Daycare/Nursery Safety

Is the daycare/nursery periodically inspected for hazards?

Church-operated nurseries and toddler areas can be convenient programs for parents and enriching for children. However, churches that have nurseries and toddler areas on site must be fully aware of the risks associated with caring for very young children. A variety of steps must be taken to minimize those risks with proper safety and security measures. Ultimately, the church must assume full responsibility for the wellbeing of every child entrusted to the organization.

Any area in the church that is used for a nursery or toddler care should be inspected on a weekly basis to identify potential hazards. Modifications to the area may also be necessary so it provides children with the safest and most secure environment possible.

Recommendation(s):

The following items should be reviewed concerning inspecting a nursery for existing hazards:

• To help prevent electrocution, all electrical outlets should be equipped with outlet covers. Be sure the outlet covers cannot be easily removed by children and are large enough so that children cannot choke on them.
• Drapery/blind cords should be out of reach of cribs and children as they a pose strangulation and entanglement hazard.
• Diapering area must be separate from children's play areas. Choose a changing table with high safety rails on all sides to prevent babies from rolling off of the change table. Always use the safety strap to secure babies.
• Safety gates should be modern and safe (non-accordion style).
• Any dresser, shelves or similar equipment should be appropriately anchored to the wall to prevent them from accidentally tipping over.
• Any lower drawers of dressers, file cabinets or similar furniture should be equipped with appropriate latches to keep children from being able to open.
• Ground Fault Circuit interrupters (GFCI) outlets should be installed on any outlets within three feet of a water source.
• All loose hanging wires and appliance cords should be kept out of reach of children.
• Remove all plastic bags from the nursery area.
• Properly functioning UL-listed smoke detectors should be installed in each room.
• Potentially dangerous products including medicines and cleaning supplies should be stored in original, labeled containers in locked cabinets.
• Television and audiovisual equipment on moveable carts should be properly secured with straps or mounting brackets.
• Doors to closets, hallways and other rooms should be equipped with a lock.
• Procedures should be in place for warming bottles so as to protect children from burn injuries. Note that slow cookers operate at a higher temperature and are not appropriate for warming bottles.
• If hot water radiators are installed at floor level, this exposes the children to severe burns if they were to grab or come in contact with the radiator surface. To reduce the risk of burns, protective covers should be installed covering the hot water radiators.

Tasks:

1. Daycare/Nursery safety inspections

   Inspect the daycare/nursery on a regular periodic basis for safety hazards

Is the daycare/nursery equipment periodically inspected?

There are hundreds of types of nursery equipment on the market intended to be used with children, however many of these products are used incorrectly, poorly designed or over time their condition deteriorates to a level where they are no longer safe. Many churches will also accept nursery equipment that is donated from their members or even the public. However, the same problems arise from using the donated equipment as well as many of the donated items will be accepted without any of the manufacturers paperwork. Without this paperwork, the piece of equipment may not be used according to manufacturer's recommendations and could jeopardize the safety of the children. The following information is some important safety requirements for various types of nursery equipment. The requirements can help ensure that your current equipment is safe and that any new or donated nursery equipment does not have any safety hazards that could jeopardize the safety of the children using the equipment.

Recommendation(s):

The following items should be reviewed when inspecting a daycare/nursery's equipment for existing hazards:

Cribs

New crib safety standards went into effect in June of 2011. These new mandatory standards will: 1) stop the manufacture and sale of dangerous, traditional drop-side cribs; 2) make mattress supports stronger; 3) improve slat strength; 4) make crib hardware more durable; and 5) make safety testing more rigorous. The new safety standards aim to keep children safer in their cribs and prevent deaths resulting from detaching crib drop-sides and faulty or defective hardware.

If your church owns or operates a child care facility and charges a fee for its services, your child care center is covered by the new crib rule. Even if you do not charge a fee, if your child care workers are paid, in all likelihood the new regulations also apply to your organization. Starting on December 28, 2012, child care facilities must use only cribs that comply with the new crib standards.

