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Play benefits all areas of a child’s development. One important aspect of this time is unstructured play, also called free play.

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Educators at your child's early childhood education and care service might have told you that they use a 'play based' approach for children's learning and development.

Play is an activity where children show their remarkable ability for exploration, imagination and decision making. While play is often described as 'children's work', it is intensely enjoyable for them. The type of play children engage in and its purposes change over the course of childhood from infancy to adolescence.

You may have realised that as a parent, you don't generally have to make children play or provide incentives to play. This is because children seem to have a natural urge to play and playing brings a level of pleasure and interest which means it can be maintained without external rewards.

How does play support your child's development and learning?

Physical development - active play using large and small muscles such as climbing, running, ball games, digging, jumping, and dancing. This supports children's overall health and sense of wellbeing, physical growth, appreciation for the benefits of active lifestyles and skills for independence in self-help such as dressing or feeding.

Social and emotional development - dramatic and imaginative play which includes dressing up and role play can develop positive social and emotional skills and values. This provides opportunities for children to:

practise how to work with other children, negotiate ideas, and make choices and decisions

develop self-confidence by experiencing success and challenges

learn to control their emotions, reduce impulsive behaviour, or reduce stress as they act out feelings and events that might be worrying them

develop empathy and fairness as they learn to play alongside and with other children.

Cognitive development - when your child plays individually and with others their cognitive skills, such as thinking, remembering, learning and paying attention are all being developed. Children develop the following cognitive skills through play:

problem solving

the power of imagination and creativity

concepts such as shapes, colours, measurement, counting and letter recognition

strengths such as concentration, persistence and resilience.

Literacy and numeracy development - play requires thinking, language, interactions, curiosity and exploration. Through play children develop skills and understandings including:

an increased understanding of words and their use

listening and speaking skills

writing skills through scribbling, painting and drawing

learning how stories work (plot, characters, structure, purpose and format of words on a page)

learning that objects can stand for something else (a block can be a symbol for a telephone) which is foundation learning for formal reading, spelling and numeracy because letters, words or numerals are part of symbol systems

learning that letters, words, symbols, numerals and signs have a purpose and are meaningful to others.

What does a play based approach to learning look like?

Educators at early childhood education and care services use a wide range of play based experiences for children's learning and development rather than using structured 'lessons' or formal teaching experiences. They set up games indoors and outdoors that are age appropriate, which can be played safely and enjoyably by every child.

Educators encourage children's learning through play by:

providing resources that reflect children's ages, interests, knowledge, strengths, abilities and culture to stimulate and support play. Resources which allow open ended use of items like blocks or cardboards boxes foster creativity and the ability to manipulate concepts mentally as children. For example, turn a box into a car.

planning play experiences based on the assessment of children's individual differences, interests, developmental needs and ability. For example, as a child learns to hold a pencil to draw and write, educators will give children different sized objects to grasp, and to build strength in the child's fingers.

observing children as they play so that they can understand how they play with other children, what skills and understanding they demonstrate in play and what activities can strengthen their skills in play.

joining in children's play to extend the child's learning and to model skills such as reasoning, appropriate language, and positive behaviours.

providing large blocks of unhurried and uninterrupted time for play for children's ideas and games to develop.

How can you contribute to your child's learning through play?

Children's success as learners depends on strong foundations developed from infancy. Play based learning fosters critical skills, understanding and dispositions which are essential for your child's lifelong learning and wellbeing. You can encourage your child's learning through by:

sharing information about your child's interests and abilities with their educators so that they can plan play experiences for your child based on their interests and abilities

playing with your child

discussing your child's program with the educators at your child's service, and the activities your child enjoys playing and taking part in

advocating for safe and interesting play spaces in your local community.

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The importance of play in children's learning and development

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Learning through play is one of the most important ways children learn and develop.

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The importance of play

Play is central to your child's learning and development. When your child plays, it gives them many different ways and times to learn.

Play also helps your child:

build confidence

feel loved, happy and safe

understand more about how the world works

develop social skills, language and communication

learn about caring for others and the environment

develop physical skills.

It's important for children to have plenty of different types of play experiences. This includes unstructured and structured play, indoor and outdoor play, solo and group play, craft and creative play, and so on. When children get variety, it's good for all aspects of their learning and development - physical, social, emotional and imaginative.

Different types of play: unstructured and structured

Unstructured, free play is unplanned play that just happens, depending on what takes your child's interest at the time.

Unstructured, free play is particularly important for younger children because it lets them use their imagination and move at their own pace.

Examples of unstructured play might be:

creative play alone or with others, including artistic or musical games

imaginative games - for example, making cubbyhouses with boxes or blankets, dressing up or playing make-believe

exploring new or favourite spaces like cupboards, backyards, parks, playgrounds and so on.

You can be part of your child's unstructured play. But sometimes all you'll need to do is point your child in the right direction - towards the jumble of dress-ups and toys on their floor, or to the table with crayons and paper. At other times, you might need to be a bit more active. For example, 'How about we play dress-ups? What do you want to be today?'

Structured play is organised and happens at a fixed time or in a set space. It's often led by a grown-up. Older children are more likely to enjoy and benefit from structured play.

Examples of structured play include:

outdoor ball games like kicking a soccer ball

water familiarisation classes for toddlers or swimming lessons for older children

storytelling groups for toddlers and preschoolers at the local library

dance, music or drama classes for children of all ages

family board or card games

modified sports for slightly older children, like Cricket Blast, Aussie Hoops basketball, NetSetGO netball, Come and Try Rugby and Auskick football.

Structured and unstructured play can happen indoors or outdoors. Outdoor play gives your child the chance to explore, be active, test physical limits - and get messy!

How play develops with children

As your child grows, their attention span and physical skills develop and the way they play will change. Your child will get more creative and experiment more with toys, games and ideas. This might mean they need more space and time to play.

Also, children move through different forms of play as they grow. This includes playing alone, playing alongside other children and playing interactively with other children.

Your child will love playing with you, but sometimes they might prefer to play alone. Your child might just want you to give them ideas and let them know how their play and games are going. And sometimes your child might want to play with other children - no grown-ups allowed!

Newborns and babies: play ideas to encourage development

Just looking at your face and hearing your voice is play for your baby, especially if you're smiling.

You might like to try the following play ideas and activities with your little one:

Music, songs or bells develop hearing and movement. You could try gentle tapping on your baby's tummy while you sing.

Peekaboo is great for your baby's social and emotional development.

Gentle tickles or objects with different textures develop the sense of touch. You and your baby could experiment with things like feathers, mud, metal or foam.

Objects of different sizes, colours and shapes can encourage your child to reach and grasp.

Sturdy furniture, balls, toys or boxes can get your child crawling, standing and walking.

Regular tummy time and floor play are very important for young babies. Tummy time encourages your baby to move and roll and helps them develop muscle strength and control. It also lets your baby see and experience the world from a different perspective. All you need is a playmat or blanket on the ground or floor.

Toddlers: play ideas to encourage development

Here are some ideas your toddler might enjoy:

Large and light things like cardboard boxes, buckets or blow-up balls can encourage your child to run, build, push or drag.

Chalk, rope, music or containers can encourage jumping, kicking, stomping, stepping and running.

Hoops, boxes, large rocks or pillows are good for climbing on, balancing, twisting, swaying or rolling.

Dress-up games with scarves, hats and so on are good for imagination and creativity.

Hills, tunnels or nooks can encourage physical activities like crawling, climbing and exploring.

If you put on some favourite music while your toddler plays, they can also try out different sounds and rhythms. You might also like to sing, dance and clap along to music with your child.

Preschoolers: play ideas to encourage development

Here are some ideas to get your preschooler's mind and body going:

Old milk containers, wooden spoons, empty pot plant containers, sticks, scrunched-up paper, plastic buckets, saucepans and old clothes are great for imaginative, unstructured play.

Simple jigsaw puzzles and matching games like animal dominoes can improve your child's memory and concentration.

Playdough and clay help your child develop fine motor skills.

Favourite music or pots and pans are great for dancing or making music.

Balls can encourage kicking, throwing or rolling.

When you're encouraging your child to kick or throw, see whether you can get them to use one side of their body and then the other.

School-age children: play ideas to encourage development

Your school-age child can have fun with the following objects and activities:

Furniture, linen, washing baskets, tents and boxes are great for building cubbyhouses.

Home-made obstacle courses can get your child moving in different ways, directions and speeds.

Games like 'I spy' are great for word play. They also develop literacy skills.

Simple cooking and food preparation activities are great for developing science, numeracy, literacy and everyday skills.

Your child's own imagination can turn your child into a favourite superhero or story character.

If your child is interested, you could think about getting them into some sports or team activities for school-age children. Other possibilities include after-school or holiday art and craft activities.

Homemade toys and free activities can help children learn and develop. They're often the most creative ways for you and your child to have fun together.

If your child doesn't want to play

There might be times when your child doesn't want to play. For example, they could be tired or bored by doing the same activity for too long. This is common and usually nothing to worry about.

But sometimes a lack of play - or a lack of interest in play - can be a sign of a developmental disorder.

Here's when to consider speaking with a health professional or your child's educator:

Your baby doesn't seem to get into interactive play like peekaboo.

Your toddler has an extremely narrow interest in toys or doesn't use toys in a functional way. For example, your child is interested only in spinning the wheels of a toy car instead of driving it around the room like other children the same age.

Your preschooler isn't interested in playing with other children or in playing pretend games.

Languages other than English

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Play is more than just fun for babies and children. It's how they learn and develop. Playing with your child is one of the most important things you can do. Article available in: Arabic, Dari, Dinka, Hakha Chin, Karen, Persian, Simplified Chinese, Swahili, Tamil, Vietnamese.

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Our farm to school work began in 2008 and was an extension of our farmer-buyer networking events. Most recently, we've focused on expanding our existing networks and partnerships to reach our state's youngest children.
Please visit our Farm to School 2021 workshop page to learn more about these events and practical support - focused on building connections and skills around ways to incorporate local food and agricultural education in schools and community institutions - happening across greater Minnesota.
What is Farm to School?

Farm to School is a nationwide movement, involving three main tenets:

Local procurement

Nutrition education

Gardening

The goal is to develop lifelong healthy eating behaviors and community vitality by strengthening regional food systems. Easy, fun and affordable changes can be the first steps toward healthier children, communities, and landscapes.

The National Farm to School Network has a wide variety of resources to inform Farm to School efforts.

