OUR SAVIOR EARLY CHILDHOOD CENTER

HEALTH POLICIES AND PROCEDURES
[As approved by the Department of Human Services (DHS)]

Health and Safety Policy

Mrs. Laura Guetzkow, Registered Nurse, is the center consultant.  Mrs. Guetzkow will assist us in developing Health Policies and in keeping them current.  Mrs. Guetzkow will assist in screening, referral, and follow-up procedures and provide advice about children with special needs.

Ridgeview Excelsior Clinic is available as an emergency resource during the hours of operation.  Phone:  952-906-7855.

If parents of a child object to medical examination or treatment on the grounds of their religious beliefs, the parent must complete a Health Care Summary and sign a statement indicating their objections to medical examinations and treatment on grounds of religious beliefs.

The Center has a first-aid kit available at all times.  Mrs. Laura Guetzkow, R.N., has approved the contents yearly.

Though Lutheran schools are not required by law to accept or to provide adapted programs for handicapped children, they will, nevertheless, make their decision in the spirit of the Gospel and their service to people.

1.  If a child who has AIDS, ARC, or is HIV positive seeks admission to the 
    school, a pre-enrollment conference including the child's parents, 
    physician, probable teacher, and the Administrator will take place to determine:
  
    a.  AIDS-induced impairment of the child's mental function.

b.  Psychological impairment manifested in assaultive behavior and the potential exposure of others to infected    blood.

    c.  The immunization status of the child.

    d.  The necessary limits on the child's curricular and extra-curricular
        school participation.

    With this information, the school will determine whether or not the child is to be enrolled.

2.  Each enrolled child is expected to meet immunization requirements of 
    the school for the protection of the student body and faculty.

3.  As part of the health or religion curriculum, the faculty will provide
    appropriate instruction about AIDS and its prevention.  These instructions are available for review in the childcare office.
4.  As appropriate in the religion curriculum, teachers will emphasize the
    compassion of Christ to the sick, the promise of divine care for those
    who place themselves at risk in the service of others, the hope of the
    resurrection in the presence of terminal disease and the celebration of
    the new life in Christ through faith while physical life disintegrates 
    in dying.

Caring for a Sick Child at the Center
If a child becomes ill in our care, every attempt should be made to keep him/her comfortable until the parent arrives.

I.   Until the parent arrives:

     A.  A cot and blanket should be available for the child.

     B.  The ill child should be separated from the other children, but 
         should be within sight and hearing of an adult.

II.  Notifying Parents:

     A.  Parents need to be notified and informed to make arrangements to
         have the child picked up from the Center.  If parents cannot be 
         reached, notify the person designated on the Emergency Form and
         Registration Form.

     B.  If neither parents nor persons designated on the registration form
         can be reached, or if parents are delayed in picking the child up:

         1.  Continue to assess the child's condition frequently.

         2.  If the child has a fever, continue to monitor the child's
             temperature.

         3.  If you feel the child's condition warrants medical attention,
             contact the child's source of health care, or if necessary,
             your local emergency resource.

Exclusion of Sick Children from the Center
In order to protect all children in the Center, we request that parents make other arrangements for the care of their child if symptoms of illness are present.  If a child develops one or more of the following symptoms while at the Center, he/she will be isolated until the child can be picked up.  

The symptoms include:

1.  Fever:  A temperature registering above 100` (oral) or 99' (axiallary).

2.  Nausea and/or vomiting.

3.	Diarrhea:  an increase number (2 or more) of  loose stools.

4.	Undiagnosed rashes (other than mild diaper or heat rash).

5.	Communicable infections.  Specific information regarding the disease, method of spread, prevention, and control measures are detailed in Infectious Diseases in Childcare.  (Copy in Childcare Office.)

6.	Child is not able to participate in child care program activities with reasonable comfort or requires more care than the program staff can provide without compromising the health and safety of other children in care.

7.	There may be additional illnesses that necessitate exclusion.  Always feel free to consult with our Health Department for assistance in evaluating individual cases.

The length of time an individual should be excluded from a program will vary depending on the illness or disease.  The current guidelines for readmitting children for specific communicable diseases are:

CHICKEN POX:  Until all the blisters have dried into scabs and no new  blisters or sores have started within the last 24 hours; usually by day 6 after the rash began.      

