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After studying this chapter you will be able to:
▸▸ Describe how to conduct health appraisals, daily health checks, and nutritional health
▸▸ Explain why it is important to perform health screenings in early childhood settings.
▸▸ Maintain health records in an early childhood setting.
▸▸ Understand the process of typical sensory development.
▸▸ Identify signs of possible disabilities in vision, hearing, speech/language, and
▸▸ Evaluate a child’s social and emotional well-being.
▸▸ Include families in health appraisals, daily health checks, and screenings.
▸▸ Talk with families about health referrals.
▸▸ Collaborate with other professionals in the health screening and service of young
Introduction to Assessing Health
7.1 Introduction to Assessing Health
Assessing the health of a child is one of the most important functions a caregiver can perform. Accurate and prompt assessments of ill health or a potential medical condition can
help a child receive medical attention promptly, prevent complications from developing, and
decrease the chances of other children in the center becoming ill. However, care must be
taken to make sure that the assessment is done accurately to avoid alarming parents unnecessarily. Further, caregivers must remember that the news of a possible problem may upset
parents; therefore caregivers should approach parents in a sensitive manner to increase the
likelihood that the child receives timely intervention to ensure the best outcome possible.
Health Appraisal Through Observation
An observation is a careful, visual inspection of the child. Caregivers should perform a
visual inspection of each child every day when the child arrives at the center, such as while
the caregiver is greeting the child and the parents at arrival. Visually observing the child
provides caregivers with a benchmark for the child’s appearance that day and can help
caregivers quickly identify any signs or symptoms of illness that may develop over the course
of the day. Additionally, it can help caregivers identify any illness a child has, or preexisting
bruises or scrapes that a child may have acquired from playing before the child arrived at the
center. Any concerns should be discussed with the parent. However, any signs of possible
trauma should be discussed with the center director to determine if the injury rises to the
level that requires reporting to child protective services. Daily health checks are a good
way for center staff to identify any unusual behavior, should it appear. Daily checks will help
caregivers identify a change in a child that may signal the start of an illness, and obtain
appropriate treatment for the child. Early identification will generally prevent a more serious situation
from developing (e.g., a cough turning into bronchiThe
best way to conduct a daily
tis), which will help to lower the rate at which infechealth check is to use four of the
tion, viruses, and other ailments are introduced into
five senses: sight (looking for sympthe child care center.
toms), hearing (listening for unusual
sounds), touch (noting any fever),
and smell (sniffing for incontinence
or other unusual odors).
Daily checks are an initial step in a more thorough
investigation, and should not be used to alarm the
child or the parent. If something unusual is noticed,
the other staff at the center should be alerted and
asked to keep watch for additional symptoms.
When Should Daily Health Checks Be Done?
Caregivers should perform daily health checks shortly after the child arrives at the center, ideally, before the parent has left the facility. Caregivers should encourage parent involvement
and input. If the child had difficulty sleeping the night before or went to bed late, he or she
may appear lethargic. This is important information to have so that staff do not jump to a
conclusion that the child is sick because of inactivity.
How Should Daily Health Checks Be Done?
To begin a quick but thorough daily health check, the examiner should get in a position
that allows a clear look at the child at eye level (Healthy Childcare Consultants, Inc., 2012;
North Carolina Child Care Health & Safety Resource Center, 2002; National Health and Safety
Introduction to Assessing Health
Performance Standards, 1992). Hovering from above may leave the
child feeling judged, whereas a position at eye level can help to
put the child at ease. In this position, the caregiver should visually examine the child for any obvious physical signs of poor health
such as a rash, whether the child is pale or flushed, and whether
there is any discharge from the eyes, nose, or mouth (Healthy
Childcare Consultants, Inc., 2012; Indiana Institute on Disability
and Community, 2011a; National Health and Safety Performance
Standards, 1992). Other signs to look for include any visible sores
that may be oozing, changes in the child’s skin color (e.g., redness
or bruising) or texture (e.g. lumps, inflammation), skin tenderness,
itchiness, or any area that the child may seem to be protecting or
covering, indicating pain or irritation (Healthy Childcare Consultants,
Inc., 2012; Indiana Institute on Disability and Community, 2011a;
North Carolina Department of Health and Human Services, 2005;
North Carolina Child Care Health & Safety Resource Center, 2002;
National Health and Safety Performance Standards, 1992).
