1992 marked a new era for Canada’s Food Guide and the U.S.D.A.’s Basic Four Food Groups, both of which were revised to meet the nutritional standards of today’s healthy lifestyle.

For example, Canada has added peanut butter to its list of meat and alternatives while the U.S.D.A. has replaced its Four Basic Food Groups with a pyramid of daily portions. Fats, added as a fifth group, occupy the top position on the pyramid indicating the smallest allotment. Grain products on the other hand take up the entire and noticeably larger bottom segment thus illustrating significant differences in recommended daily intake. In addition the U.S.D.A. has added key symbols throughout the pyramid to demonstrate the fat and sugar content of each group.

If these new food guides do anything they remind us that a well-balanced diet is important, especially where children are concerned. Parents are, by nature, conscientious nutritionists when it comes to their family’s health. Oh sure, the odd fast food meal slips into the well-planned weekly menu but even the experts concede that in moderation these meals are not really bad. It’s what gets (or doesn’t get) eaten when parents are not around that is cause for concern. This is particularly so when a child is in daycare for a great portion of the day and meals such as breakfast and lunch are part of that care.

Child Care and Meal Planning

It is important then that parents take the time to go over their child’s diet with the provider even before they place their child in a center or home. They should ask to see a menu and should look it over thoroughly to ensure it is:

• balanced and nutritious, and
• that their child will enjoy and more important, actually eat what is being served.

Most licensing boards require that weekly menus be posted in a conspicuous place where parents can review them. Although menus are the first indication of a provider’s knowledge of nutrition, there are many other things, as the following list indicates, that are part and parcel to providing healthy meals and establishing good eating habits.

Parents should ensure that:

• food preparation areas are clean and well maintained. Cleanliness and good hygiene are vital to reducing the spread of germs and diseases. A solution of nine parts water to one part bleach is a suggested cleanser.
• diaper changing areas are not located close to the food preparation area.
• staff practice good hand washing techniques.
• all eating utensils are rinsed in a bleach solution, then rinsed again.
• baby bottles and other perishable foods are tightly covered, properly labeled and stored in the refrigerator.
• meals are served in small groups and are pleasant and enjoyable, not rushed. It is important for providers to join the children at meal times as this enhances the child/provider relationship, fosters social skills, and enables the provider to properly supervise the group. It is during this time the provider can note the child’s food intake.
• their children are being served adequate portions. Most licensing boards require that children who are in a provider’s care for three hours be served a snack; for five hours a meal and a snack; for any time thereafter two meals and a snack. Meals should consist of at least one third of the faily recommended portions as per the Food Guide.
• their provider is receptive to them leaving expressed breast milk.
• they are welcome to join their child at meal time or any time.

Special Diets

A child who requires a special diet is of major concern to both the parents and the provider. To be certain the child is eating only recommended food parents should discuss the diet at length with the provider. They may also choose to provide their child’s meals and snacks.

Most parents and providers know that a child’s appetite varies from day to day just as his or her preference for certain foods changes as often as the wind blows. The best they can do is respect the child’s growing independence while at the same time try to find new, interesting foods that the child will like. No easy feat to be sure. But as tempting as it may be sometimes, a child should never be forced to eat.

HIV (Human Immunodeficiency Virus), the virus that leads to AIDS (Acquired Immune Deficiency Syndrome) is transmitted from one person to another by blood, body fluids containing blood, vaginal secretions, sperm, breast milk, and through unprotected intercourse or sharing contaminated needles. It is also transmitted from mother to child during pregnancy, delivery, or by breastfeeding.

In order to transmit HIV three conditions must be present:

• The blood must be fresh
• It must be in a sufficient quantity
• It must have a route of entry into the bloodstream of the infected person.

It is important for child care centres and family dayhome providers to adopt universal precautions to control the spread of any infection, including HIV. Where blood is involved, it is also important to use universal precautions, the measures developed to deal with blood-borne diseases like HIV and hepatitis B. These universal precautions include:

• Wash hands immediately after exposure to blood
• Cover cuts
• Use absorbent material to stop bleeding
• Wear disposable latex gloves when there is a lot of blood or if you have open cuts. Wash hands immediately after removing gloves
• Immediately clean blood-soiled surfaces with a bleach solution (household bleach kills HIV)
• Machine-wash bloodstained laundry separately in hot soapy water
• Place bloodstained materials in sealed plastic bags and discard in a lined, covered garbage container.

HIV is a fragile virus, and no cases of transmission through casual contact have been reported in child care anywhere in the world. HIV is not transmitted by:

• Touching, hugging, or kissing
• Sharing food, dishes, drinking glasses, or cutlery
• Being coughed, sneezed or cried on
• Sharing toys, even those that have been mouthed
• Diapers or toilet seats
• Urine, stool, vomit, saliva, mucus, or sweat (as long as it is untainted by blood).