CONJUNCTIVITIS:  WITH PUS AND/OR FEVER OR EYES PAIN:  Until the child has been evaluated by healthcare provider, and until 24 hours after antibiotic treatment begins, or until the healthcare provider has cleared for readmission.

WITHOUT PUS:  (clear, watery discharge without fever, eye pain, or eyelid redness) No exclusion necessary. 

HEAD LICE:  Until first treatment is completed and no live lice are seen.

IMPETIGO:  Until treated with antibiotics for 24 hours, and sores are drying or improving.

INFLUENZA:  Until fever is gone, and the child is well enough to participate in routine activities.

PINWORMS:  Until 24 hours after the treatment has been started.

RINGWORM:  Until 24 hours after the treatment has been started.  Children with Ringworm should not participate in gym, swimming, or other activities likely to expose others.

SCABIES:  Until 24 hours after treatment begins.

STREP THROAT:  Until 24 hours after antibiotic treatment begins, and the child is without fever.
Parents of any child who does not seem well enough to participate in the Center activities will be called.

When a child enrolls in the Center, parents will be informed of the policies that relate to exclusion of sick children.  Parents will be encouraged to establish a plan for back-up care should their child become ill.

Notification of Infectious or Communicable Diseases
When a communicable disease occurs, the Center will notify the parents that their child has been exposed to this disease by sending home the proper form that includes the name and symptoms of the disease.  Likewise, parents should inform the Center, as soon as possible, if their child contracts a communicable disease.

     1.  The manual, "Infectious Disease in Child Day Care," will be the resource for communicable disease information.

Medical Administration
No medication should be given without authorization from the child's physician and parent.  Parents must fill out the Medication Permission form.  The medication must be in the original pharmacy container and can be given only as prescribed.  A legible label of prescription medications shall be on the container.  These directions must be followed carefully.  If there is an expiration date on the label, the medicine may not be given beyond this date.  Read the label to ensure proper storage and to see if medication needs shaking before administration.  Medication must be in its original container.

1.	Parents must sign a medication permission form and the appropriate information must be completed.  The teacher accepting the completed medication permission form is responsible to make sure the form is filled out correctly.  Be sure to remind parents that medications must be taken home daily.

2.	Teacher accepting medication and/or medication permission form will immediately place masking tape on the child's clothing stating the dosage and time to be given.

	3.  Medication permission forms are to be place on the clipboard assigned to the child's teacher.

	4.  Medications are to be stored either in the refrigerator or the cabinets above the counter immediately.

5.	Morning teacher is responsible for giving the lunchtime medication before changing over to the next teacher.  Afternoon teachers are responsible for giving afternoon medications.  Before the medicine is given, check medicine container twice for correct name, time, and dose instructions.

6.	 When medications are given, the medication permission form must be signed immediately with the time, date, and your initials.  Remove the child's tape and discard.

7.	When a medication error is discovered, the teacher will notify the Director immediately.  (An error may be wrong dose, wrong time, wrong route, omission, wrong child, etc.)

8.	 The child will be monitored closely for any possible adverse reactions.

9.	 As soon as the error is found, the parent/guardian will be notified of the nature of the error.  If the wrong medication was given, it should be determined if a known drug allergy exists.

10.	If a known allergy exists, a physician should be notified immediately for possible treatment.  If swelling of the face, tongue, or throat occurs and/or respiratory distress develops, 9-1-1 should be called.

11.	 If the error was the result of the wrong time, dose, route or omission, contact of a doctor will be at the discretion of the parent/guardian.

12.	Actions will be taken to correct the cause of the error and the Report of Error in Administration of a Medication will be completed and placed in the child's file.

13.	Medication permission forms are to be returned to the cupboard or bulletin board in the classroom where the child attends the morning session.

14.	When medication is gone or medication permission form expires, put medication permission form into medication folder.

Medication permission forms are needed for prescribed medications, non-prescribed medication, sunscreen, and insect repellent.  It is not necessary for the teacher to initial the medication permission forms for sunscreen or insect repellent.