Trainers, providers, and other early childhood educators: Download this PDF to learn more about Renewing the Countryside's Farm to Child Care workshops.

We continue to provide coaching, technical assistance, and support to early care & education providers at all types of settings. Please reach out if you're interested in our consulting services.

Resources on Farm to School:

Farm to School Core Elements by Minnesota Department of Health

Farm to School by Minnesota Department of Health

Farm to School by Minnesota Department of Education

Farm to School by University of Minnesota Extension

Direct coaching and technical assistance:

In 2019, our staff are working on a number of projects, including collaborations in St. Paul and Southeastern (Greater Minnesota) communities to provide one-on-one Farm to ECE assistance to providers at a variety of settings. Contact us at grace at rtcinfo dot org with questions or to learn more.

Farm to Child Care Club:

In 2015, we piloted a peer learning group model that not only connected providers with training, technical support, and each other, but also farmers willing to sell CSAs to the child care settings, and connect with the children they work with. Reach out to learn more!

Resources on how to find local food:

Farm to Preschool's Local Food Purchasing page will get you up to speed, including local purchasing ideas for centers and family child care providers.

Gardens: Georgia Organics' video will help you begin to think about how you can grow some of your own food in a garden, given your space and time.

Our colleagues at the Public Health Law Center have recently developed a flier to help child care providers and other early childhood educators understand how Farm to Child Care strategies complement existing licensing, quality ratings, and best practices standards, here.

Activities, lesson plans, and curricula ideas
Farm to Preschool Curriculum by UEPI
Farm to Child Care Curriculum by IATP
How's it Growing? How-to Guide by Emily Mehr
Preschool Lesson Plans by Growing Minds
Consider the community assets and resources you already have at your fingertips: Master Gardeners, food hubs, nearby school districts, local public health (SHIP) professionals and early childhood family education (ECFE) programs.

More resources, guides, and local food purchasing ideas here. We cover more resources in our training, so please connect with us!
Download the PDF here
Farm to child care training

We have designed and developed a farm to child care "train-the-trainer" online course that had state-wide participation through Child Care Aware spring 2014, 2015, and 2016. This training is designed to give child care professionals and others involved in early childhood health and education the skills, tools, and confidence to implement Farm-to-School type systems, activities, and curriculum for the pre-K children they care for.

Approved for up to 5 in-service hours through MNCPD for providers. Trainers may work in partnership with local SHIP coordinators. This project has been made possible thanks to generous support from the Center for Prevention at Blue Cross Blue Shield of Minnesota and the Cargill Foundation. If you're interested in participating in a train-the-trainer, please let us know at grace at rtcinfo.org.
Our partners in Farm to Early Care and Education
Get this training in your community!

Contact Grace at grace [at] rtcinfo [dot] org with questions and/or to find out:

If there are already trainers in your area, with whom your child care group or association can set up a workshop

About potential upcoming Farm to Child Care Training of Trainers, if you'd like to train on this material.

Farm to Child Care Producer Directory

In June 2014, Renewing the Countryside conducted a survey to assess farmers' and ranchers' interest in selling to child care settings. As a result of the positive response, this directory includes all growers who mentioned an interest in making their information available and selling to child care settings in their area.

If you are searching for a farmer near you and do not see one here, please contact us and we may be able to connect you with farmers who do not yet appear in this directory.

If you are a farmer who would like to get involved with Farm to Child Care, please get in touch! Many farmers see the benefits of increasing access to healthy, locally grown food; educating children about where their food comes from; new revenue sources for their farms; and building more relationships within their communities.

To move the farm to school agenda forward in Minnesota, the University of Minnesota Extension and Minnesota Department of Health co-convened a statewide Farm to School Leadership Team in April 2011. The Farm to School Leadership Team works through partnerships across Minnesota to build farm to school initiatives that help kids eat healthy, support n earby farmer s , foster economic vitality, and strengthen communities. Eleven member organizations have joined the group that strives to maximize the resources, ideas and impact of the state's many farm to school efforts:

Click here to learn more about the Farm to School Leadership team .

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Farm to Child Care. Learn how to find and serve local foods, prepare quick, healthy, and safe meals/snacks for children using local produce and how to engage children in understanding where their food comes from through gardening, field trips, cooking, activities, and stories.

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Farm to Early Care is growing in Minnesota!

Minnesota has a vibrant community of Farm to Early Care stakeholders across the state. Sign up here for our quarterly newsletter where we will share resources, highlight funding opportunities and lift up innovative success stories-and join our Facebook group to ask questions, share your experiences, and find out about resources and upcoming events!

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Minnesota has a vibrant community of Farm to Early Care stakeholders across the state. Sign up here for our quarterly newsletter where we will share resources, highlight funding opportunities and lift up innovative success stories-and join our Facebook group to ask questions, share your experiences, and find out about resources and upcoming events!

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Farm to Early Childhood Education | Grow For Kids

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Emergency preparedness for child care programs is important because there is a good chance an emergency will happen at some point. In an emergency, child care providers are on the front lines to keep children and staff safe.

Emergency Plans

Emergency plans are an important tool in knowing what to do in the event that an emergency happens while children are in your care. Creating an emergency plan gives child care providers an opportunity to think of how to respond to various scenarios before they happen.

Emergency plans are required by some entities, such as:

State licensing

Quality Rating and Improvement Systems (QRIS)

Child Care and Development Fund (CCDF)

Head Start Performance Standards

Accreditation Standards

Caring for Our Children National Health and Safety Performance Standards Guidelines for Early Care and Education Programs (4th edition)suggests that facilities should develop and implement a written plan that describes the practices and procedures they use to prepare for and respond to emergency or disaster situations. Their suggested emergency plan components include:

Information on disasters likely to occur in or near the facility, county, state, or region that require advance preparation and/or contingency planning

Plans (and a schedule) to conduct regularly scheduled practice drills

Mechanisms for notifying and communicating with parents/guardians in various situations

Mechanisms for notifying and communicating with emergency management public officials

Information on crisis management

Identification of primary and secondary meeting places and plans for the reunification of parents/guardians with their children

Details on collaborative planning with other groups and representatives

Continuity of operations planning

Contingency plans for various situations

There are many emergency plan templates available to use as a reference. Make sure you are using your state's required plan template if one is available.

Emergency Plan Templates

Webinar: Let's Get Ready - Planning Together for Emergencies

Evacuation/Shelter-in-Place

The type of emergency determines how you should react.

You will need to evacuate when conditions are safer outside the building than inside the building. Sometimes after an evacuation, you are unable to return to your site and must relocate. It is important to have an initial relocation site in addition to back-up relocation sites; one within walking distance and another outside of the area.

In certain emergencies, it is best to make sure everyone is safe inside and to isolate children and staff from the outside environment. The need to shelter-in-place should be based on notifications from local emergency officials or weather forecasts.

Practice Drills

It is important to practice evacuation and shelter-in-place drills on a regular basis.

Follow state licensing and other applicable regulations for drill frequency and type

Practice drills should be held regularly

Involve all children who are present at the time of the practice drill in the drill

Give children simple instructions and talk about what is happening

Complete a drill log

The UCSF California Childcare Health Program has Sample Emergency Disaster Drills available to review.

Child Care Aware® of North Dakota has a Child Care Program Emergency Drill Log available.

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Emergency Plans Emergency plans are an important tool in knowing what to do in the event that an emergency happens while children are in your care. Creating an emergency plan gives child care providers an opportunity to think of how to respond to various scenarios before they happen.

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Summarize driver and attendant qualifications

Select safety items for a vehicle safety kit

Practice a daily pre-trip vehicle safety inspection

Apply safety guidelines when transporting children by car, van, school bus, or other vehicles

Know

Your program may offer transportation to children for a variety of reasons. These range from daily transportation to and from the program to an occasional field trip. Regardless of how often you transport children, you need to know how to keep them safe on the road.

To transport children, standard adult-to-child ratios must be maintained. You must have permission to transport children. In the previous lesson on Special Considerations for Trips Away from your Program, the Apply section has a sample field trip permission form template. Talk to your administrator about your program's procedures for permission slips.

Driver Qualifications

The driver of any vehicle transporting children must (American Academy of Pediatrics, 2011):

Be at least 21 years old

Be licensed to drive the vehicle (a commercial license may be necessary)

Have a safe driving record for at least five years

Have no criminal record involving crimes against children or involving drugs or violence

Have no medical conditions that impair the ability to drive

Have no alcohol or prescription drugs that would affect the ability to safely drive a vehicle within the past 12 hours

Agree not to smoke in or near the vehicle

Do not transport children in your personal vehicle.

Attendant Qualifications

In addition to the driver, at least one adult should be present in a vehicle transporting children. While the driver focuses on road safety, an attendant focuses on keeping the children safe in the vehicle. The attendant is responsible for monitoring health and safety needs and ensuring safe behavior. The attendant should have training or experience in child development or early-childhood education. This person should also have valid first-aid training and certification.

See

Vehicle Safety

A vehicle safety kit should be stored securely in any vehicle used to transport children. These items should only be accessible to the driver, attendant, and emergency responders. These include:

First-aid kit

Fire extinguisher

Seat-belt cutter

Maps

Charged cell phone

The name, address, and telephone number of the school-age program

Emergency contact information for each child

Any prescribed medications for a particular child (breathing treatments, epinephrine injector, etc.)

Do

The staff should conduct a daily pre-trip safety inspection. Make sure the vehicle is clean. There should not be any obstructions on the floor or seats. The Apply section contains a sample pre-trip inspection form. Talk to your administrator about the forms you will use in your program. Note and correct any problems, such as low tire pressure or dirty windshields. Vehicle maintenance records, driver's license numbers, license plate information, and insurance information should be stored on-site and in the vehicle as appropriate.

Child Safety

Keeping children safe in a moving vehicle is a serious matter and a major responsibility. Safety involves proper seating, vehicle conditions, transportation policies and procedures, and child behavior. The following guidelines will help you keep children safe.
In a car or van:

Use a car seat or child-restraint system. Follow local, state, and federal laws. For young school-age children a booster seat may be necessary.

Make sure you know how to install the seat correctly. Check that the seat is installed correctly and the child is secured correctly before the vehicle moves.

Never allow a child to sit in the front seat of a vehicle.

Replace a car seat if it has been recalled, involved in an accident, or is beyond the manufacturer's "date of use."

In a school bus:

Use an approved child safety restraint system designed for children under 50 pounds.

Make sure the restraint system is installed and used correctly.

Do not place restraint systems in emergency exit rows.