▲ Daily health checks identify
any changes in the child's typical
appearance and help prevent the
spread of infection.
Next, caregivers should perform an auditory check for any sound
that the child may be making that indicates a situation requiring
further investigation. Child care center staff should encourage par- © Stockbyte/Thinkstock
ents to note any problems the child or someone else in the family
is having (e.g., siblings with a cold, earache, sore throat, etc.). Alternatively, the caregiver may
hear something from the child to indicate that the child is ill or in pain, such as coughing,
wheezing, difficulty breathing, or hoarseness. If a child is whimpering or moaning and unable
to be soothed by the caregiver after a reasonable period of time, the child may be injured or
coming down with some illness (Healthy Childcare Consultants, Inc., 2012; Indiana Institute on
Disability and Community, 2011a; North Carolina Department of Health and Human Services,
2005; North Carolina Child Care Health & Safety Resource Center, 2002; National Health and
Safety Performance Standards, 1992).
Daily, caregivers should also evaluate a child’s health by smell. Any unusual odors or sudden changes in odors are possible signs that the child may be suffering from an ailment.
Examples include if the child’s breath smells like fruit or sugar; if the child’s breath is particularly unpleasant or smells rotten; or if the child produces an unpleasant smell after he or
she has urinated or had a bowel movement (Healthy Childcare Consultants, Inc., 2012; North
H E A LT H I N A C T I O N :
Conducting Daily Health Checks
Daily health checks should be conducted calmly while the child is positioned comfortably.
They should not be intrusive to the child’s body.
The checks should respect the family’s philosophy, values, and beliefs (e.g., if the parent does not
want the caregiver to physically touch the child during the check, then any changes of the skin such
as rash, sweating, and flushing will have to be assessed by observation only).
(North Carolina Child Care Health & Safety Resource Center, 2002)
Introduction to Assessing Health
Carolina Department of Health and Human Services, 2005; North Carolina Child Care Health
& Safety Resource Center, 2002; National Health and Safety Performance Standards, 1992).
Finally, a child should be checked for fever or lack of sufficient fluids (Healthy Childcare
Consultants, Inc., 2012; North Carolina Child Care Health & Safety Resource Center, 2002;
National Health and Safety Performance Standards, 1992). A caregiver can simply touch the
child on the arm to see if the child’s skin feels clammy or if he or she appears to have a temperature, which are common signs of fever. A caregiver can check for dehydration by gently
pushing a finger down on the child’s skin. If the skin does not spring back quickly, this may
indicate the child is not getting enough fluids. Another indication of dehydration is when a
child does not visit the bathroom very often, or if, when they do, the urine is dark yellow.
After these physical checks, the caregiver should observe the child for changes in normal
activity level, behavior, or emotional state (e.g., a typically easygoing child suddenly showing signs of distress; or a usually energetic child being listless). All of these indicators of
illness and/or injury should be evaluated further and brought to the attention of the center
director and the child’s parents. In the event that there is a change in the child’s behavior
or physical presentation, the caregiver will be able to identify it quickly, recommend that
the parent seek medical attention if necessary, and protect the caregiver from allegations
that the illness or injury happened at the child care facility. Quick action on the part of
caregivers can ensure that the child receives proper attention (either parental or medical),
the child achieving the best possible outcome, and that the spread of illness in the facility
There are many daily health checklists available online. Instructions on how to conduct a
daily health check can be obtained at http://www.in.gov/fssa/files/DailyHealthCheck.