If the child care arrangement at your church involves volunteer staffed nurseries to care for children during church service and no one is paid, this is not covered by the new crib rule. Even though the standard does not apply to volunteer staffed nurseries, you are posing a risk to children if you continue to use noncompliant cribs and the use of updated cribs is now seen as best practice. You should strongly consider transitioning away from the use of noncompliant cribs.

Additionally, the following safety features should be followed concerning cribs:

• The mattress should fit snugly next to the crib so that there is no gap. If two adult fingers can be placed between the mattress and the crib, the mattress should be immediately replaced. Children can suffocate in the spaces formed between mattresses or from ill-fitting mattresses.
• There should be no missing, loose, broken or improperly installed screws, brackets or other hardware on the crib or mattress support.
• There should be no more than 2 3/8 inches between crib slats, so a baby's body cannot fit through the slats; there should also be no missing or cracked slats.
• None of the corner posts should be over 1/16th inch high so a baby's clothing cannot catch.
• Neither the headboard or foot board should have cutouts where the baby's head could become entrapped.
• Bumper pads should cover the entire inside perimeter of the crib and tie or snap in place. Bumper pads should have at least six straps or ties and any excess length of straps or ties should be cut off. Bumper pads should never be used in lieu of proper spacing between the slats and should be removed from the crib as soon as the child can pull themselves to a standing position.
• As soon as the child can pull them up to a standing position, set and keep the mattress at its lowest position. Stop using the crib once the height of the top rails is less than three-fourths of the child's height.
• Never place a child in a crib with soft bedding, such as quilts, comforters and pillows. These items increase the risk of SIDS and suffocation.
• Do not use large plastic bags or similar items as mattress covers. Plastic can cling to the childrens' faces and present a suffocation hazard.
• Mobiles or crib gyms should be removed to reduce the chances of an entanglement hazard when the child reaches 5 months or begins to show signs of being able to push or pull themselves up.

Gates and Enclosures

• There are two main categories of gates - screw fixing and pressure fitting.
  • Screw Fitting Stair Gates - Should be the only type of gate placed at the top of stairs, but they can also be put in doorways. This type of gate must be properly attached to the wall, however if properly installed the gate cannot come loose and there is no bar across the bottom which can present a tripping hazard at the top of a set of stairs.
  • Pressure Fitting Stair Gates - These types of gates expand outward until they become wedged into the doorframe. They are easy to install and don't require the need for screws or permanent adhesives. These gates are ideal for separating rooms that are on the same level but they must never be used at the top of stairs.
• Most gates are only suitable for children up to the age of 24 months. However consult the manufacturer's recommendation.
• The U. S. Consumer Product Safety Commission (CPSC) warns of an entrapment and strangulation hazard that exists with accordion-style baby gates manufactured prior to February 1985.

Highchairs

• Highchairs should have a wide base for stability
• They also should be equipped with a "crotch" strap that are independent of the tray and the buckle should easily fasten and unfasten
• The trays should securely locked.

Playpens

• Use only the mattress provided by the manufacturer. Children can suffocate in the spaces formed between mattresses or from ill-fitting mattresses.
• If using a mesh-sided playpen, make sure the mesh is less than 1/4 inch in size and that it is attached securely. This will help prevent strangulation.
• Do not use playpens with catch points, such as protruding hardware.
• Make sure the top rails of the units lock into place automatically.
• Playpens should be in good shape. Using a modified or improperly repaired unit can create hazards.
• Never place a child in a playpen with soft bedding, such as quilts, comforters and pillows. These items increase the risk of SIDS and suffocation.

Walkers

• Walkers tend to roll down stairs, which can cause broken bones and head injuries. This is how most children get hurt in baby walkers.
• Walkers also can be a hazard because children can reach higher when in a walker. A cup of hot coffee on the table, a radiator, or space heater are all now in baby's reach and may cause burns or poisoning.
• Fingers and toes can easily be caught between the walker and furniture, causing them to become pinched.