Have a plan for evacuating children from the bus. Practice your plan.

Make sure there is a spot to secure a forward-facing wheelchair with four tie-downs.

Remember any vehicle that can hold more than 10 people is considered a bus, but large passenger vans are not approved for use as school buses unless they meet certain standards.

In all vehicles:

Never leave a child alone.

Make sure the temperature is safe and comfortable. Children are not always dressed for the weather. Use the air conditioning if the internal temperature reaches 82°F. Use the heater if the internal temperature drops below 65°F.

Do a name-to-face count when children enter and exit the vehicle. Use your attendance sheet.

Check the vehicle to make sure no child has been left behind.

Lock the vehicle once you are sure no children are inside.

Teach children safety rules for transportation. These include wearing a seat belt and staying seated.

Only pick up and drop off at the curb or at an off-street location.

Make sure a parent or guardian observes the pick-up and drop-off procedures. Stay with the child until the parent or guardian verbally and physically takes responsibility for the child.

Record attendance and time of each pick-up and drop-off.

Take into account individual children's health, behavior, or mobility needs when planning where and how to secure children.

Be sure to follow your program's policies and guidelines for transporting school-age children.

American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2019). Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. (4th ed.). American Academy of Pediatrics. https://nrckids.org/CFOC

National Association for the Education of Young Children (2007). Early childhood program standards and accreditation criteria: The mark of quality in early childhood education. National Association for the Education of Young Children.

National Highway Traffic Safety Administration. (1999). Guidelines for the transportation of preschool-aged children. https://www.nhtsa.gov/people/injury/buses/guide1999/prekfinal.htm

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Summarize driver and attendant qualifications Select safety items for a vehicle safety kit Practice a daily pre-trip vehicle safety inspection Apply safety guidelines when transporting children by car, van, school bus, or other vehicles Your program may offer transportation to children for a variety of reasons.

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Know

Trips are an excellent way to extend the curriculum. The right trips can capture school-age children's interests and allow hands-on experiences children cannot get in their program. Trips also take advantage of the resources within your own community: nature preserves, police and fire stations, businesses, museums, and farms are all interesting venues for trips. Trips do not need to be elaborate, though. School-age children can learn so much from a walk around the block, a visit to the recreation center next door, or many other regular experiences.

In general, there are two types of trips you might take with children: routine trips and field trips. Routine trips are activities you do regularly that take you away from your center. Examples include walking to the community center, park, library, pool, or other venues near your program. Field trips are one-time events. You might take a field trip to the zoo, museum, farm, grocery store, or a variety of other community locations. To ensure children's safety, both types of trips must be carefully planned and carried out.

Be sure to use your knowledge of child development when planning any trip. Keep trips short, so children do not get over-tired. Focus your trip on the content children are interested in or learning about. For example, if children have been studying food, you might visit the produce section of your local grocery store or commissary. This might be more appropriate and less tiring for the children than spending an entire day at a farm. Be wary of trips that involve crowds or noisy locations. These make it difficult to supervise children. They also make it harder for children to have hands-on opportunities. Remember, children can do more in small groups than they can in large groups.

You must be prepared to keep children safe on trips away from the building. There are a variety of dangers children might experience. A child might be injured or experience a medical emergency, such as an asthma attack. In the worst scenario, a child may disappear or face life-threatening injuries. Careful planning can help you prevent harm.

See

Good practices for trips away from the building can take a variety of different forms. Watch how this program ensures accountability for children.

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Watch as a teacher describes ways to ensure safety on a field trip.

Do

Your first priority is to keep children safe on trips away from the center. Here is what you can do to make sure this happens:

Before the Trip

Do your research. All trips should be planned as part of your overall program activities. Trips provide hands-on learning opportunities that children cannot get in your program space. Think about how your planned trip extends learning. Make sure a field trip is necessary. Is it possible or more appropriate to bring the experiences to the center? Once you decide on a trip, visit the location first. Make sure the location is safe and age-appropriate. Decide on your route and mode of transportation (walking, buses, etc.). Identify emergency resources at the destination: shelter locations, emergency phones, restrooms, etc.

Get consent. Let parents know about the trip you are planning. Send home a written permission slip for field trips. Include information that families will need, like the location, date, time, cost, and transportation plans. Make sure you have a permission slip on file for routine trips. Make a plan for caring for the children who are not allowed to go on the trip.

Collect fees (if applicable). If there is a fee for the trip, a paid staff member should collect these fees prior to the trip. If you are using public transportation, make sure you know how much the fare is. Collect exact change in advance.

Know your ratios. Maintain the appropriate staff-to-child ratios at all times. When on a field trip, it is best practice to have additional adults along for safety and security. Be sure to make group assignments, so all adults know whom they are responsible for and children have a consistent adult for guidance.

Recruit volunteers: Identify parents or others who will help on the field trip. Make sure that at least one paid staff member on the trip has current first-aid and CPR certification.

Travel safely. Make a plan for safe travel. Learn about travel policies for your program and make arrangements for vehicles. Make sure child safety restraints are available in all applicable vehicles.

Pack well. Make sure you have the health and safety documents and materials you will need. Bring the following materials:

First-aid kit (see Apply section); one per vehicle or group

Care plans for children with special health needs

Medications or equipment for children with special health needs

Cell phone

List of emergency contacts (poison control, hospitals, etc.)

Accurate roster

Emergency contact information for families

Copy of children's registration information

Hand sanitizer or wipes

Drinking water

Maps

Written transportation policy, emergency plans, medical release and permission for emergency medical treatment

Currency (especially outside of the United States) in case a cell phone malfunctions or for emergency incidentals

Plan meals. Depending on the length of your trip, you may need to provide a snack or meal to the children. Plan the food you will bring and how you will transport it safely. Remember that perishable foods have to be kept cold, and so do some medications. Check to see whether water is available at your destination or plan to bring water.

Plan for hygiene. Make sure children can wash their hands frequently. Identify locations of restrooms at your destination. Even if your program does not regularly allow hand sanitizer, check to see if it is OK to bring on field trips.

Stand out. Make sure you will be able to identify the children in your group quickly. Use a sticker with the name and contact information of your program. Consider providing children and staff with matching T-shirts or hats to wear on the field trip.

Review safety rules. Make sure children know and understand how to be safe on trips outside the building. Review the rules and practice them. Tell children exactly what to do if they get separated from the group.

Spread the word. Remind parents of the trip the day before. On the day of the trip, post a sign on your program door. It should say where you are going and when you will return.

On the Trip

Use your roster and take count. Have an accurate roster with you at all times. Use it to count children before you leave the center, in a vehicle, as children exit a vehicle, and when you get to the destination. Count regularly while at your destination, and repeat these procedures when you return to the center. Assign a specific group of children to each adult and make sure they know how and when to count. Make sure all children are accounted for at all times.

Teach children safe travel skills. If you are walking near traffic on your trip, follow safe pedestrian rules:

Only cross at a corner.

Only cross when traffic signals say it is safe.

Always look left, right, and then left again before crossing.

Always use sidewalks and crosswalks.

Help children notice traffic signs. Talk about what they mean.

If you are traveling in a vehicle, make sure you follow all policies for vehicle safety. This includes using proper child safety restraints.

Perform your required safety inspection on the vehicle before traveling.

Secure each child in his or her own safety restraint.

Only allow children to enter the vehicle from the sidewalk.

Supervise children while in the vehicle.

Always check the vehicle for sleeping children before exiting. Never leave a child alone in a vehicle for any reason.

Think about communication. Have a cell phone with you at all times. You may need to call for emergency assistance.

Think about prevention. Make sure children never go into public restrooms by themselves. Avoid leaving any adult alone with children. Remind children of safety rules throughout the trip.

Have fun! Talk to the children, sing songs, and play games. Help them notice the interesting features of the world around them. Provide clipboards so they can take notes or draw pictures.

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Special Considerations for Trips Away from Your Program

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Trips are an excellent way to extend the curriculum. The right trips can capture school-age children's interests and allow hands-on experiences children cannot get in their program. Trips also take advantage of the resources within your own community: nature preserves, police and fire stations, businesses, museums, and farms are all interesting venues for trips.

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Recognize safe procedures for arrival and departure.

Evaluate procedures for pickup and drop-off for safety.

Discuss with school-age children how to travel safely to and from the program.

Know

School-age children will come to and leave your program in many different ways, and transportation-related injuries are a very real risk for school-age children. It is important to prepare for walkers, bus riders, bike riders, and those who are dropped off by car. For all these, knowing and observing traffic safety rules is the first step in preventing accidents. It is also important to know specific policies about how school-age children arrive and depart from your facility.

Drop-off and Pickup

It is very important to have a drop-off and pickup process that consider activities on your program's property and in the surrounding areas. Many programs set a designated drop-off zone. The cars enter a designated lane in single file to eliminate congestion and disorder and to lessen the risk of accidents. Without a process, drop-off and pickup could become chaotic and cause traffic issues on nearby streets. Congestion and confusion can also lead to unsafe driving behaviors as drivers rush or become frustrated. The process that your program chooses for loading and unloading should be discussed and demonstrated with the children, families, staff, and drivers.

Your program will have procedures for safe arrivals and departures, including for children arriving or departing unattended. Never let a school-age child leave your program unattended unless there is specific consent allowing them to do so. Be sure to check with your program for specific rules and guidelines.

See

This video highlights what children should know about getting to and from your program.

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Watch this video to learn about important safety tips to share with children.

Do

Arrival and Departure

Pickup and drop-off are risky times for children. It is important to supervise closely and help children learn how to be safe. Some ideas that can help with safety during drop-off and pickup are:

Post signs so drivers know where to drop off and how to exit.

Talk with your program manager about having a lane that is just for drop-off and pickup.

Assist children as they enter and exit motor vehicles.

Remind parents or guardians of procedures. Provide maps in program newsletters and announcements.

If your staff members at your program are responsible for walking children to or from school or transporting them in a government vehicle, be sure to model good behavior by following traffic and pedestrian rules. Check with your program's policies about walking with or transporting children; a walkie-talkie or cell phone and first-aid kit may also be required.

Teaching Children to Travel Safely

It is your responsibility to make sure children know how to reach your program safely. They may ride a bus, walk, or ride a bike. Teach children safety guidelines for each mode of transportation.

Monitor children's compliance with safety guidelines. Talk to children about the importance of wearing helmets and following traffic laws.

