Child health and wellbeing

HS24 Room temperature

Criteria

§ Rooms used by children are kept at a comfortable temperature no lower than 18°C (at 500mm above the floor) while children are attending.

Rationale/intent

The criterion aims to uphold the wellbeing of children. Note that the wellbeing of adults at the service is covered by the Health and Safety at Work Act.

Guidance

Temperature in rooms used by children

The temperature in rooms must be no lower than 18°C at 500mm above the floor when used by children. Services should ensure that the heating is turned on (if required) before children arrive for the day to give time for the rooms used by children to heat up to 18°C.

Temperatures are kept no lower than 18°C

To ensure the temperature in rooms used by children is kept no lower than 18°C, a service must have a means of checking the temperature regularly at 500mm above the floor. This might include a thermometer that can measure ambient room temperature attached to the wall at 500mm above the floor or a portable thermometer.

Services will need to manage fluctuations of temperature in rooms used by children, for example, caused by the opening and closing of doors to the outside space, so that the temperature in rooms used by children is kept no lower than 18°C.

Rooms used by children at a comfortable temperature

18°C at 500mm above the floor is a minimum requirement. World Health Organisation guidelines, including those for vulnerable persons such as young children, have been considered in setting this minimum.

Services may choose to keep a higher indoor temperature but should ensure that is comfortable for children. Having a service temperature that is too warm could lead to lethargy.

Other licensing criteria that interact with HS24

• PF2 Premises support effective supervision
• PF12 Lighting, ventilation, heating and acoustic materials
• PF13 Outdoor activity space
• C9 Range of experiences

HS25 First aid qualifications

Criteria

There is an adult present at all times for every 25 children attending (or part thereof) that:

• holds a current first aid qualification gained from a New Zealand Qualification Authority accredited first aid training provider or
• is a registered medical practitioner or nurse with a current practising certificate or
• is a qualified ambulance officer or paramedic.

If a child is injured, any required first aid is administered or supervised by an adult meeting these requirements.

Documentation required

Copies of current first aid (or medical practising) certificates for adults counting towards this requirement.

Rationale/intent

The criterion aims to uphold the safety of children by ensuring adults with the necessary skills and knowledge to deal with injuries and illness are present at all times and readily available.

Amended May 2016.

Guidance

Information on the required first aid qualifications is available on the first aid page of this website.

First aid qualifications for early learning services and kōhanga reo

This includes who to contact to have an international first aid qualification assessed to see if it meets requirements.

When a centre takes some children on an excursion and some children remain at the centre, the first aid qualification ratio must be met both on the excursion and at the centre.

HS26 Response to infectious illnesses

Criteria

§ All practicable steps are taken to ensure that children do not come into contact with any person (adult or child) on the premises who is suffering from a disease or condition likely to be passed onto children and likely to have a detrimental effect on them.

Specifically:

• the action specified in Appendix 2 is taken for any person (adult or child) suffering from particular infectious diseases and

  Appendix 2: Infectious diseases for criterion HS26

• children who become unwell while attending the service are kept at a safe distance from other children (to minimise the spread of infection) and returned to the care of a parent or other person authorised to collect the child without delay.

Rationale/intent

The criterion aims to uphold the health and safety of children by preventing undue exposure to disease or illness while attending the service.

Guidance

It is very common for early childhood services to have to deal with children experiencing different forms of illness. Some will be infectious, that is, spread from person to person or from animal to person. Other forms of illness do not spread and will only affect the child or adult who has the illness.

It is not always easy to tell when a child is becoming ill. (A change in behaviour can be one indicator.) It is also quite difficult to tell what has caused the illness and whether or not it is infectious. Familiarity with the information in Appendix 2 of the criteria on infectious illnesses, incubation periods, symptoms, recommended exclusion times from attending the service and so on, will be helpful.

ECE services must take steps to minimise the contact of children with any person who has an infectious illness.

When a child becomes ill at a centre, the sooner they can be taken home, the better. The centre is not usually set up to deal with sick children for long periods of time, although an area away from other children at the centre where sick children can rest comfortably under supervision, while waiting to be taken home is required. For more information see PF27 Isolation area.

PF27 Isolation area

Services should develop a procedure with parents/whānau about what will happen when a child is ill or appears to be becoming ill. This will ensure there is common understanding about what will happen if a child is brought to the centre who is already ill or who becomes ill while there. It is vital to have up-to-date contact information for the parents on children’s enrolment records.

Having a policy and procedure to cover exclusion for general or infectious illness will assist staff to make a decision about whether or not to exclude a child on the grounds of ill health – either on the spot or when parents have a doctor’s diagnosis.

Refer to HS27 Medical assistance and incident management (below) for the requirement to keep records of serious illnesses.

When an illness appears to be affecting many children or adults, the service should contact their local public health unit for information and advice.

Regional Public Health produce a number of fact sheets on a variety of diseases.

Fact sheets – Regional Public Health | Health New Zealand

Things to consider

When children should stay away from the service

In general children should stay away from an early childhood service when they are ill and causing concern or:

• have no interest in activities or play
• have little energy – want or need to sleep or rest for long periods
• cry easily, are irritable or in pain
• constantly want to be held and comforted, are ‘clingy’
• have a fever
• have diarrhoea or vomiting.

