It is important that the parent/guardian respond in a timely manner and pick up may not exceed one hour from the point of notice.  Immediate pick up ensures the continued care needed for the ill child and the prevention of infection to other children and staff.

THE FOLLOWING GUIDELINES SERVE AS A FRAMEWORK OF SPECIFIC SYMPTOMS FOR WHICH THE CHILD WILL BE EVALUATED FOR TEMPORARY EXCLUSION:

  •  FEVER – It is possible for children to run a low grade fever upon waking from a nap or for teething infants.  According to the American Academy of Pediatrics, those fevers are below the 100.5 reading. However, if an axillary (under the arm pit) temperature reading is 100.5 or higher, the child will be removed from the group and kept comfortable until you are notified and take your child home.  Prompt pick up is expected (within 1 hour of notice).  Beyond the first day of absence, it is important that the child is free of fever for at least 24 hours without the use of fever reducing medication before the child may return to care

Other physical or behavioral symptoms where the child will be considered for exclusion from school may include but are not limited to:

  • Vomiting – A child vomiting can occur for many reasons; a cold and the child has swallowed too much mucous or some children have a quick gag reflex or a child was crying so much that they made themselves vomit.  These reasons would not necessarily be reasons for a child to be excluded for the day.  If indeed the teacher suspects an intestinal virus then the parent would be contacted and expected to pick up their child within 1 hour of notice.  The child should not return to school the next day unless there a doctor’s note indicating the child is no longer contagious
  • Diarrhea - If a child exhibits diarrhea and a teacher suspects a contagious illness the parent will be contacted and expected to pick up in a timely manner.  There can be reasons why a child may have diarrhea which would not mean exclusions such as an introduction to new foods or medicines etc.  However, if a teacher suspects a virus and has sent a child home, the child should not return the next day unless there is a doctor’s note indicating they is no longer contagious.
  • Unidentified Rash – If a child is sent home with an unidentified skin condition or rash, the child may not return without a physician’s note stating they are not contagious to others.
  • Listless or unable to participate in normal daily activities – often if children exhibit this behavior along with other symptoms, a teacher may contact the families and it may be determined that the child must be picked up early. 
  • Upper respiratory complications – although children do contract upper respiratory symptoms during cold and allergy seasons, if the complications are interfering with normal day behaviors and cause for concern of contagion to others or the general health of the child, that teacher may contact the parent and require the child be picked up early.
  • Unexplained change in behavior and or appearance – Potential evidence of pink eye, lice or any other unexplained symptoms or behaviors may be reason for a teacher to request a parent to pick their child up early or require a note from a doctor before returning to care.
  • Conjunctivitis – Children exhibiting a discharge around the eye or redness and itchiness.  Unless the symptoms are due to a known allergy or irritant, the child should be seen by a doctor. If the child is diagnosed with bacterial or viral conjunctivitis, the child must remain at home the full day following the onset of the symptoms or provide a doctor’s note that they no longer pose a health risk to others.

If your child has been sent home or onset of symptoms occurred at home, it is important that your child not return to school the following full day.  If symptoms continue beyond the next day, the child must be free of contagious symptoms at least 24 hours before returning to school or provide a doctor’s note indicating child’s wellness and not in danger of contaminating others.

Below is a list of symptoms, but not conclusive, that the NJ State Licensing regulations (for more detail see regulation # 10:122-7.1(a),(b),(c) and (d)) recognize as symptoms which may warrant exclusion:

  • Severe pain or discomfort, acute vomiting, acute diarrhea
  • Elevated oral temperature of 101.5 or greater or axillary temperature of 100.5 or greater
  • Behavioral or visual physical changes:  lethargy that is more than expected; yellow eyes or jaundiced skin; red eyes with discharge; infected, untreated skin patches; difficult rapid breathing or severe coughing; skin rashes in conjunction with fever or behavior changes; weeping or bleeding skin lesions that have not been treated by a health care provider; sores with drooling or stiff neck; signs of head lice or symptoms of other common childhood illnesses.

Head Lice is not a communicable illness but in a child care setting where children are in close proximity, and sleeping on the mats near other children, the chances of lice jumping from person to person is a greater probability than in other types of settings. Although lice are a nuisance and not an illness, the remedy requires the use of chemicals which families may not want to undergo multiple times. For that reason, UNOW has declared itself a nit free environment.  Children who contract head lice should not return to UNOW until they are free of nits.  If there is an incident of head lice; information will be distributed to families, notifying them of the incident and the necessary steps to rid the child and the environment of lice.

NOTIFICATION OF EXPOSURE TO CONTAGIONS:  Classroom families will receive a health alert notice any time their child may have been exposed to a communicable illness while attending UNOW.  The health alert notice will include the name of diagnosed illness along with possible symptoms and remedies. The names of children with the diagnosed illness will remain confidential.  If it is an illness that affects the entire wing or school, a health alert notice will come through the UNOW family list-serve.  Otherwise expect notices from the classroom teacher or wing program coordinators.

Medication Administration Policy & Procedures

PURPOSE:  This policy was written to encourage communication between the parent, the child’s health care provider and the child care provider to assure maximum safety in the giving of medication to the child who requires medication to be provided during the time the child is in child care.

INTENT:  Assuring the health and safety of all children in our Center is a team effort by the child care provider, family, and health care provider.  This is particularly true when medication is necessary to the child’s participation in child care.  Therefore, an understanding of each of our responsibilities, policies and procedures concerning medication administration is critical to meeting that goal.