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Recognize safe procedures for arrival and departure. Evaluate procedures for pickup and drop-off for safety. Discuss with school-age children how to travel safely to and from the program. School-age children will come to and leave your program in many different ways, and transportation-related injuries are a very real risk for school-age children.

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Know

Think back to happy moments from your childhood. Do you remember riding a bike around your neighborhood? Going swimming with friends? Learning to fix a snack all by yourself? Likely, these events are memorable because you felt independent.

Just like we did, school-age children crave independence and challenge. School-age children are active and curious. They enjoy exploring and taking risks. Often, though, they don't understand the danger in the risks they take. They put trust in their environments and their budding abilities. They think they cannot get hurt. By reducing hazards in your environment, your program can allow school-age children to explore safely during this important phase of life.

Safe Indoor Spaces

Your indoor space can become safer just by meeting the daily needs of the children in your program and keeping the developmental needs of school-age children in mind. Programs for school-age children are busy places with multiple activities going on at the same time.

All of this activity can lead to injuries or accidents. Arranging the space in your area so that a variety of activities can go on without disruption or collisions between children will make a safer indoor environment. Separating active games or sports from quiet activities like reading or homework minimizes distractions and accidents. It also creates clear traffic patterns that prevent running and collisions. Finally, effective furniture and equipment arrangement helps you supervise school-age children for safety.

Safe Outdoor Spaces

It is very important for staff to station themselves throughout the outdoor space so they can supervise all children. Often, outdoor play equipment cannot be moved, so staff must actively supervise by moving around the equipment.

When children go outside, it is important to make sure that there is ample shade and access to drinking water. Inspections of the sidewalks will be necessary to make sure they are not slippery from ice or mud.

See

Every program will set up indoor and outdoor environments differently to maintain safety. What does a safe environment look like in your school-age program? We can think about this question in three ways. First, we think about our facilities. Second, we think about how we arrange and organize our learning spaces within the facilities. Finally, we think about the condition of the materials in the environment. This lesson will focus on facilities and learning spaces. You will learn about materials in the next lesson.

Your Facility

Your facility has been designed with safety in mind. Watch this video to see the ways your program helps keep children safe.

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Watch this video to see the ways your program helps keep children safe.

Your Learning Spaces

Next, we think about the ways we organize our learning spaces. Much of what you do as part of your job every day will help you keep children safe indoors and outdoors. Arranging your spaces with the developmental needs of children in mind will help keep them safe. Watch this video to learn more about the features of learning spaces that help keep children safe.

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Watch this video to learn more about the features of learning spaces that help keep children safe.

Indoor and Outdoor Conditions

We must consider the condition of the physical space and facilities indoors and outdoors. Look for these items-listed in Caring for Our Children (2019)-and correct them before children are permitted to play:

Missing or broken parts

Protrusion of nuts and bolts

Rust and chipping or peeling paint

Sharp edges, splinters, and rough surfaces

Stability of handholds

Visible cracks

Stability of non-anchored large play equipment (e.g., playhouses)

Wear and deterioration

Broken or worn electrical fixtures or cords

In many settings, your outdoor space may be used by the community at night. Or perhaps your program shares a community park. Even if your outdoor space is protected by a fence, it is still possible that hazardous materials could find their way onto the outdoor space. Before you take school-age children outside, you must be vigilant about inspecting the outdoor space each day. Look for:

Debris, such as glass, cigarette butts, litter, building supplies

Animal excrement and other foreign material

Mulch that is spread too thin

Standing water, ice, or snow

Surfaces that are too hot or cold for children to touch safely

Natural objects that might cause harm: sharp rocks, stumps, roots, branches

Unsafe insects: anthills, beehives, or wasp nests

Ditches, holes, wells, traps

Exposed power lines or utility equipment

Remember to check the temperature of play surfaces. Metal or plastic slides, benches, and poured concrete surfaces can get very hot and very cold. Inspect surfaces for cracks caused by temperature changes or water damage.

Do

Now that you understand the importance of keeping school-age children safe and know what safe environments look like, it is up to you to make sure your environment is safe. The best way to ensure that your environment is safe is to do "safety checks" and inspections. It is necessary to do both daily and monthly safety checks.

You should begin each day by carefully inspecting indoor and outdoor play areas and equipment. This will help you prevent major injuries or accidents. The next lesson on Safe Games and Learning Materials will give you more information about safety checks.

Completing this Course

For more information on what to expect in this course and a list of the accompanying Learn, Explore and Apply resources and activities offered throughout the lessons, visit the School-Age Safe Environments Course Guide.

Please note the References & Resources section at the end of each lesson outlines reference sources and resources to find additional information on the topics covered. As you complete lessons, you are not expected to review all the online references available. However, you are welcome to explore the resources further if you have interest, or at the request of your trainer, coach, or administrator.

American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2019). Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. (4th ed.). h ttps://nrckids.org

Blank, S. (2005) Hours that Count: Using After-School Programs to Help Prevent Risky Behaviors and Keep Kids Safe. Hamilton Fish Institute.

Council on Accreditation (COA; 2008). After School Program Standards. New York, NY: Council on Accreditation.

U.S. Consumer Product Safety Commission (n.d.). Public playground safety checklist: Document # 327. https://www.cpsc.gov/safety-education/safety-guides/playgrounds/public-playground-safety-checklist

U.S. Consumer Product Safety Commission (n.d.). Think Toy Safety. Washington, DC: Consumer Product Safety Commission.

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Providing a Safe Environment Indoors and Outdoors

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Think back to happy moments from your childhood. Do you remember riding a bike around your neighborhood? Going swimming with friends? Learning to fix a snack all by yourself? Likely, these events are memorable because you felt independent. Just like we did, school-age children crave independence and challenge.

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How to Help Your Kids Stay Healthy at Daycare | iCare

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Daycare is a necessity when kids need a place to be while the parents are at work. While there are many benefits of daycare services, […]

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Your kids are probably so excited to see the lower fall temperatures in the weather forecast, but as a parent, the changing temps make you fear getting the dreaded phone call that your child is sick and needs to be picked up right away from daycare. At Children's World , we know that infants and toddlers are more susceptible to infections because they're coming into contact with illnesses they've never had before, and studies have even shown that babies and toddlers in daycare were sick more frequently but were less likely to fall ill once they started grade school. The bottom line is that getting sick is inevitable while attending daycare, but here are a few tips from Children's World child care Greenville NC with things you can do to prevent your kid from catching a bug while there:

Healthy Eating Boosts Immunity

Experts agree that a healthy diet high in fruits, vegetables, and iron-rich foods, as well as plenty of sleep, are key to a strong immune system. This can significantly reduce the number of colds and flu bugs your child picks up while in child care Greenville NC , and can even protect the rest of your family against these minor ailments.

Enforce Hand-Washing Regularly Throughout the Day

Teaching your little ones to wash their hands before and after every meal and at regular intervals throughout their day can reduce the build-up of germs on skin surfaces and can keep children safer when in contact with others in their peer group. Staff members at the daycare should also maintain these best practices as well.

Understand Your Daycare's Sick Policy

Most facilities, including Children's World child care Greenville NC , require parents to pick up their children immediately if they have a fever. When children do fall ill, it is critical that the daycare provides separate and safe areas for these children before they are picked up by parents or guardians. This can protect well children against exposure to the disease while allowing sick children the chance to rest and recuperate. Be sure you understand and agree with the daycare's policy and find out if it's being enforced.

Vaccinate

Despite recent controversies, vaccination remains the most effective way to protect against many serious childhood illnesses. Most major public health organizations, as well as Children's World , endorse the use of vaccines to prevent children from contracting or spreading these potentially dangerous diseases. Following the advice of your pediatrician can help you reduce the risks for your own child and the children with whom he or she has contact.

Keep Shared Toys Clean

Regular cleaning and sanitation of toys and other shared items in preschool and child care environments can help to prevent the transmission of colds and flu among younger children. Since nearly everything finds its way to infant and toddlers' mouths, keeping toys and plastic surfaces clean and germ-free can reduce the risk of disease transmission in these child care Greenville NC centers for early childhood education.

Children's World Child Care Greenville NC

At Children's World Learning Center, we know that the early years of life matter because early experiences affect the brain. As a child's brain grows, the quality of the experiences that a child has creates either a sturdy or fragile foundation for all of the development and behaviors that follow. Parents want to make educated choices for their families, and getting things right the first time is better than trying to fix them later. Contact us today!

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5 Tips to Keep Your Child Healthy at Daycare | Children's World

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Here are a few tips from Children's World child care Greenville NC with things you can do to prevent your kid from catching a bug at daycare.

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Know

The Importance of Healthy Environments

Have you ever gone to a restaurant and sat down at a sticky table or found dried food on your fork? Have you ever hesitated about picking up a pen at the bank or grocery store because the person in front of you had a cold? Have you ever put a public toilet seat down with your foot just to avoid touching it? Have you ever stayed in a hotel room that made you want to avoid touching the comforter or the remote control?

Most people have experienced some of these uncomfortable and stressful health-related situations. As adults, we can respond to such situations by visiting a different restaurant or hotel, or by washing our hands as soon as we leave the bank or restroom stall. We want to stay healthy and we want to believe that our environments are reasonably clean. Children and their families have these same desires. Child development programs must provide environments that are clean and that prevent the spread of communicable diseases. It is your responsibility to make sure infants and toddlers have a safe and healthy environment for play and learning.

Germs

Germs are the cause of infectious diseases. Unfortunately, germs cannot be seen by the naked eye and they are generally transmitted without us even knowing it. Germs are transmitted as a result of:

Direct contact: Touching the fluid from another person's infection (e.g., saliva, nasal mucus), transmitted through environmental objects, such as toys, cabinet handles, equipment, or person to person. It only takes a small drop of fluid for transmission to occur.

Respiratory: Spread via the mouth and nose through the air when someone sneezes or coughs.

Blood infections: Spread when blood, and sometimes other bodily fluids, enters the blood stream of another person.

Fecal-oral transmission: Spread to a person's mouth (oral) via hands soiled with feces that touch food, surfaces or objects. Germs from feces are invisible. Hands and surfaces may appear clean, though feces germs can still be present. Disease from fecal-oral transmission can make adults and children very ill.

There is no way to completely eliminate the transmission of germs, especially with all the mouthing, touching, and picking that happens in infant and toddler programs, but there are ways to decrease the transmission of germs among children, staff and families. In addition to following your program's health related policies, it is essential that you adhere to your program's cleaning and sanitation requirements and follow proper hand washing procedures to minimize the occurrences of spreading germs (see Lesson Two for more on handwashing).