Caring for a sick child is heart wrenching. Those once active tykes look at you with puppy dog eyes and pouting lips. All they want is a hug that’ll make everything better. For children in child care, all they want to do is go home.

To make sure your child will be as comfortable as possible when he/she becomes ill at the daycare centre or home, talk to your caregiver about her ill-child policy. Ask her to show you where your child will go if he is sick or how he will be comforted until you arrive. Though your child will have to be separated from the rest of the children, he should never be out of sight or hearing range of the caregiver.

You’ll also want to know just when you will be notified should junior develop a fever or lethargically wander around the family dayhome. Ask the caregiver if she has had any training in how to recognize the signs of sickness or if the centre has a pediatrician available to answer their questions and concerns about any illness. Is there a chart from the health department they can refer to?

Find out what the caregiver will do if your child develops a fever or becomes dehydrated. If your child begins vomiting or has a bad case of diarrhea? At what point is the caregiver prepared to call for emergency help? Are you comfortable with your caregiver’s policies and sick child knowledge?

Before you ask your child care provider to administer medication, even over the counter remedies like Tylenol or Panadol, be sure the bottle is clearly labeled.

According to Deborah Kernested, in Administering Medication to Children (Interaction, Fall 1993), there are “five rights” to ensuring the safe administration of medication. These are:

• the right child
• the right medication
• the right dose (amount)
• the right time
• the right route (oral, nasal, rectal, eye, ear or injection).

Kernested, though talking to caregivers, has some valuable advise that can be applied to parents as well. Among these:

• be familiar with your centre’s regulation for the administering of medications
• asking your physician to prescribe medication that can be administered at home, rather than at the centre
• filling out a written permission form (See Business Forms in our Exclusive Products section to order ready-to-use Permission forms.)
• discussing your child’s medication at length with the person responsible for administering medication
• reviewing the label and the doctor’s orders
• asking to see the sheet used to record the administering of medication to be sure your child received the medication at the prescribed times and at the right dosage.
• ensuring that your child’s reactions to the medication (if any)

are recorded on the record sheet. She also recommends parents get their physician to put the use of the medication in writing and that this be given to the caregiver.

Obviously the best way to reduce the number of colds and respiratory infections your child gets is to apply some very basic hygiene and infection control measures. As always, take a few minutes to discuss the caregiver’s or centre’s hygiene practices with them. Visit the washroom to make sure that soap and towels, preferably paper, disposable towels are available, that each child has a place of his own to store personal items like toothbrushes and combs, and is assigned her own washcloth.

Good handwashing practices make a vast difference in the number of infections that spread through the centre or home, particularly after diaper changing.

In addition to good hand washing and diaper changing practices, Child Care Action Campaign, in their Information Guide 18, Infectious Diseases and Child Care recommends that:

staff use a paper towel to turn off the facet after they have washed to avoid contaminating their clean hands;

• toilet trained children use flush toilets, and always wash their hands afterwards;
• tissues be available for runny noses and be disposed of at once;
• children wash their hands immediately after they use them to wipe their nose or cover coughs;
• tables are washed and sanitized before meals;
• cribs and cots are three feet apart; children should have their own linen; both linen and cots should be cleaned regularly;
• and that toys be washed regularly and kept clean.

Statistics prove that more children die each year from injury-related accidents than from any other cause. In fact, three out of 10 children require medical help as a result of an accident. What makes these statistics so startling is that most of these injuries could have been prevented.

By applying a few safety and child-proofing measures, parents can make their home snug and secure. For parents who’s children are in child care the process is two-fold, for not only must they be concerned about safety in their own home, but in the daycare centre or daycare home as well. For their own peace of mind, parents should inspect their daycare or day home on a monthly basis to ensure the following safety measures are being met and maintained:

• telephone numbers for the police, fire department, hospital, ambulance and poison control center are posted by each telephone
• fire detectors are in working order
• cupboards containing cleaning supplies, medicines and other toxic substances are safety-latched
• stairwells are closed off with properly installed gates
• electrical outlets have plastic covers
• knives, razors, matches and other dangerous objects are out of the reach of the children
• furniture and equipment are free of splinters, rusty nails and lead paint
• poisonous plants are out of the children’s reach
• the center or home is free of dangling cords or hanging table cloths
• the first aid kit is within easy reach and is completely stocked
• pot and pan handles are turned away from the edge of the stove and the stove knobs are not within a child’s reach
• the outside playing area is free of broken glass, construction materials, tools, lawn mowers, car parts, has a secure fence and a tightly-closed trash container
• toys, both inside and outside are free of broken or loose parts; small objects are not within reach of an infant or toddler
• child care equipment such as cribs, high chairs, playpens, etc., are in working order, free of loose or broken parts, and most important,
• children are being properly supervised, and the center or home is maintaining the proper staff/child ratio as set out by the local licensing board.