Bassinets and cradles

• Bassinets and cradles should have a wide base to prevent tipping over.
• The mattress should fit snuggly within the bed frame. Children can suffocate in the spaces formed between mattresses or from ill-fitting mattresses.
• The rocking mechanism should have a locking device.
• They should not be used with children who can roll over or pull themselves up.
• They should not contain any beads or other decorative material that could become a choking hazard.

Toy Chests

• Chests should not be equipped with latches that could entrap the child.
• The chest should be equipped with ventilation holes.
• Any chest equipped with a lid should have spring loaded hinges that will support the lid in any position and keep it from slamming.

Strollers

• Strollers should have a wide base to prevent them from tipping over.
• Strollers should be equipped with a frame-locking mechanism that would prevent the stroller from accidentally collapsing.
• The brakes should securely lock the wheels.
• They also should be equipped with a seat belt and crotch strap that are securely attached to the frame.

Changing tables

• A protective barrier should be on all four sides (either a rail or solid wood).
• A safety belt or strap should be provided to prevent the baby from falling.
• Changing tables should be properly equipped with drawers or shelves for storage. This will prevent accidentally leaving the baby on the table to retrieve supplies.

Pacifiers

• Only one-piece pacifiers should be used to avoid choking on small parts.
• The shield should be large enough that it can't fit into a baby's mouth, at least 1-1/2 inches wide and equipped with air holes.
• Ribbon, string, yarn or similar items should not be tied to the pacifier.
• All pacifiers should be regularly inspected for cracks in the rubber or loose parts.
• Any damaged pacifiers should be properly disposed of immediately.
• Pacifiers should be cleaned according to manufacturer's recommendations.

Tasks:

1. Daycare/Nursery equipment safety inspections

   Inspect the daycare/nursery equipment on a regular periodic basis for safety hazards.

Are all daycare/nursery toys periodically inspected?

There are thousands of new toys manufactured every year, all with the goal of providing entertainment to children. However, many of these toys are designed solely for the intent of entertaining and safety is never given any consideration. Safety should always be a major factor when either purchasing new toys or before accepting donated toys. Besides making sure that any new toys are safe, all existing toys should be periodically inspected to help make certain that the toys remain safe for the children attending the nursery.

Recommendation(s):

The following items should be considered before buying or accepting any toys.

• Are children allowed to only play with those toys recommended for their age?
• Have toys and furnishings in the nursery been reviewed to see if they are subject to any safety recalls?
• Any toys with sharp edges or points should be avoided.
• Check any small parts on toys to determine if they are securely fastened.
• Only toys specifically designed for outdoors use should be used outdoors.
• Toys made with cloth carry the labels "flame resistant," "flame retardant" or "nonflammable."
• All broken toys should be repaired back to new condition or thrown away.
• All moving parts should be securely attached.
• There should be no slots or holes that can pinch childrens' fingers.
• The toy itself is big enough where it cannot be put into a child's nose, mouth, or ears. (Marbles and beads are examples of toys that are too small.)
• Toys for older children should be stored in a separate location away from toys for younger children.
• Make sure ride-on toys are well balanced to reduce the chances of them tipping over.
• Children should not be allowed to sleep with battery operated toys.
• Toys should be periodically cleaned to keep them sanitary.
• Toys should not be painted with lead based paints.
• The inside of toys should not be filled with a potentially harmful substance, such as small pellets.

Tasks:

1. Daycare/nursery toy safety inspections

   Inspect the daycare/nursery toys on a regular periodic basis for safety hazards.

Does the daycare/nursery have written drop-off and pick up procedures?

Security is a growing concern at daycare centers, which confront issues ranging from custody disputes to the threat of child abductions. One way for a day care to increase there security in this area is to develop appropriate drop-off and pick-up procedures. Drop-off and pick-up procedures are designed to help insure the safety, security and well being of the children attending the nursery by ensuring children are only picked-up by the appropriate individual.