Cleaning, Sanitizing, and Disinfecting: What's the Difference?

Although we often use the words cleaning, sanitizing and disinfecting interchangeably, they each have their own meaning. To provide a safe and healthy environment for children, you need to understand the difference between each term (American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education, 2019). This will help you know which products are designed for each purpose.

1. Cleaning means to remove dirt or debris from a surface and sometimes involves scrubbing or friction in order to remove the debris. For example, you spray a table with a mix of water and detergent to remove food products and debris after a meal.

2. Sanitizing means to reduce germs on a surface. When you a surface, it meets most health regulations. Sanitizing products usually are not effective unless the surface has been cleaned first. After cleaning the table with detergent and water, you spray an approved mix of water and bleach to sanitize the table and kill germs. A sanitizer may be appropriate to use on food-contact surfaces (dishes, utensils, cutting boards, high chair trays), toys that children may place in their mouths, and pacifiers.

3. Disinfecting means to destroy most germs on a surface. Disinfecting a surface is often necessary when it has made contact with body fluids. Disinfecting usually requires a stronger bleach-water mixture. You disinfect on non-porous surfaces, such as diaper-change tables, countertops, door and cabinet handles, and toilets and other bathroom surfaces.

Keep in mind that infants and toddlers should not be near surfaces, materials, and toys (including meal and snack tables and diapering tables) while the surfaces or items are being sanitized or disinfected. Inhalation of chemicals as they are being applied can be dangerous. All chemicals should be locked and out of reach of children.

Cleaning should be a habit and a priority, however it should never distract you from supervising or engaging with the infants and toddlers in your care. In the Explore activity, you will reflect on how to best share the cleaning tasks in your classroom amongst the caregivers, so that you can help ensure healthy environments and responsive caregiving for the children in your care.

Any products you use to clean, sanitize, or disinfect should be approved by the Environmental Protection Agency (EPA) to ensure they are safe for you to use. When you clean, sanitize, or disinfect, you should follow approved procedures. Typically, this means washing the materials or surface by hand with soap or detergent and water, sanitizing or disinfecting, and allowing the object to air dry. You can also use a dishwasher to sanitize toys or materials if it has a sanitize setting or a high-temperature option.

The U.S. Department of Health and Human Services (DHHS) and the Centers for Disease Control (CDC) recommend that if an EPA approved disinfectant is not available, then you should use a fresh chlorine bleach solution. The DHHS and CDC provide the following guidelines on preparing and using the solution:

Add 1 tablespoon of bleach to 1 quart (4 cups) of water. For a larger supply of disinfectant, add ¼ cup of bleach to 1 gallon (16 cups) of water.

Apply the solution to the surface with a cloth.

Let it stand for 3 to 5 minutes.

Rinse the surface with clean water.

See

What do clean and healthy environments look like for infants and toddlers? In these environments, cleanliness is a habit. Soiled or mouthed toys go into a labeled "soiled toy" bin for cleaning. Spray bottles are available for cleaning and sanitizing; soap mixtures and bleach mixtures are changed daily. Watch the video below to see ways infant and toddler caregivers maintain a clean and healthy environment.

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Clean environments prevent the spread of communicable disease.

Standard and Universal Precautions

Another way to reduce the risk of transmission of microorganisms (germs) that can cause infection is to practice standard or universal precautions. Standard precautions cover all situations where you may come into contact with body fluids, but universal precautions apply specifically to contact with blood, and does not apply to contact with feces, nasal secretions, sputum, sweat, tears, urine, saliva, or vomit unless these body fluids also contain blood. In child care settings, standard precautions involve using barriers to prevent contact with body fluids from another person, as well as cleaning and sanitizing contaminated surfaces. You can read more about standard precautions in the Standard and Universal Precautions as they Apply to Child Care Settings fact sheet found in the Learn section below.

Barriers you might use to help prevent bodily fluid contact might include:

Moisture-resistant disposable diaper table paper

Disposable towels

Gloves

Plastic bags, securely sealed

You should always use disposable non-porous gloves when blood or body fluids containing blood may be involved.

Gloves may be optional for diapering and contact with other bodily fluids described above, but check with your coach, trainer, or administrator for times your program or Service guidelines recommend using gloves. Gloves are not necessary for feeding human breast milk.

Whenever gloves are worn, you should practice good hand hygiene. See Lesson Two for more on handwashing and Lesson Three for more on glove procedures.

Do

Your role is critical in ensuring your classroom is a clean and healthy environment where children learn and thrive. This section describes what you can do to keep your classroom healthy. The Apply section below provides a more detailed schedule to help support healthy practices.

Keeping Your Classroom Healthy

Toys and Classroom Materials

One toy can be used by many children every day. Toys can become a home for germs, especially when infants and toddlers put them in their mouths, cough or sneeze on them, or touch them after toileting. It is very important to regularly clean and sanitize the toys in your room. To do this:

Keep a box or bin labeled "soiled toys." When a child mouths a toy, coughs, or sneezes on it, place the toy in the bin. According to the American Academy of Pediatrics, you can keep soapy water in the bin or the bin can be a dry spot for storing toys until you can clean them. Make sure you have cleaned and sanitized the toy before returning it to the learning environment.

Clean activity spaces, dress-up clothes, and machine-washable cloth toys at least weekly.

Clean hats daily.

Clean mouthed toys after each use and sanitize them daily.

You can put plastic toys in the dishwasher to clean and sanitize them.

Classroom Surfaces

Many surfaces in your classroom probably serve multiple purposes. Maybe you serve snacks on a table that is later used for a sensory activity, or children use the same sink to wash their hands after using the restroom or after art. Cleaning, sanitizing, and disinfecting surfaces on a schedule can help you maintain a healthy environment. Cleaning guidelines for surfaces in your room include:

Clean and disinfect door knobs and handles daily.

Clean and sanitize food-preparation surfaces before and after each use.

Clean and sanitize dishes after each use.

Clean and sanitize food tables and trays before and after each use.

Clean countertops after each use and sanitize daily.

Clean the refrigerator monthly if you have one in your classroom.

Clean the floors daily.

Clean and disinfect the drinking fountain daily.

Clean phone receivers daily.

Vacuum carpets daily.

Toileting and Diaper Changing Areas

The restroom or changing area is the location where germs and bacteria are most likely to spread. It is very important to keep toileting and diapering areas clean. These guidelines will help you limit contamination:

Clean and disinfect any changing surfaces after each use.

Clean and disinfect sinks and faucets daily. If the sink is also used for non-toileting routines, disinfect it after toileting use.

Clean and disinfect countertops daily.

Clean and disinfect floors daily.

Cribs, Cots and Bedding

In full-day programs, it is important to provide a healthy environment for sleep. Lice and skin infections can be spread through blankets or bedding that are stored and cleaned improperly. Follow these suggestions for healthy sleep environments:

Store each child's bedding (sheets, blankets, pillows, sleeping bags) separate from the other children's bedding.

Launder sheets and pillow cases weekly or before being used by another child.

Clean cribs and cots weekly or before being used by another child.

Launder blankets monthly. If the blankets touch the child's skin, clean weekly.

Completing this Course

For more information on what to expect in this course, the Healthy Environments Competency Reflection, and a list of the accompanying Learn, Explore and Apply resources and activities offered throughout the lessons, visit the Infant & Toddler Healthy Environments Course Guide.

Please note the References & Resources section at the end of each lesson outlines reference sources and resources to find additional information on the topics covered. As you complete lessons, you are not expected to review all the online references available. However, you are welcome to explore the resources further if you have interest, or at the request of your trainer, coach, or administrator.

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Have you ever gone to a restaurant and sat down at a sticky table or found dried food on your fork? Have you ever hesitated about picking up a pen at the bank or grocery store because the person in front of you had a cold?

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How Every Child Can Thrive by Five | Molly Wright | TED

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It is easy for us to identify a child's physical needs: nutritious food, warm, clean clothes, a roof over their heads, routine bedtimes, medical care when needed.

However, a child's mental and emotional needs may not be so obvious. Good emotional health helps children to develop socially and learn new skills. In addition, having good friends and receiving reassurance and positive encouragement from adults help children develop self-confidence, high self-esteem, and a healthy emotional outlook on life.

Statistics show that 50% of mental health problems are established by age 14 and 75% by age 24. 10% of children and young people (aged 5-16 years) have a clinically diagnosable mental problem ( The Mental Health Foundation) which is why laying solid emotional foundations from birth is so crucial for the wellbeing of next generations.

From birth, children have a strong need for love. Babies are delicate and dependent on those caring for them to survive. This love helps babies feel safe in the world and builds trust in other people. Cuddles and other small actions demonstrate your love and help them feel more secure. It also strengthens the bond between the parent and baby.

In addition to needing love, babies need to feel safe. They depend on adults to keep them safe; they can only let you know how they are feeling through laughing or crying. If they get a quick response to the emotion that they are displaying it can have a positive effect on their emotional development.

This care and attention form the baby's perception of the world; they realise that their cries are answered with caring and this reinforces a positive image of the people around them.

This solid foundation of emotions sets babies up for success in all areas of life.

As babies grow into toddlers they are developing physically, cognitively and linguistically; they also begin to develop relationships. It is at this stage that children's emotional feelings start to have an impact on their daily functioning including their behaviour, for example why do they throw tantrums?

We often label it as "the terrible twos". Every tantrum a child throws, however petty the reason for the tantrum may be, all they want is to feel understood. Fighting over a toy or crying about not getting a snack can seem insignificant to us. After all, from our point of view, these don't seem important enough to justify the kind of meltdowns toddlers can have.

But you won't get through to the child, much less calm them down, unless you first show them that you understand. Try putting yourself in their shoes; this means showing empathy and actually thinking about what they might be feeling. That toy or snack at that moment in time seems the most important thing in the whole world to the toddler.

Talk to them, show that you understand how they are feeling - this doesn't mean giving in to the demands - explain how they might be able to cope with this difficulty. Validate their feelings; toddlers don't want to feel brushed aside or misunderstood, they want to feel that they are understood and that the depth of their feelings is understood.

When the tantrum is over, don't hold a grudge. However annoyed you may feel, don't let your feelings fester for the rest of the day; the toddler has already got over it, forgive and move on. Making the toddler feel "guilty" for the way you are feeling about how they behaved will have a detrimental effect on their emotional development; it's their behaviour that is wrong.