On the whole, most providers are extremely safety conscious and will welcome a parent’s inspection. However, a provider who refused to let a parent inspect the premises for safety concerns or does not rectify any concerns after repeated requests by the parent to do so, should be reported to the local licensing board. At this point a parent would be wise to find alternate care for their child.

Children often do not want to go to sleep. Going to sleep means missing out on things. Many children are still afraid of the separation at night, especially those under three.

• Children generally find comfort and security in rituals (special things you do at bedtime). They help children prepare for the idea of going to bed.
  • A typical ritual may include a relaxed bath, a drink, cuddle, story, kiss and ‘goodnight’.
  • Work out your ritual around what is special for your child.
  • The half hour before bed is not a good time for tickles, wrestles, quarrels, TV or other excitement. It helps to have a ‘wind down’ time and dim the lights to help prepare for sleep.
• Let children know in advance that bedtime is coming, eg. “just one more game and then it’s time to get ready for bed” – and mean what you say. This can prevent the pestering for more time to stay up.
• Explain to children that everything that they want has to be done before bed. Calls for drinks, trips to the toilet, etc. Tell your child that you love her and will be nearby.
• Some children can relax more easily with a night light, soft music or a story tape playing.
• Many toddlers like to take a special toy to bed or have their dummy
• Some also need the door open so that they know that you are near. If your child is anxious, let her know that you will pop in during the night to check how she is.
• The inner confidence to feel secure when parents are not present is still developing by three to four years of age. If night waking is being caused by separation anxiety, it usually improves after four years of age.
• At times when children are sick, lonely, sad or frightened they may need help to go back to sleep.
• The changes in your child’s life, eg. moving house, separations, family tensions or staring preschool, can be a factor.

A 36-year-old Toronto man has been charged with sexually assaulting a boy he was babysitting.

The 10-year-old victim was allegedly assaulted over the course of two years while in the care of the adult, Toronto Police said yesterday.

And investigators fear there may be more victims.”He would get to know families and eventually end up babysitting for them,” Det. Liz Benoit said.”The investigation is continuing and there could be other victims out there.”Benoit said the accused would befriend people through community groups and look after children at their homes.Thomas Chung Tam has been charged with sexual assault, and two counts each of sexual interference and sexual exploitation.

Anyone with information should contact Toronto Police at 416-808-1305 or Crime Stoppers at 416-222-TIPS.

Tam is to appear in a Finch Ave. W. courtroom today.Meanwhile in Pickering, Durham Regional Police are looking for a man who approached a nine-year-old boy at an arena and offered him a ride in his van.

The boy was sitting on a snowbank on the north side of Don Beer Arena, on Dillingham Rd. around 4:30 p.m. on Dec. 15, police said yesterday.A man was seen leaving the arena, getting into a van in the parking lot and then driving towards the boy.

The man started a conversation with the boy, introduced himself as Steve, and offered to give the youth a ride to find his parents. The boy ran into the arena.

The man is white, about 50 and 6-feet-tall. He had greyish-brown short hair and a moustache and wore a green wool vest.

(AP) Paula Burcham ran the kind of day care working mothers dream about.

Her house was immaculate, the children’s meals were home cooked. Kids would line up to get a hug from “Mama Paula.”

But the families who trusted Burcham didn’t know she was giving over-the-counter medicines to their children without their permission. Some now suspect she was using the drugs to sedate cranky little ones.

On Aug. 15, Burcham was sentenced to eight years in prison for giving a 3½-month-old girl a lethal dose of Benadryl. And since Grace Olivia Fields’ death in December 2001, her parents have found they are not alone in their loss.

In the last three years, at least 10 other cases of day care workers allegedly sedating children with cold medicines and cough syrups have been investigated nationwide. Four babies died in those cases. At least four people were charged, with one acquittal, and some cases are still pending.

Grace’s mother, Tracy Fields, and other parents are now pushing for new laws that would make it a felony for day care workers to give a child medicine without written permission from a parent or a doctor’s order. One state has already passed such a law.

“I don’t want any other parents to go through this,” Fields said. “It didn’t take a whole lot for this beautiful little baby to die from an over-the-counter medicine.”

There is also a growing movement among medical examiners for greater awareness of the practice, as some pathologists fear babies who died after being drugged were written off as sudden infant death syndrome cases.

Burcham had poured about a tablespoon of children’s Benadryl into a four-ounce bottle of breast milk before feeding it to Grace. The dose was three times more than what would be needed to sedate an adult.

Burcham admitted giving the baby the drug, but denied it was to control behavior. Her critics aren’t swayed.