Hazard Examples:

• During Wednesday night fellowship, a mentally challenged adult male entered the children's area and left with a two-year-old girl without being noticed. They were later located in a restroom in another area of the church with both the man and the girl in a state of undress.

Recommendation(s):

For young children who are less than a specified age determined by your church (for example, less than 10 years old), child check-in/check-out procedures are strongly recommended for proper supervision.

Consider following the following basic, yet effective approach for child check-in/check-out procedures: The child is signed in by a parent or guardian who receives a "child check" similar to a claim check. Upon returning to pick up the child, the parent or guardian must present the child check in order to sign out the child and leave with them. If a parent or guardian is unable to present the child check, a church leader must be contacted. The leader will be responsible for deciding whether to release the child. As another safeguard, anyone who does not have a child check should not be allowed into the area where children are present. More sophisticated systems, such as paging systems, electronic ID cards, etc. are also available in the marketplace.

In addition to having a record of all the children who are in a particular area of the church, check-in/check-out procedures help to minimize the following risks:

• A stranger leaving with a child;
• A non-custodial parent leaving with a child;
• A child who may wander off or try to leave on their own; and
• An intruder entering the childcare/education area.

Tasks:

1. Daycare drop-off and pick up procedures

   Develop and implement a written policy on drop-off and pick-up procedures for children attending the daycare/nursery.

2. Daycare drop-off and pick up procedures training

   Train all employees and/or volunteers whose jobs are impacted by your daycares policy on drop-off and pick-up procedures of children attending the daycare/nursery.

Does the daycare/nursery have adequate staff to child/youth ratios?

Appropriate staff to child ratios is important in providing adequate supervision. When an adult is left responsible for watching more children than a designated staff to child ratios recommends, the risk of accidents and injuries is sure to increase. Always make sure there are adequate adults who have been properly selected and screened to maintain adequate adult to child ratios for any on or off-site youth activities. If your church provides childcare or operates a nursery, be sure to check with mandatory locals and state requirements for mandatory staff-child ratios.

Recommendation(s):

Whenever possible, consider increasing the number of adult supervisors beyond these levels.

Tasks:

1. Daycare/nursery staff-to-child ratios

   Develop and implement a written policy on maintaining appropriate staff-to-child ratios. This policy should include all activities associated with all ages of children as well as any daycare/nursery operations.

2. Daycare/nursery staff-to-child ratios training

   Train all employees and/or volunteers whose jobs are impacted by your daycares policy on maintaining appropriate staff-to-child ratios

Is there a policy for dispensing and storing of medications?

Providing a child with medication - including prescription as well as over-the-counter medicine is a tremendous responsibility.

Recommendation(s):

To help ensure careful and accurate administration of medication to treat illnesses and prevent health problems at day care, the following checklist should be reviewed:

• Medicines should only be given when absolutely necessary. It is safest for children to receive their medicines at home. When this cannot occur, and medicine must be administered to the child during child care hours, a formal policy must be in place. The requirements below must be met before medication can be administered. The rules and forms exist to protect the child, the parent, and the child care provider against harmful mistakes
• Any staff member who will administer medication should receive training. Safety is promoted when staff is specifically trained in medication administration.
• Before administering any medication, make sure you have written instruction from the health care provider and the parent's written request.
• Keep the medicine at the daycare facility. When medication is sent back and forth from home to day care, it increases the chances of lost medicine, unsafe storage, and other children accidentally taking the medicine. Pharmacies can split the prescription.
• A safe and secure method of medication storage is critical.
• Written documentation of every dose is mandatory. It is also important to document missed or late doses and errors. This helps to prevent further mistakes.

Tasks:

1. Dispensing and storing medications policy

   Develop and implement a written policy on dispensing and storing of medications.

2. Dispensing and storing medications policy training

   Train all employees and/or volunteers whose jobs are impacted by your daycares policy on dispensing and storing of medications.