Medication Storage

Refrigerator medications must be stored in a container marked “Medications” in the refrigerator in the Childcare office.  Non-refrigerated medications will be stored on the top shelf of closed cabinet in child's room in a covered plastic container.

Individual Accidents

Parents of all children in the Center are required to submit a medical release form giving the Center permission to seek medical attention for the child in case of an emergency.  The parents should update the Center on any change in home, work, and medical phone numbers.

Accident Log and Report

Any accident should be recorded on an accident report form signed by parent and filed in the Center's office.  Parents should be notified that first aid measures were carried out.  The accident log will be reviewed semi-annually by the Director and teaching staff.

Reporting to the Department of Human Services

Within 24 hours after the occurrence of an accident where the child has to see a doctor or an unusual accident, such as the death or serious injury of a child, a report shall be submitted to the department.  A serious injury shall be defined as one that requires the hospitalization of the child. A report hall also is submitted following the occurrence of a fire that requires the services of the fire department.

Emergency Medical Care

In case of an emergency, every effort will be made to contact the parent or designated adult responsible for the child.  If neither can be contacted, medical care will be provided until the parents can be notified. Emergency vehicles will provide transportation.

In case of an emergency, Methodist Hospital will be used.

If an emergency arises, the staff shall follow the steps under, ACTIVATING EMERGENCY MEDICAL SYSTEM.

ACTIVATION EMERGENCY MEDICAL SYSTEM

I.    Call the emergency service or Poison Control Center

           Emergency Service - 911
           Poison Control Center - 347-3141

II.   TALK SLOWLY AND PLAINLY

      Tell the answering party:

      1.  Nature of the problem
      2.  Agency needed (police, fire, or rescue)
      3.  CORRECT address of incident and location in building
      4.  Patient's name and age
      5.  Treatment accomplished so far

III.  DO NOT hang up.

      1.  More information may be needed.
      2.  Dispatcher may be able to give added instructions

IV.   Assign person to direct emergency services to exact location.

      1.  Post person at main entrance
      2.  Give good description of location
      3.  Remember several services may be involved--direct all

V.    Have the following information ready (found on emergency card):

	 1.  Patient's name
	 2.  Parent's name
	 3.  Doctor's name
	 4.  Medical history (diseases, medications, allergies)
	 5.  If poisoning provide a sample of the product or save the vomit.
	 6.  Your observations of patient to this point

REMEMBER - If in doubt notify emergency services. Take no unnecessary chances.
            
Accidents in Transit

When going on field trips, Center staff should take money for making phone calls, a first aid kit, and emergency numbers for the children.  Before the trip, please check that all necessary items are in the kit in case anything has been depleted.

I.    Vehicle Accident

      A.  Call the police immediately
      B.  Call the Center and inform them of the accident and the number of children on the bus.  
      C.  Stay with the children until the Center or bus driver makes new transportation arrangements.

II.   When the Bus Driver or Children are Personally Injured

      A.  Designate someone to call the police if they have not already arrived.
      B.  Ask the police or designate someone else to notify the Director of the Center.
C.	The Director will go to the hospital to support the children and staff and to help with child identification as needed.  One person will stay at the Center to monitor calls.

III.  For Staff Who Take the Emergency Call

A.	Request that the police or a competent adult sees that all the children are examined medically.
B.	Call the supervising teacher or Director.
C.	Notify other staff members of what has happened, and give them pertinent details so they will be able to answer phone calls or questions informatively.
D.	 Call parents of children who were on the bus at the time of the accident.

	     -  Be calm--do your best not to alarm the parents.

-	If you know a child has been injured and has been taken to the hospital, tell parents that the children are being examined and ask the parents to go to the hospital.
-	 If you were informed that none of the children seemed to be injured, tell the parent that the children are being examined at the hospital and ask the parent to go to the hospital.

E.	Stay at the hospital until everything is under control and until a parent or designated adult has come to the hospital for each child.

Transportation Breakdown

When a vehicle used in transportation of the children breaks down, the Center staff needs to:

1.	Call the Center and inform them of the situation and location of the breakdown including the number of children there.
2.	Staff members should stay with the children until the Center makes new transportation arrangements.