In explaining that, let the toddler know that they are still loved and that you forgive mistakes. They will learn that although you dislike certain behaviours, they are loved. At this stage of development toddlers can't regulate their emotions, they need you to guide them.

Toddlers respond positively to praise. At this time, they are learning, absorbing knowledge and information. They are desperate to show you their new skills and achievements and for you to show your approval and pride. Showing interest in a toddler's latest finger painting or dance moves, for example, goes a long way to building their self-esteem. Giving them encouragement when things are not going to plan helps develop their thinking skills and perseverance.

However, this is also the stage when toddlers want to be able to "do it themselves" and this can lead to them flinging themselves into unsafe situations. Toddlers need to know that they can explore and try things out but that you will be there to step in if they overstep the safe boundaries. Having the feeling that they are not on their own, that we are setting limits, gives them security and feelings of comfort, even if at times they may push these boundaries. They want to feel you won't let them come to harm.

Toddlers' emotional needs include:

This is the stage when children are experiencing the world outside the home more and more. They start school, and this can be both exciting and unsettling for them. They need support to guide them, praise for their achievements and someone to be there to comfort and encourage them when things go wrong.

Routine helps children to feel safe and flourish. Knowing what to expect makes them feel more secure. At this age they are experiencing big changes, and a structured framework helps them handle these experiences. Setting times for meals, play, school, homework and bed helps children deal with all the differing aspects of their life, and knowing the routine helps to instil a sense of control - they know what to expect.

Control is inherently important to children, not being controlled but feeling they have control over themselves. Providing a sense of autonomy, giving the child choices they can pick from, for example "do you want to wear a t-shirt or jumper today?", gives the child a feeling of "power" over their lives and enhances their decision-making skills.

They may not always make the most appropriate decision, a t-shirt on a freezing cold day, but they will learn from this in a "safe environment". Allowing children to make their own choices helps develop problem-solving skills especially when they haven't made the best choice. How are they going to resolve this? Provide more choices, don't solve it for them, that way they will learn that things don't always go to plan first time.

At this age children start to feel anxious particularly if they see grown-ups around them worrying or fretful. A good example of this is when grown-ups react to bad news on the TV. The grown-ups may be feeling stunned by the news, for example so many thousands have died from COVID, but to a child this may be overwhelming.

They may feel that every grown-up they know may be at risk and they are powerless. Talk to them about the topic, help them to feel empowered, not frightened. What can you do as a family to keep those people the child knows safe? In turn this will give them a feeling of safety; they are doing something positive. Simple, positive things that the child can do will instil a sense of power, for example perhaps raising money for the NHS through sponsored silences gives children a positive way to combat things that seem hopeless and nurture a feeling of achievement.

Supporting children in their interests, for example cheering from the sidelines, being interested in ponies or tractors or creepy-crawlies, even if you hate them, encourages children to explore the world and find out what they like and what they don't. Often these interests are a five-minute wonder, but that should be their choice; however, you never know whether they may turn that messy art project into their life's work and passion. Your encouragement and support will pave the way to have the confidence to follow their dream.

Children's personalities are beginning to develop as too is their need to be valued as an individual. Starting to ask their opinion about things like where to go on a family day out, what colour they would like for their bedroom or do they like your new hairstyle shows a child that they are respected and valued. Be mindful what you say to the child; you probably wouldn't dismiss a friend's opinion as ridiculous even if it is, so value the child's opinion, show them they have a safe space to voice it even if you have to disagree with it.

The teenage years are a time of considerable change. It starts with the change from the safety of being on the top rung of their first school to the bottom rung of their new senior school. All those feelings of vulnerability return; they need reassurance and positive affirmation that they can deal with these changes, after all they dealt with them when they started their first school.

Teenagers often look all grown-up, but their emotional development is often behind their physical development. How they respond to situations with good judgement and their awareness of long-term consequences can often be immature - they haven't had enough experience to rely on. As they start to make their independent way in the world, they need the reassurance that you will always be there for them.

As their hormones kick in there will be a roller-coaster of emotional highs and lows, and you can play an important part in supporting and guiding them to feel good about themselves as they deal with heightened emotions. This unconditional love and support are crucially important; allowing them the freedom to be more independent gives them confidence and builds their self-esteem. Negotiation and compromise help. When a teenager is asserting their independence, you may not approve of something they want to do but by discussing the matter adult to adult, you should be able to reach a consensus agreeable to both parties, neither party loses face and arguments are avoided.

They may make mistakes, make unwise decisions or feel the world is against them, however, knowing that they have someone to turn to who will not be judgemental, who will forgive them when, for example, they drink too much when they promised they wouldn't, or their behaviour and mood is rebellious, will give them the confidence to face the challenges, find solutions and learn from their mistakes.

All the work that you have put in over the years to ensure that you have built firm emotional foundations will help you to communicate with the teenager as you both understand each other. There will be days when all you get is a grunt in response, when they look at you as if to say "you have no idea, you have never been young, you don't know how I feel" but you do and sometimes you have to be very creative in finding ways to communicate at times like these. Sometimes you don't even need to say anything, a small gesture to remind them they are loved goes a long way.

By nurturing a child's emotional needs will help them grow into a happy, emotionally intelligent, emotionally balanced adult. You have provided them with a solid emotional foundation. They have learned by your example and have grown and developed into a healthy adult who is confident, self-assured and independent but who knows that you will always be there for them when you are needed.

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What are the emotional needs of a child?

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Children's mental and emotional needs may not be so obvious. Good emotional health helps children to develop socially and learn new skills.

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It is easy for parents to identify their child's physical needs: nutritious food, warm clothes when it's cold, bedtime at a reasonable hour. However, a child's mental and emotional needs may not be as obvious. Good mental health allows children to think clearly, develop socially and learn new skills. Additionally, good friends and encouraging words from adults are all important for helping children develop self confidence, high self-esteem, and a healthy emotional outlook on life.

A child's physical and mental health are both important.
Basics for a child's good physical health:

Nutritious food

Adequate shelter and sleep

Exercise

Immunizations

Healthy living environment

Basics for a child's good mental health:

Unconditional love from family

Self-confidence and high self-esteem

The opportunity to play with other children

Encouraging teachers and supportive caretakers

Safe and secure surroundings

Appropriate guidance and discipline

Give children unconditional love.
Love, security and acceptance should be at the heart of family life. Children need to know that your love does not depend on his or her accomplishments.

Mistakes and/or defeats should be expected and accepted. Confidence grows in a home that is full of unconditional love and affection.
Nurture children's confidence and self-esteem.
Make time for play!
Encourage Children to Play
To children, play is just fun. However, playtime is as important to their development as food and good care. Playtime helps children be creative, learn problem-solving skills and learn self-control. Good, hardy play, which includes running and yelling, is not only fun, but helps children to be physically and mentally healthy.
Children Need Playmates
Sometimes it is important for children to have time with their peers. By playing with others, children discover their strengths and weaknesses, develop a sense of belonging, and learn how to get along with others. Consider finding a good children's program through neighbors, local community centers, schools, or your local park and recreation department.
Parents Can be Great Playmates
Join the fun! Playing Monopoly or coloring with a child gives you a great opportunity to share ideas and spend time together in a relaxed setting.
Play for Fun
Winning is not as important as being involved and enjoying the activity. One of the most important questions to ask children is "Did you have fun?'' not "Did you win?"

In our goal-oriented society, we often acknowledge only success and winning. This attitude can be discouraging and frustrating to children who are learning and experimenting with new activities. It's more important for children to participate and enjoy themselves.
TV use should be monitored
Try not to use TV as a "baby-sitter" on a regular basis. Be selective in choosing television shows for children. Some shows can be educational as well as entertaining.
School should be fun!
Starting school is a big event for children. "Playing school" can be a positive way to give them a glimpse of school life.

Try to enroll them in a pre-school, Head Start, or similar community program which provides an opportunity to be with other kids and make new friends. Children can also learn academic basics as well as how to make decisions and cope with problems.
Provide appropriate guidance and instructive discipline
Children need the opportunity to explore and develop new skills and independence. At the same time, children need to learn that certain behaviors are unacceptable and that they are responsible for the consequences of their actions.

As members of a family, children need to learn the rules of the family unit. Offer guidance and discipline that is fair and consistent. They will take these social skills and rules of conduct to school and eventually to the workplace.
Suggestions on Guidance and Discipline

Be firm, but kind and realistic with your expectations. Children's development depends on your love and encouragement.

Set a good example. You cannot expect self-control and self-discipline from a child if you do not practice this behavior.

Criticize the behavior, not the child. It is best to say, "That was a bad thing you did," rather than "You are a bad boy or girl."

Avoid nagging, threats and bribery. Children will learn to ignore nagging, and threats and bribes are seldom effective.

Give children the reasons "why" you are disciplining them and what the potential consequences of their actions might be.

Talk about your feelings. We all lose our temper from time to time. If you do "blow your top," it is important to talk about what happened and why you are angry. Apologize if you were wrong!
Remember, the goal is not to control the child, but for him or her to learn self-control. Provide a safe and secure home.
It's okay for children to feel afraid sometimes. Everyone is afraid of something at some point in their life. Fear and anxiety grow out of experiences that we do not understand.

If your children have fears that will not go away and affect his or her behavior, the first step is to find out what is frightening them. Be loving, patient and reassuring, not critical. Remember: the fear may be very real to the child.

Signs of Fear

Nervous mannerisms, shyness, withdrawal and aggressive behavior may be signs of childhood fears. A change in normal eating and sleeping patterns may also signal an unhealthy fear. Children who "play sick" or feel anxious regularly may have some problems that need attention.

Fear of school can occur following a stressful event such as moving to a new neighborhood, changing schools, or after a bad incident at school.