pdf. The Indiana Institute on Disability and Community has a child care health and safety
daily checklist that can be obtained from http://www.iidc.indiana.edu/styles/iidc/defiles/
ECC/CCR-HSDailyChecklist.pdf. This checklist is based on the American Academy of
Pediatrics (AAP) Model Child Care Health Policies and consists of two simple questions
with a number of sub-questions, including questions to ask parents. The North Carolina
Department of Health and Human Services has a daily child care health check form
that tracks a child’s behavior and physical condition on a weekly basis so that caregivers can quickly see weekly averages for children. This form can be obtained from http://
ncchildcare.dhhs.state.nc.us/PDF_forms/healthcheck.pdf. Finally, the National Resource Center
for Health and Safety in Child Care has a chart with a variety of symptoms with accompanying
causes, typical child complaints, and recommendations. This chart can be obtained at http://
nrckids.org/CFOC3/PDFVersion/PDF_Color/CFOC3_A.pdf. It is important to note that hardcopy records should be kept of these daily health checks in order to observe any sort of patterns that could predict future health issues. Caregivers should not rely on memory alone.
These records should be kept in a secure location and only viewed by essential staff to ensure
that there are no breaches of confidentiality.
Health screenings are routine examinations that can indicate if a child has a condition that
requires medical intervention in an area such as vision, hearing, or oral health. Some of these
screenings can identify possible developmental delay (e.g., in speech, language) and indicate
that a child needs to be referred to a specialist for supplemental assistance or intervention
that can improve the developmental outcome (Centers for Disease Control and Prevention
Introduction to Assessing Health
[CDC], 2011d). If these health issues are not caught early, they can lead to learning problems
when the child enters school. For instance, a child with an undiagnosed hearing problem
may not achieve the required developmental milestones for speech. This could be misdiagnosed as a learning problem instead of a hearing problem. Alternately, a child with a vision
problem may not be able to distinguish between letters, again possibly being referred for
learning problems. Early childhood caregivers are in a prime position to identify these issues
and work with parents so that the children in their care receive prompt attention to correct
any health issues as soon as possible. The sooner early intervention is received by the child,
the better the child’s developmental prognosis. The AAP has published a chart listing the
most important screenings, their timing, and characteristics (http://practice.aap.org/content.
Maintaining Health Records
A child’s health record is a collection of medical
information (physical, dental, cognitive, etc.) about
the child such as dates of diseases, illnesses, vaccinations, operations, and medications. A child’s medical record should include the contact information
for the child’s primary health care provider, dentist,
and mental health care professional (if applicable); a
log of the child’s vaccinations, including dates; any
known food allergies or dietary limits; a list of the
dates of any major illnesses or accidents; and a list
of medications the child is currently taking, including over-the-counter drugs, and instructions for dos- ▲ Health records keep track of important informaage (Farrer & Zamani, 2003). Maintaining accurate tion regarding a child's medical history.
and complete child health records assists caregivers © iStockphoto/Thinkstock
in identifying gaps in a child’s medical care, such as
missed vaccinations, thereby better assuring that a child receives the appropriate medical
attention. Accurate records also assist caregivers in providing better quality care to all children
and aid caregivers in developing individualized programs for children who have prolonged
medical conditions or particular medical needs (e.g., asthma). Comprehensive child health
records also provide caregivers and center administrative staff necessary information to determine if the child requires care beyond what the child care center is able to provide (e.g., a child
who develops a condition with severe dietary restrictions).