“She found a way to make those kids sleep half the day,” Fields said, adding her 2½-year-old daughter told her she was given “bubble gum” flavored medicine before nap time at Burcham’s.

Drug makers are adamant that their medicines aren’t intended for infants and put warnings on containers that doctors should be consulted for use in any child younger than age 6.

Dr. William Sears, a pediatrician and author of books on infant sleep, said it is an “old school” practice to use cold and allergy medications to sedate babies, but even using a small amount of drugs is dangerous.

“Categorically, sedative medications have no place in day care,” he said.

Young babies need to awake easily to protect themselves from dangers like choking when they spit up. The sedative interferes with that natural waking mechanism, Sears said.

Sharon Dabrow, associate professor of pediatrics at the University of South Florida, said some pediatricians do advise parents to use appropriate doses of Benadryl to sedate children who are at least 12 months old. Dabrow doesn’t recommend it.

“Our society is so wrapped up around medications being a fix for anything,” she said. “To be using it (Benadryl) on a 3-month-old is just horrible.”

In Mobile, Ala., Robert and Mary Hernandez’s 2-month-old son, Douglas, died last year at day care after being given a combination of drugs found in allergy and cold medicines.

A toxicology test turned up the drugs. A grand jury is expected to hear the case later this year.

The Hernandezes have sought a state lawmaker’s help to introduce legislation that would make it a felony for a day care provider to give a child medication without their parents’ permission or the consent of a doctor.

Parents whose children died in Ohio and North Carolina have waged similar campaigns.

Last month, North Carolina made it a felony to give children medicine without permission. That law was named for 5-month-old Kaitlyn Shevlin, who died in 2001 after being given the generic form of Benadryl. Her caretaker, Josephine Burke, served four months in prison on misdemeanor charges of child abuse and neglect.

Ohio communities have begun adopting ordinances prohibiting the unauthorized use of medicines in day cares following the 2000 death of Allison Kuczmarski. Baby sitter Karen Zemba pleaded guilty to reckless homicide for giving the baby Benadryl, but was sentenced to just 250 hours of community service.

The cases of five otherwise healthy infants who died from overdoses of diphenhydramine, one of the ingredients in Benadryl, were detailed in an article published earlier this year in the Journal of Forensic Science.

The research began after high levels of the drug were found in a baby who died in Virginia in 2001. Everyone who had access to the child has denied giving him the medicine; the case remains under investigation.

In all five cases examined in the project “the medication was not used for the benefit of the infant, but for the benefit of the person administering it,” said Andrew Baker, the assistant chief medical examiner in Minneapolis who led the research project. “We aren’t talking about runny noses or allergies here.”

Baker said he hopes the article will persuade pathologists to conduct toxicology tests on babies who die from seemingly no cause. He also warned parents to be wary of day care providers who give medicines without permission, even appropriate doses of needed ones.

“I believe things like this are probably very rare,” Baker said. “But the reality is unless you are testing for this, you are never going to know.”

OKLAHOMA CAPITOL — Unlicensed childcare facilities operating in Oklahoma will no longer be tolerated when a change in the state law goes into effect Nov. 1.

When Gov. Brad Henry signed House Bill 2643 into law June 2, it expanded the use of an emergency order to close any unlicensed child care facility operating in Oklahoma that is not in compliance with mandated child care licensing requirements.

Prior to HB-2643, an emergency order could only be used to close a licensed child care facility for being out of compliance with state requirements. The law now gives Oklahoma Child Care Services (OCCS) the authority to act on unlicensed child care.

“While we do not believe the majority of people provide unlicensed child care to violate the law, it is illegal, and the new law gives us the authority to act when such operations are brought to our attention,” said OKDHS Child Care Services State Licensing Coordinator Janice Matthews.

Some states have seen a surge in unlicensed child care as the economy tightens on working families across the country. Oklahoma’s legislative action last session is an attempt to get ahead of any possible surge occurring in Oklahoma.

“The Child Care Facilities Licensing Act of 1963, states that anyone who provides care to children must be licensed in Oklahoma,” Matthews said. “The amendment of this Act strengthens the original intentions.

“We know unlicensed childcare is attractive to some parents because it can be less expensive. At the same time, unregulated care can be more dangerous for children in care because providers may not be meeting the minimum health and safety requirements that are in place. Parents need to understand unlicensed facilities are illegal in Oklahoma.”

This is also a notice for parents who will be inconvenienced by having to leave their jobs to remove the children from the unlicensed facility. Additional time could also be lost from work while parents try to locate a licensed program at the last minute.

Oklahoma Department of Human Services OCCS does not want the new law to be a hardship for parents but are mandated by law to enforce the closure of unlicensed care. Facilities currently providing child care without a license can contact the local OKDHS Human Services Center in their area before Nov. 1 to begin the process to become licensed.