Children may not want to go to school after a period of being at home because of an illness.
When to seek help
Parents and family members are usually the first to notice if a child has problems with emotions or behavior. Your observations with those of teachers and other caregivers may lead you to seek help for your child. If you suspect a problem or have questions, consult your pediatrician or contact a mental health professional.
Warning Signs
The following signs may indicate the need for professional assistance or evaluation:

Decline in school performance

Poor grades despite strong efforts

Regular worry or anxiety

Repeated refusal to go to school or take part in normal children's activities

Hyperactivity or fidgeting

Persistent nightmares

Persistent disobedience or aggression

Frequent temper tantrums

Depression, sadness or irritability

Learn more about specific mental health conditions and children Where to seek help
Information and referrals regarding the types of services that are available for children may be obtained from:

Mental health organizations, hotlines and libraries

Other professionals such as the child's pediatrician or school counselor

Other families in the community

Family network organizations

Community-based psychiatric care

Crisis outreach teams

Education or special education services

Family resource centers and support groups

Health services

Protection and advocacy groups and organizations

Self-help and support groups

Other Resources

American Academy of Child and Adolescent Psychiatry
www.aacap.org

Federation of Families for Children's Mental Health
Phone: 703-684-7710
www.ffcmh.org

Family Support America
Phone: 312-338-0900

National Association of School Psychologists
Phone 301-657-0270
www.naspweb.org

Sources

"Facts for Families," America Academy of Child and Adolescent Psychiatry
"Children's and Adolescent's Mental Health," US Dept. of Health and Human Services
copyright 1997 revised 2/00

This pamphlet is copyrighted. Permission to reprint must be obtained from Mental Health America. 2/00

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What Every Child Needs For Good Mental Health

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It is easy for parents to identify their child's physical needs: nutritious food, warm clothes when it's cold, bedtime at a reasonable hour. However, a child's mental and emotional needs may not be as obvious. Good mental health allows children to think clearly, develop socially and learn new skills.

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Appendix N: Protective Factors Regarding Child Abuse and Neglect pages 498 - 499.

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Appendix N: Protective Factors Regarding Child Abuse and Neglect pages 498 - 499.

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Appendix M: Recognizing Child Abuse and Neglect: Signs and Symptoms pages 494 - 497

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Appendix M: Recognizing Child Abuse and Neglect: Signs and Symptoms pages 494 - 497

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Child Safety: Child Abuse and Maltreatment
Nate Chomilo: Hello. I'm Doctor Nate Chomilo. I'll be your host for this episode of "Keeping Them Safe." Today's topic is child abuse and maltreatment and how to keep children safe in your programs, centers, and family child care homes. Requirements for your programs vary greatly from state to state. Most states, territories, tribes, or local health departments may have different regulations, training requirements, or other procedures in place. It is important to understand and follow your state or local regulations. As wonderful as it is to care for children, it can be overwhelming and stressful for families and caregivers. It is important for caregivers and teachers to be aware of the physical signs and symptoms of child abuse and neglect or child maltreatment, and as professionals you should recognize signs of stress to avoid situations where a child may be abused or mistreated by program staff. As early childhood education professionals, you are mandated by law to report any suspected child maltreatment to your local protective services and police. The same laws protect you from any adverse consequences related to reporting any abuse you may suspect. Often, reporting of any suspected case of child maltreatment will initiate family support services regardless of whether the child was determined to be abused or not. Some states, territories, and tribes have specialized programs in place for families experiencing stressors that lead to unintentional neglect due to inadequate income, housing, or parenting concerns that are a result of overstressed home environments.

First, let's talk about ways to prevent child maltreatment. All staff caring for children have to receive training on the different types of abuse and the dangers related to being abused or exposed to violence. This training should address ways to identify signs of stress in families and how to assist families through timely and appropriate referrals to resources and support when needed. Another way to prevent child maltreatment is for caregivers and teachers to understand how to promote protective factors. Children with special needs are at a higher risk for being abused, so staff should understand how to protect vulnerable children from child maltreatment.

Next, let's talk about prohibited caregiver or teacher behaviors. As caregivers and teachers, you have a large impact on a child's safety, growth, and development. In order to assure that children feel safe and protected in your program, caregivers and teachers should know that the following behaviors are prohibited: corporal punishment, isolating children in an area where they cannot be seen or supervised, binding or restricting movement by tying a child, withholding food or drink as a form of punishment, teaching or learning methods that punish, demean or humiliate a child, any form of emotional abuse, verbal, abusive, or derogatory language. You can find more guidance from "Caring for Our Children," a collection of best practice standards for early care and education programs. Head Start program performance standards also align with many of the "Caring for Our Children" guidelines when it comes to prohibited behaviors. For more information on the prevention of child maltreatment, please review the resources provided on the landing page. Caring for groups of young children can be stressful at times. Staff may have their own personal stressors such as illness or their own experience with trauma or maltreatment, which can impact how they respond to stress. So, an important strategy for the prevention of child maltreatment is prioritizing and supporting staff wellness. When programs support and prioritize staff wellness, staff are better able to provide the quality care and nurturing that children need. For more ideas and strategies on how to support staff wellness, please see the resources on the landing page.

Finally, let's talk about recognizing and reporting suspected child abuse, neglect, and exploitation. Since caregivers and teachers are mandated reporters, it is important to have a written policy for reporting child maltreatment. Every staff should be aware of this policy and know what and how to report suspected abuse. Caregivers and teachers should be trained regularly on the prevention of child maltreatment, as well as how to recognize the signs of child abuse and neglect. If you need help accessing appropriate child maltreatment trainings, make sure you reach out to your local pediatricians, child care health consultants, children's hospital, or child protection advocates for guidance and support. At the end of this episode, be sure to check out the online webinar as well as resources for staff and families on the video page.

Before we close, I have two reflective questions for you. What plans and policies do you have in place to help staff identify and report suspected child maltreatment? How do you support staff wellness as a way of creating safe and nurturing environments for children? Thank you for spending this time with me. We will see you on another episode of "Keeping Them Safe." Remember the more you learn, the safer they are.

In this video, hear from Dr. Nate Chomilo, M.D., about the importance of keeping children safe from child abuse and maltreatment, both in early education settings and at home.

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Learn the importance of keeping children safe from harm. Find out ways to help protect children from abuse and maltreatment, both in early education settings and at home.

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Child Abuse and Neglect Education page 32

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Child Abuse and Neglect Education page 32

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Did you know that negative experiences in childhood and the teenage years may put children at risk for chronic health problems, mental illness, and substance use in adulthood? These negative experiences are known as adverse childhood experiences (ACEs). ACEs are potentially traumatic experiences, such as neglect, experiencing or witnessing violence, and having a family member attempt or die by suicide, that occur in childhood (birth to 17) that can affect children for years and impact their life opportunities. Fortunately, we can prevent ACEs and we can educate parents, communities, and policymakers about how to help children grow up in a safe and stable environment.

This page explores risk factors (things that increase the likelihood of experiencing ACEs) and protective factors (things that protect people and decrease the possibility of experiencing ACEs). Individual, family, and community factors can affect the likelihood of these experiences, but they may or may not be direct causes of ACEs. Because ACEs include many different types of experiences, including abuse, neglect, household challenges, and other traumatic events that may occur outside the home such as bullying, teen dating violence, and witnessing community violence, there are many risk and protective factors that apply to the range of different ACEs. This page lists examples of the many common risk and protective factors that are related to multiple ACEs, but may not be related to all ACEs. This list is not meant to be exhaustive. It is also important to note that experiencing some ACEs can increase the risk of experiencing other ACEs. Although some risk and protective factors are at the individual and family level, no child or individual is at fault for the ACEs they experience.

Please note the term "caregiver" will be used throughout to refer to parents and those who care for children but may not be biological parents.

Risk Factors

Individual and Family Risk Factors

Families experiencing caregiving challenges related to children with special needs (for example, disabilities, mental health issues, chronic physical illnesses)

Children and youth who don't feel close to their parents/caregivers and feel like they can't talk to them about their feelings

Youth who start dating early or engaging in sexual activity early

Children and youth with few or no friends or with friends who engage in aggressive or delinquent behavior

Families with caregivers who have a limited understanding of children's needs or development

Families with caregivers who were abused or neglected as children

Families with young caregivers or single parents

Families with low income

Families with adults with low levels of education

Families experiencing high levels of parenting stress or economic stress

Families with caregivers who use spanking and other forms of corporal punishment for discipline

Families with inconsistent discipline and/or low levels of parental monitoring and supervision

Families that are isolated from and not connected to other people (extended family, friends, neighbors)

Families with high conflict and negative communication styles

Families with attitudes accepting of or justifying violence or aggression

Community Risk Factors

Communities with high rates of violence and crime

Communities with high rates of poverty and limited educational and economic opportunities

Communities with high unemployment rates

Communities with easy access to drugs and alcohol

Communities where neighbors don't know or look out for each other and there is low community involvement among residents

Communities with few community activities for young people

Communities with unstable housing and where residents move frequently

Communities where families frequently experience food insecurity

Communities with high levels of social and environmental disorder

Protective Factors

Individual and Family Protective Factors

Families who create safe, stable, and nurturing relationships, meaning, children have a consistent family life where they are safe, taken care of, and supported

Children who have positive friendships and peer networks

Children who do well in school

Children who have caring adults outside the family who serve as mentors/role models

Families where caregivers can meet basic needs of food, shelter, and health services for children

Families where caregivers have college degrees or higher

Families where caregivers have steady employment

Families with strong social support networks and positive relationships with the people around them

Families where caregivers engage in parental monitoring, supervision, and consistent enforcement of rules

Families where caregivers/adults work through conflicts peacefully

Families where caregivers help children work through problems

Families that engage in fun, positive activities together

Families that encourage the importance of school for children

Community Protective Factors

Communities where families have access to economic and financial help

Communities where families have access to medical care and mental health services

Communities with access to safe, stable housing

Communities where families have access to nurturing and safe childcare

Communities where families have access to high-quality preschool

Communities where families have access to safe, engaging after school programs and activities

Communities where adults have work opportunities with family-friendly policies

Communities with strong partnerships between the community and business, health care, government, and other sectors

Communities where residents feel connected to each other and are involved in the community

Communities where violence is not tolerated or accepted

ACEs don't have a single cause, and they can take several different forms. Many factors contribute to ACEs, including personal traits and experiences, parents, the family environment, and the community itself. To prevent ACEs and protect children from neglect, abuse, and violence, it's essential to address each of these factors.

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Violence is a significant problem in the United States. From infants to the elderly, it affects people in all stages of life. In 1992, CDC established the National Center for Injury Prevention and Control (NCIPC) as the lead federal organization for violence prevention. CDC is committed to stopping violence before it begins.

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Kiera: I didn't have a good childhood. When I was six, my mom's boyfriend killed my little sister in front of me.

[Music]

Kiera: He punched her in her stomach and -- because she peed on herself. She was two.

Felisha: I was addicted to methamphetamines, and it got to the point where I didn't think I was going to come back.

Carlos: There's like basically no family structure. I was at aunt's house, at grandma's house, at dinner here, dinner there, maybe no dinner. Sometimes all I would have is like school lunch. Paula: I didn't know how to stop. I didn't know where to go, who to turn to. I just didn't know. I had this battle and I had this addiction that had a strong hold on me and I didn't -- I didn't know what to do with it.