GUIDING PRINCIPLES and PROCEDURES:

  1. Whenever possible, it is best that medication be given at home.  Dosing of medication can frequently be done so that the child receives medication prior to going to child care, and again when returning home and/or at bedtime.  The parent/guardian is encouraged to discuss this possibility with the child’s health care provider.
  2. The first dose of any medication should always be given at home and with sufficient time before the child returns to child care to observe the child’s response to the medication given.  When a child is ill due to a communicable disease that requires medication as treatment, the health care provider may require that the child be on a particular medication for 24 hours before returning to child care.  This is for the protection of the child who is ill as well as the other children in child care.
  3. Both prescribed medication and over-the-counter medication will only be given when ordered by the child’s health care provider and with written consent of the child’s parent/legal guardian.  A “Permission to Give Medication in Child Care” form are available at the UNOW main office and will hereafter be referred to as Permission Form.  All information on the Permission Form must be completed before the medication can be given.  Copies of this form can be duplicated or requested from the child care provider.
  4. “As needed” medications may be given only when the child’s health care provider completes a Permission Form that lists specific reasons and times when such medication can be given.
  5. Medications given in the Center will be administered by a staff member designated by the Center Director and will have been informed of the child’s health needs related to the medication and will have had training in the safe administration of medication.
  6. Any prescription or over-the-counter medication brought to the child care center must be accompanied by the instructions of a health care professional, be specific to the child who is to receive the medication, in its original container, have a child-resistant safety cap, and be labeled with the appropriate information as follows: 
    • Prescription medication must have the original pharmacist label that includes the pharmacists phone number, the child’s full name, name of the health care provider prescribing the medication, name and expiration date of the medication, the date it was prescribed or updated, and dosage, route, frequency, and any special instructions for its administration and/or storage.  It is suggested that the parent/guardian ask the pharmacist to provide the medication in two containers, one for home and one for use in child care.
    • Over-the-counter (OTC) medication must have the child’s full name on the container, and the manufacturer’s original label with dosage, route, frequency, and any special instructions for administration and storage, and expiration date must be clearly visible.
  7. Examples of over-the-counter medications that may be given with instructions from the health care provider include:
    • Antihistamines
    • Decongestants
    • Non-aspirin fever reducers/pain relievers
    • Cough suppressants
    • Topical ointments, such as diaper cream or sunscreen
  8. All medications will be stored:
    • Inaccessible to children
    • Separate from staff or household medications
    • Under proper temperature control
    • A small lock box will be used in the refrigerator to hold medications requiring refrigeration.
  9.    For the child who receives a particular medication on a long-term daily basis, the staff will advise the parent/guardian one week prior to the medication needing to be refilled so that needed doses of medication are not missed. 
  10. Unused or expired medication will be returned to the parent/guardian when it is no longer needed or be able to be used by the child.
  11. Records of all medication given to a child are completed in ink and are signed by the staff designated to give the medication.  These records are maintained in the Center.  Samples of the forms used are attached to this policy and include:
    • Permission to Give Medication in Child Care
    • Universal Child Health Record
    • Emergency Contact Sheet
    • Medication Administration Log
    • Medication Incident/Error Report
  12. Information exchange between the parent/guardian and child care provider about medication that a child is receiving should be shared when the child is brought to and pick-up from the center.  Parents/guardians should share with the staff any problems, observations, or suggestions that they may have in giving medication to their child at home, and likewise with the staff from the center to the parent/guardian.
  13. Confidentiality related to medications and their administration will be safeguarded by the Center Director and staff.  Parents/guardians may request to see/review their child’s medication records maintained at the Center at any time.
  14. Parent/guardian will sign all necessary medication related forms that require their signature, and particularly in the case of the emergency contact form, will update the information as necessary to safeguard the health and safety of their child.
  15. Parent/guardian will authorize the Director or Director Designee to contact the pharmacist or health care provider for more information about the medication the child is receiving, and will also authorize the health care provider to speak with the Director or Director’s designee in the event that a situation arises that requires immediate attention to the child’s health and safety particularly is the parent/guardian cannot be reached.
  16. Parent/guardian will read and have an opportunity to discuss the content of this policy with the Director or Director’s designee.  The parent signature on this policy is an indication that the parent accepts the guidelines and procedures listed in this policy, and will follow them to safeguard the health and safety of their child.  Parent/guardian will receive a copy of the signed policy including single copies of the records referenced in this policy.
  17. The Medication Administration in Child Care Policy will be reviewed annually by the following:
  18. Child Care Director                _____________________________________________
  19. Licensing Consultant              _____________________________________________
  20. Child Care Health Consultant _____________________________________________
  21. Parent/guardian                    _____________________________________________

REFERENCES:  Information for the Medication Administration in Child Care Policy was derived from the current Manual of Requirements for Child Care Centers in New Jersey and Caring For Our Children—The National Health and Safety Performance Standards for Out-of-Home Child Care Programs, second edition. 

Permission to Administer Topical Ointment/Lotion

Parental authorization must be provided for staff to apply over-the-counter topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, and powders, such as sunscreen, diapering creams and baby lotion. Topical Authorization forms are available upon request.

Item must be provided in its original container, will only be administered based on directions for use and age recommendations on container, and labeled clearly with the child’s name. Staff will keep items out of reach of children when not in use.

Medical Special Care Plans and Allergies

Children with ongoing medical or physical conditions, such as diabetes, feeding tubes, asthma and nebulizers, food or environmental allergies, seizures etc., must provide a medical special care plan that is signed by a licensed medical doctor.  All medications required must follow our medication policy.  Teacher may need training in procedures.  If a child requires an epi-pen; there must be two prescribed epi pens on site at all times.  Epi-pens are kept in first aid bags and travels with the child in locations while in care. Teacher will monitor medication and notify families before they have expired.  All medical special care plans must be updated at least annually.