Adult Accidents

If an accident occurs on the job where serious complications may develop or where employment time may be lost, the employee should be medically examined immediately.  The following procedures should be followed:

	 A.  Report the accident to the Director and/or Administrator.
	 B.  Arrange for the employee to see a physician.
	 C.  Make sure that an accident report is filled out.

Missing Persons

In the event that t child is missing, the staff should notify the Director and proceed with the following steps:

1.	The immediate area should be thoroughly searched.
2.	The police should be notified.  A picture will be given to police to assist with the child's description.
3.	Parents should be notified immediately if there is no indication of the child's whereabouts.
4.	Remaining staff shall stay with their own children.  The Director may wish to ask other school or church staff members to help in the finding of the missing person.

Missing Parents
If a parent does not arrive to pick up their child, the staff should:

	 1.  Try to contact the parent at work or home.
	 2.  Call the emergency number on the registration card and have that person pick up the child.
3.	Tape a message to the door window so the parent is informed of the situation and location of their child if they should show up at the Center.
4.	The staff should notify the Director so the Director can continue calling the parent until contact is made.

Alternate Child Pick-up Procedures

The following procedures will be implemented if a parent is unable to pick up their child and they send an alternative adult:

I.  A parent informs Center using a written, signed message (We will accept phone messages.  In the event we do not recognize the phone callers voice, we will call back to verify the information.) with the following information:

          a.  Alternate adult's name
          b.  Phone number where this alternate adult can be reached
          c.  Brief description of the adult

  II. Staff must check alternate adult's ID.

III.  If an unauthorized person wants to pick up a child and there has been no phone call or written message from the child's parent, the staff MUST NOT let the child go.  A staff person must call the child's parents to verify information, then check ID after parent says the child can go with the adult.

Incapacitated Adult

If an adult comes to get a child and is obviously incapacitated, the following procedure will be implemented:

	 A.  Staff will suggest an alternative:  (1) call taxi (2) call other parent.

	 B.  Inform parent the police will be called if they are uncooperative--do so if necessary.

	 C.  Send child to another room with another staff person until situation is under control.

	 D.  If staff suspects adult has been drinking but is not definite; the following procedure will be implemented:
a.	Follow adult and child to car; write down vehicle make, model, color, and the direction car is traveling on Highway 7.
b.	 Call 911--report suspected incapacitated driver; give the above information.  
c.	Get officer's name and document the entire incident.

If any known or suspected child abuser attempts to pick up a child, staff must not let child go.

First Aid

If it appears that the accident may lead to future complications or in any way is serious; the child needs to be medically examined.  The following procedure should be followed:

A.	A member of the Center staff should carry out immediate first aid.
B.	A member of the Center staff will wear plastic gloves when dealing with vomit, urine, bowel movements, and blood to protect against the spread of AIDS or Hepatitis B.
C.	A member of the Center staff should contact the parents in order for them to come and take the child for necessary medical care.
D.	 In case the parents or the alternate listed emergency number can not be reached, the Director will have the authority to call a previously designated physician and/or call the local emergency unit for treatment and/or transportation to a hospital.  A staff person should accompany the injured child to the hospital and stay until the parent arrives.
E.	In some emergency situations, the staff will contact the local emergency unit before calling the parent (i.e. cessation of breathing).

First Aid Procedures
FALLS OR INJURY: Wash hands before you attend a child's wound.  Apply gloves.  Cleanse the injury thoroughly with clean running water and soap.  Apply sterile dressing if the wound is bleeding.  If bleeding persists, apply direct pressure to the wound with a clean cloth.  After the bleeding has been controlled, apply additional layers of cloth to form a good-sized covering and then bandage.  Dispose all blood items in a plastic bag. 

NOSEBLEEDS: With gloved hands, firmly hold soft cartilage for 10 minutes minimum without interruption.  Hold child's head forward applying ice if necessary.  If bleeding persists, call Center doctor or child's source of medical care.  Discourage nose blowing or sniffing after nosebleed.  Vomiting may occur.

BURNS:  

	 TYPES                   DEGREE OF BURNS
      1.  Chemical            1.  First Degree - red skin, pain
      2.  Fire burns          2.  Second Degree - blisters, pain
      3.  Electrical            3.  Third Degree - whitened, usually painless
      4.  Scalding or hot liquids. 
         