Child care practitioners who keep precise and comprehensive child health records can also serve as a
A hearing or vision issue can be
useful support system for parents. For instance, if a
misdiagnosed as a learning problem
family does not have a pediatrician, a center’s request
or developmental delay.
for the child’s medical information may prompt parents to obtain a pediatrician, and the center can help
them locate one. These requirements also encourage communication between parents and
caregivers. Caregivers can learn a lot from the information provided by parents, which can
make caring for the child easier. For instance, when a parent provides medical information
about the child, the parent may note a medical condition (e.g., allergy) in another family member, which could also impact the child. The center’s child health records give child care providers a more complete picture of a child’s health and help them to notice any changes that
Early Detection of Atypical Sensory Conditions
H I G H L I G H T:
Recommendations Regarding Maintenance
of Child Care Medical Records
The types of mandatory medical information that should be kept by a child care facility vary from
state to state. The following minimum items are recommended by the California Childcare Health
• Name, address, and phone number of medical, dental, or mental health care providers
• Documentation of current immunizations (“blue card”) or signed waiver by parent releasing child
• Medical assessment, including dietary allergies and restrictions
• Emergency instructions, and signed consent for emergency medical treatment
• Record of illness or injury requiring treatment by a health care provider or dentist, and for which
the center provided assistance
• Record of current medications, including the name of prescribing health care provider and
• Signed and dated authorization for activity away from the center
(Farrer & Zamani, 2003)
may indicate a more serious condition. Additionally, this information equips caregivers so that
they can respond appropriately and quickly in the event of an emergency involving the child.
For full information on selecting a secure location for medical records, see the National Health
and Safety Performance Standards (1992), which endorse the practice of selecting a specific,
secure location in which to keep all of the child medical information.
Each child care center should institute a policy that allows it to obtain the correct amount of
information without becoming intrusive (Farrer & Zamani, 2003; The National Health and Safety
Performance Standards, 1992). Caregivers need a certain amount of information to ensure the
best possible care is provided to every child in their care; in the pursuit of this goal, caregivers sometimes will become privy to sensitive medical information about the child. Caregivers
should treat all medical information as confidential and not discuss it with anyone who is not
authorized. It is recommended that caregivers sign confidentiality agreements with their centers to protect themselves, the centers, the families, and most importantly the children in their
care (Farrer & Zamani, 2003; The National Health and Safety Performance Standards, 1992).
7.2 Early Detection of Atypical Sensory Conditions
Sensory development is defined as a child’s progress in vision, hearing, and speech/
language. Although there is a wide range in which typically developing children reach certain
developmental milestones, unusual progress in any of these areas should trigger further investigation. If a child displays any of the conditions described below, the caregiver should talk to
the parents to ensure that the child receives more in-depth evaluations.
Early Detection of Atypical Sensory Conditions
H I G H L I G H T:
Children should have their vision assessed by a qualified health care professional at the
• The first 3 months
• Between 6 months and 1 year
• Close to their 3rd birthday
• Shortly after their 5th birthday
To assess a child’s visual skills, it is important to
understand the progress of typical visual development. Vision is the ability to sense or perceive objects
with the eyes.
Normal Vision Development
During the first month of life, a baby’s pupils will
widen or narrow when exposed to a light source.
Babies will direct their eyes toward an item placed
near their face. If given a choice, newborns will
choose to look at black-and-white patterns, simple
shapes, and people’s faces. From 1 to 3 months of ▲ As their eyes begin to work together, infants
age, infants will watch an item that is held to one often enjoy watching themselves in a mirror.
side of their body, follow it past the middle of their © iStockphoto/Thinkstock
body, and continue watching it all the way to the
other side of their body. In infancy, the eyes work together and are able to follow items moved
up and down. Infants enjoy watching themselves in a mirror. Also at this age, babies will look
around for specific sounds and they enjoy examining their hands (Bedinghaus, 2010; Heiting,
2010; Bailey & Wolery, 1989).
Between the ages of 4 months to approximately 1 year, babies are able to focus all their
attention on an item (e.g., their favorite toy) that is approximately 3 feet away. They will try
to reach for and hold onto different things at 3 feet
and mimic different faces that people make. Babies
all children reach developmental
at this age also are able to detect colors, distinmilestones at the same time, and
guish various shapes, and demonstrate that they
some never reach them. This can be
have object permanency. Object permanency is
the cognitive ability to understand that if an ob ...
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