Christina: I had little brothers I had to protect, but at the same time, I indulged in her addiction with her. I was no longer a child. I was just there.

Molly: When I was nine, there was a secret that my dad was an alcoholic and he committed suicide. We were all in the house. He shot himself in the head.

Kahtea: It wasn't really until I -- until the next relationship where I almost died that I really began to understand what had happened to me as a child and how those things permitted this -- the subsequent events to happen.

Denise Dowd: It was many years ago, about 20 years ago, and the paper here in Kansas City had published an article accompanied by all these pictures of young people who'd lost their lives to homicide. And so I was looking at this just sort of overwhelmed with the -- how many faces were there, young faces. And I was with a colleague of mine, an older colleague, and she looked over my shoulder and she looked at the newspaper and she said, "That was my patient, that was my patient, he was my patient, she was my patient. In fact, most of these kids that you're looking at right now were our patients here at the children's hospital." And I happened to look through these medical records at these kids and they typically would go something like this: At the age of two months, a baby comes in to be evaluated for bruising. Child Protective Services is called. There's a hotline that is made and there's a diagnosis of abuse made. Taken out of the home maybe for a few months, returned to the home. At the age of two years, multiple documentation of missed visits for immunizations at the Well Child Clinic, just not showing up. At the age of four or five, coming in without a controlled behavior, diagnosed with ADHD, put on medication. At the age of 10, coming in for fighting in school, maybe a fracture of the hand from punching. It's called a "boxer's fracture," actually. Diagnosis made, in addition to fracture, of oppositional defiant disorder, put on more medication. At the age of 12, comes into the emergency department after a fight for a jaw fracture. And then at the age of 14, comes in with a full trauma activation, cardiac arrest from a gunshot wound to the chest. Everywhere along the line that we had an opportunity as a health care person, as a health care system, hospital, to do something.

Nadine Burke-Harris: The challenge I was having as a doctor was that if I have a child who has a heart problem, I refer them to the cardiologist, where if they have allergies, I refer them to the allergist. But if I have a child who's experiencing the multiple sequelae of early adversity and are demonstrating systems of toxic stress in clinic, there's no place for me to refer them.

Denise: This is a chronic disease. It's not just something that happens. From the time that they're born leading up to that point, there are multiple things happening in their lives to put them in that situation. And it was before we used the terms "toxic stress." It was before the -- we used the term "ACEs." But that's exactly what that was.

Nadine: We know that the cascade of stress hormones that flood through a child's body when they're exposed to chronic adversity, that's leading to heart disease, that's leading to chronic obstructive pulmonary disease. That's leading to increased risk of obesity. But these things happen later. The behavioral issues are the ones that we see when a child is two and three and four years old, and they portend long-term health problems, and we can see that in kids when they're little.

Brijin Gardner: Toxic stress is something that we see every day. It's -- early experiences organize the brain. And the early experiences that many of our children have are traumatic. A lot of our kids are living with parents who are mentally ill, who are being exposed to drug use and at risk. They're living in poverty every day. They're hungry, they're neglected, they're abused.

Nadine: What we see in kids who are exposed to chronic adversity is that this fight-or-flight system which is supposed to be a once in a very longtime life-saving response is activated over and over and over again. And so it goes from being life-saving to health-damaging. It goes from being adaptive to being maladaptive. And so we see these kids when they are trying to sit still in the classroom and learn, right? It's one of the biggest places that we see this maladaptive response.

Amy Reames: We focus a lot on social-emotional wellness here. So we really put a lot of that into the curriculum. If we don't have that foundation, then we can't -- we can't do anything else. You know, if you have a child that is not socially or emotionally well, then we can't expect them to sit down and do a lesson on math or literacy or something. Nadine: "ACEs" stands for Adverse Childhood Experiences, and that comes from the real seminal study that was done in this field by Dr. Vince Felitti and Dr. Robert Anda. What they found was for those adults who had a history of adverse childhood experiences -- and these experiences include physical, emotional, or sexual abuse, physical or emotional neglect, a parent with mental illness, substance dependence, or who had been incarcerated, domestic violence or parental separation or divorce. There were two things that they found that were tremendously striking in this study. One was just how common it was even among their middle-class population. So 64% of their population had at least one adverse childhood experience, and 12.6% of their population had four or more adverse childhood experiences. The second thing that they found was there was a dose response relationship between early adversity and numerous health and behavioral outcomes.

Denise: The more ACEs you had, numbered them, right, zero to nine or ten, the more likely it was that you were going to have one of these diagnoses.

Nadine: What was really an eye-opener for the medical community was that if you had four or more adverse childhood experiences, your risk of chronic obstructive pulmonary disease was 260% as compared to someone with an ACE score of zero. For hepatitis, it was 250%. If you were a woman and you got pregnant, your risk of having a miscarriage, if you had four or more adverse childhood experiences, was 180%, almost double that of a woman who got pregnant and had no adverse childhood experiences. And so we've really begun to understand that there were biological and physiologic underpinnings and a direct connection between early adversity and health problems in adulthood.

Denise: Currently, medical practice in general does not include asking about ACEs, all right -- ascertaining ACEs. And importantly is it implies that pediatrics, pediatric care is a two -- at least a two-generation process. Right? Because if you think about it, your patient, the little kid, are going to achieve many of their ACEs, neglect, abuse, through their parent or somebody related to them. So you have to address the ACEs in both of those generations and try to get -- first of all, asking about it, really uncovering it, and then getting the help that people need.

Donna O'Malley: We have a lot of young mothers who they themselves have experienced toxic stress from many exposures in their lives where their trauma's never been treated and now they're trying to parent.

Denise: The most important vital sign that you can assess as a physician is the vital sign of the relationship between the parent and the child.

Nadine: The focus on early childhood, on the social-emotional learning that happens during that time, and some of the programming their doing here at Operation Breakthrough is really a model for best practices in terms of how we can do early intervention with our kids and start to lay the foundation for healing work in terms of responding to ACEs.

Amy: We have an arc program that we use that is for -- it's our Head Start Trauma Smart program, so it's basically on how to help children that go through a lot of trauma. We try to take the approach from the whole child which includes the family. That's why we have an interdisciplinary team that we work with, so it includes the teachers and the education coordinator, but also we have a therapy department, we have our children's Mercy Clinic, and we have the family advocates here. So we try to work as closely as we can with the families because we know we can't do it without them.

Brijin: We are a tiny, tiny mental health center in this huge Head Start setting. This is -- it's unheard of to have mental health on site in a Head Start center. There are consultants that come in and only see, you know, four to five kids, but we are here and we're able to see, you know, 60 kids, 126 kids, and then generally the population, and through the partnership with Children's Mercy, through partnerships with other medical facilities, we're able to get kids into services that they need to be successful in school, to be successful in life, to maintain their family situation, to maintain their living situation.

Felisha: My oldest was three and she's been a part of Operation Breakthrough since we got here, and they, through therapy and everything else, I mean, I've stayed sober for almost six years now, and I owe a lot of that to the advocates and the therapy department.

Shawna: It's wonderful. They're my village. They're my little village. I wish I could put them in my purse and take them with me everywhere.

Brijin: This organization provides so much safety and care for these people. When we do intakes and assessments, a lot of the parents talk about Operation Breakthrough as if it's a person, just "Operation Breakthrough is here for me." Operation Breakthrough is the first place a lot of families go after a crisis has happened. Female: How you feeling today?

Child: Happy.

Jim Caccamo: There aren't a lot of Operation Breakthroughs, frankly. And so Head Start offers a really high-quality early learning program for the children, but more importantly, it's a comprehensive program. It's a program that address health needs, dental needs, mental health needs, very, very supportive of parents. We do a great amount of work with parents to help them learn skills that really will benefit them life-long.

Sister Berta Sailer: These kids are bright and talented. Their parents are good people, are trying so hard. We have to have hope. I mean, I think that's what they've taken from the urban core. What society has taken is hope in tomorrow. If there's no tomorrow, it doesn't matter what I do today. And I think the hope is that if these children and families get the services they need, the children do well. Our alternative is to pay to put them in prison, and that costs much more than providing the services they need so they can grow up safe with an education. And these are good people. The kid that could cure cancer could be in this building today.

Kiera: Sister Berta had gotten my two younger brothers, and then she found out about me and she got me, too. So from there on, that was like -- that's when I felt like I actually had a childhood. I could be a kid. We were there maybe a year. I don't know exactly how long, but then my grandma got custody of us, and from there it was no more of that.

Denise: What makes a person survive? What creates resilience? What protects a person? We know a little bit. I think that we know interest in learning is one thing. A degree of emotional intelligence is another thing. A supportive adult in the home.

Kiera: I feel like I was smarter than the average child. Living with my grandma, I was put in situations where I could have been raped, molested, so many things that could have happened to me, but I was smart enough, like I recognized danger. I could sense it. I had a man who I used to babysit for, and I remember being at his house and I was watching his son. He was trying to show me something in his bedroom, and just all, you know, all the warning signs, I just felt it, and I was like no. Nadine: Her ability to know that danger is coming is critical for her being able to avoid dangerous situations and reduce her cumulative life dose of trauma. The research is telling us that social-emotional buffering, being in a caring relationship, having adults in your life who are able to self-regulate and who are able to model self-regulation helps children to be aware of when that is not happening. And sometimes all you need is that one.

Brijin: We see that the brain can change. It's not -- it's not you're traumatized and you're traumatized forever. We know we can make change, and we have modalities and evidence-based practices that can do that, and that's hopeful. But we know it, so let's do it.

Nadine: For each individual pediatrician, what you can be doing on the ground is universal screening of your patients for adverse childhood experiences. The question that we always ask is, okay, well, how can you screen if you don't have a response? Right? And thinking about what that response would be for your own clinic, who are the trusted resources in the community that you can refer to, who do you know can get shelter for a mom experiencing domestic violence, who is going to be a high-quality therapist in your community who you know does trauma-informed cognitive behavioral therapy. Making those connections is going to be, on the individual level, critically important to even being able to screen, right?

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Breaking Through: Understanding Stress and Resilience in Young Children | ECLKC

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View this 20-minute educational video to learn how toxic stress can impact a child's lifelong health and well-being. Also, find out how Head Start programs and health care professionals can support children and families to help prevent toxic stress. The user-friendly guide shows how best to use this resource.

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Nadine Burke Harris on the Impact of Childhood Adversity | Amanpour and Company