TREATMENT FOR BURNS:
 
	 1.  Remove clothing.
	 2.  Cool the burn -- immerse in cool water or apply cool wet cloth  for several minutes.
	 3.  NO BUTTER OR VANILLA (causes infection).
	 4.  No ointments (they keep in the heat).
	 5.  No benzocaine products (can irritate skin).
	 6.  Don't break the blisters.
	 7.  Place dry, sterile bandage on burn.
	 8.  Call doctor or take to the hospital if necessary.
	 9.  Apply ice pack if there is swelling.
	 10. If bandaged, change as needed as ordered by the parent or physician.

CHOKING:  Do nothing momentarily.  Give cough reflex a chance to expel the object.  If choking continues:

1.  Get behind the child, place the thumb side of your fist just below the child's rib cage; grasp your fist with other hand and press into the child's abdomen with a quick upward thrust.  Repeat as often as necessary.

If choking persists and the child becomes unconscious:

A.  Yell for help - "Call 911".
B.  Properly position the victim - open airway - then look, listen and feel for signs of breathing.
C.	If victim is breathless begin rescue breathing.  If there is resistance to your breath and victim’s chest does not rise, assume there is an obstruction.  First reposition head, tightly seal mouth and nose and breathe again.  If repositioning did not provide an open airway, assume there is a foreign body causing obstruction.  Lie child on floor, place palm of hand below sternum, place other hand on top of that hand, deliver quick upward thrusts; if necessary a series of up to 5 thrusts may be performed in rapid succession: then perform tongue/jaw lift to open mouth, and sweep for debris.  Run your index finger down inside of the cheek towards base of tongue.  Clear the debris out other side of mouth with a sweeping motion of the fingers.  Then open the airway and attempt to ventilate.  If unsuccessful, reposition and try again.  If the victim is still obstructed, repeat the above maneuvers in rapid sequence.

HEAD INJURIES:
1.  Excessive drowsiness.  The child may be sleeping after the accident.  
    He/she should arouse with ordinary measures.  Try to arouse child every
    2 hours.  If unaroused or excessively drowsy, call doctor.

2.  Persistent Vomiting.  Vomiting should ordinarily not occur more than
    1-2 times, and should not reoccur after several hours.

3.  Notify doctor if child has numbness on one side of body or has unsteady gait.

4.  Notify doctor if child complains of seeing "double" or can't focus on an object.

5.  Watch for slurred or difficult speech.

6.  Severe Headaches.  Headaches that worsen or are not relieved with medication should be reported to doctor.

7.  Notify doctor if seizure activity occurs.

8.  Staff will send home a "blow to the head" form when necessary.
  
TOOTH INJURY: If a permanent tooth is knocked out, try to replace it in the socket.  If you can't; put it in milk and call dentist.

EYE INJURY: If injury results in loss of vision, bleeding, or moderate to severe pain, tape gauze over the closed eye and bring to doctor.  If object (i.e. stick, pencil) is stuck into eye, do not remove--stabilize object and take to doctor.

INSECT BITES: Scrape off stinger if present, cleanse area with soap and water.  Apply cool compresses or ice pack.  Observe for allergic reactions (shortness of breath, wheezing -- call doctor immediately).

TICKS:  Remove tick, avoid breaking off embedded head.  Grasp head with tweezers as close as possible to point of attachment, roll slowly forward and steadily loosen grip, wash wound with soap and water.

ANIMAL BITES: Thoroughly rinse with water and wash area with soap.  Notify doctor.

CUTS:  If the wound is gaping or you cannot control the bleeding, apply a clean dry compress to the cut with steady pressure for about eight minutes.  Clean with soap and water and apply a sterile dressing.  A dirty wound may require a tetanus shot.

STEPS IN CPR:

Mrs. Laura Guetzkow RN will provide us with current CPR steps. The CPR steps will be attached at the end of this policy guide.

Poisoning Prevention

Separate locked storage areas will be provided for each of the following: art, cleaning products, and medicine.  Food will not be stored with any of the above.  Keep all cleaning fluids; drain openers, etc., in their original bottles with label intact.  Clean up all spilled liquids.

Make sure that plants are non-poisonous and hung out of reach of children.

Use only lead-free paint on equipment and walls.  Toys should have nontoxic paint on them.  Aerosol sprays should not be used.

Prevention of Choking, Aspiration, Suffocation, and Drowning

Remove all bones and shells from food before serving.  Do not give children cough drops, gum, peanuts, etc., which could cause choking.  Do not stimulate a child to laugh or cry when he/she has food in his/her mouth.

Store pins, buttons, needles, and all small pointed instruments in a childproof container out of reach.  Frequently inspect the toys to make sure that there are no small detachable parts.  Toys should be age appropriate.  Avoid using plastic bags on any equipment.

Staff members will be in attendance in the nap room and will see that sheets or blankets do not cover the children’s heads.

Toilets are a potential hazard for drowning.  Supervise children in the bathroom.

Burns and Electrical Accident Prevention
Hot water in the handwashing sink should be set no higher than 110 degrees Fahrenheit.

Children should not be allowed in the kitchen when cooking.  The temperature of the food should be checked before serving the children.  Food should be warm, not hot.

All electrical outlets must be covered or protected when not in use.  Children should be supervised so they cannot pull or chew on electrical cords.

Guards shall protect radiators, fireplaces, hot pipes, steam radiators, and other hot surfaces.

The Center is equipped with a number of fire extinguishers determined by the State Fire Marshal.  Extinguishers will be kept in working order and checked annually.  Alarm system and sprinkler system will be checked annually.

Falls
A child should not use the stairs without an adult within sight of him.  No child should be allowed to run or push others in the rooms, halls, or stairways.  Children should not leave toys on the floor when they are finished playing with them.

Prevention of Other Injuries
Toys and equipment should be checked for repair on a daily basis.  Toys should not have sharp edges and should not easily splinter or break.  Equipment and furnishings should be stable.

Overexposure to the sun should be prevented by the use of protective clothing and hats.  The use of an effective sunscreen product may be indicated; the parent must give written permission before a staff person applies such lotion.

Children should be protected from biting insects by:

     1.  Installation of screens or windows
     2.  Avoiding areas where bees are attracted -- food, garbage, flowers
     3.  Use of an insect repellent (in lotion form only) with parent's permission.

Sharp scissors, knives, matches, and other potential hazards to children shall be stored out of their reach.  The use of potentially hazardous materials and tools by children shall be strictly supervised.

Playground equipment should be checked daily and kept in proper functioning order.  The play yard should be clear of debris.

Prevention of Pedestrian Accidents
All stairways and corridors leading to exits shall be kept clear and free from obstructions at all times.  Stairways used by the children shall have reachable hand railings.

Premises shall be kept clean and sanitary.  Floors must be kept clean at all times and must not have splinters, cracks, or broken linoleum or tile and must not be slippery.  Carpeting and rugs must not be hazardous.  Entry sidewalk must be kept clear of snow and ice.

Ventilation and lighting must meet the requirements of the State/Local Building Code.

Motor Vehicles

Streets, driveways, and parking lots are sources of danger to young children.  When walking to the playground or around church property, take extreme care--have an adult at front and back of each group--never let them run ahead of the adult.

**DO remember that children need full-time protection and a constant bodyguard.

**DO keep in mind that accidents most often occur when adults are tired, daydreaming, busy talking to one another, or underestimating a child's ability.  Accidents are less apt to occur when adults are rested, watchful, alert, concerned for safety and well being.

Health Hazard Inspection

Daily inspections will be made and charted by all staff members for possible health hazards.  Accident logs will be checked routinely to see if there is a pattern to certain types of accidents.  All hazards shall be discussed with the staff and corrected, where possible.  Procedures shall be devised to prevent accidents and eliminate hazards.

Handwashing

The most important thing you can do to prevent the spread of illness is to wash your hands and the children's hands thoroughly and often.

	How to wash your hands:

	A.  Rub your hands together vigorously for at least 20 seconds using warm running water and soap.
F.	Wash under fingernails, between fingers, back of hands, and wrists.
G.	Rinse your hands well under running water.
H.	Dry your hands with a single-use paper towel.
I.	For hand-held faucets, turn off water using a paper towel instead of bare hands to avoid recontamination of clean hands.