What to do if children become ill while at the service

• Send them home as soon as possible. Recommend that they stay at home until well again.
• If a child cannot go home immediately, keep them away from others, stay with them at all times, and give them plenty of clear fluids to drink (water). Keep them cool if there is a fever and warm if they are cold.
• Assess the child’s illness. If a parent or caregiver is not available and the child seems to be becoming more ill, arrange for the child to be seen by a doctor.
• If you know what is causing the illness, make sure the child or staff member stays away for the recommended (or required) time.
• If you are not sure, but think the illness may be infectious, contact the public health unit for information and advice.

Preventing spread of illness to others

• If the illness is infectious, contact the parents or caregivers of children with low immunity. They may want to keep their children at home until the risk of illness is over.
• If other children develop the illness, take a careful look at the hygiene and cleaning routines used at your service:
  • make sure everyone is washing their hands thoroughly before eating and after using the toilet
  • check the nappy changing procedure and make sure that all staff are following it carefully
  • look at the cleaning programme, including the cleaning of toys, bedding, equipment and frequently handled fixtures and fittings such as door handles, toilet flush buttons and taps and improve the programme if necessary.
• Wash children and wipe noses with disposable wipes or cloths that are used only once.
• Make sure that any sores and weeping cuts, spots and scratches are covered at all times in all environments, and encourage children not to scratch or pick at them. If these wounds cannot be covered, the child or staff member should stay at home until they have healed.
• Make sure that staff wear gloves and use disinfectant to clean up spills, or blood or other body fluids.
• Check that cups and eating utensils are washed thoroughly in hot water.
• Keep the immunisation register up to date.
• Contact your public health service for more information and advice.

HS27 Medical assistance and incident management

Criteria

All practicable steps are taken to get immediate medical assistance for a child who is seriously injured or becomes seriously ill, and to notify a parent of what has happened.

Documentation required

1. A record of all injuries, illnesses and incidents that occur at the service. Records include:
   • the child's name
   • the date, time and description of the injury, illness or incident
   • actions taken and by whom; and
   • evidence that parents have been informed.
2. A procedure outlining the service's response to injury, illness and incidents, including the review and implementation of practices as required.

Rationale/intent

The criterion aims to uphold the health and safety of children by ensuring that children who fall ill or are injured are given appropriate care.

Amended May 2016.

Guidance

Injuries, illnesses and incidents can be a part of early childhood experiences. When a child becomes seriously ill or suffers a serious injury while in the care of the service, services must get medical assistance. This would usually be ringing for an ambulance or taking the child to see a doctor. It is always better to seek medical assistance if you are unsure of the extent of the injury or the seriousness of the illness than to risk the consequences of doing nothing.

Notifying parents

Services must notify parents as soon as possible of the event and be able to provide as much detail as possible about what happened, when and what actions the service took. It is vital to have up-to-date contact information for the parents on children’s enrolment records.

When notifying parents of an accident or incident in person, think about the sensitivity of the situation and the need for privacy away from the presence of children and other parents.

When informing parents by phone, ascertain where possible whether they have other adult support to deal with the event, for example support to look after other children, transport and so on.

Notifying other agencies

Some injuries, illnesses and accidents must be notified to specified agencies under separate legislation. Services should familiarise themselves with their wider obligations to notify these agencies.

The Ministry of Education must also be notified of such incidents.

HS34 Incident notification to the Ministry of Education

An injury and incident procedure flowchart is available for services to use.

Under the Health and Safety at Work Act 2015, ECE services must notify WorkSafe New Zealand if there is a notifiable event. Services should ensure that their health and safety practices are aligned to their obligations under other legislation.

Documentation guidance

It is important that ALL injuries, illnesses and incidents are recorded, even if only minor injuries are sustained. This is for 2 reasons:

1. A very minor injury can sometimes become more serious after a period of time, for example a minor graze becomes infected, and a child requires hospitalisation.
2. A pattern or trend in the occurrence of minor injuries may lead to awareness of the need to make changes at the service.

It does not matter who witnesses the incident. If the service is told of an incident by a visiting adult or parent, this must be documented in the same way as if an educator witnessed the incident.

The record of injury, incident or illness that services must keep will also be of assistance to paramedics or the child’s doctor if further assessment of the child’s health is required.

Report suspected outbreaks of communicable illnesses to your local Public Health service.

Public Health Contacts – Health New Zealand | Te Whatu Ora

You should keep the injury/illness/incident record for 2 years from the date of the incident.

For any injury/incident that is notifiable under the Health and Safety at Work Act 2015 (HSWA), it is a requirement to keep the records for 5 years from the date of the incident.

Things to consider

Some issues to consider are:

• If a child needs to go to hospital or the doctor, who will go with them and how will care be ensured for the other children at the centre? Ratios must still be met at the centre, and there must be a first aider remaining at the centre.
• At what point are the child’s parents/caregiver first notified about an accident or illness?
• Children’s allergies, particularly allergic reactions to medication and medical conditions that are caused by allergies.
• Maintaining a list of allergies for children attending the centre, and ready access to the list and relevant medications in the event of an allergic reaction.
• What do you do if the illness is contagious?
• There may be costs associated with calling an ambulance. Centres should plan in advance for this contingency.

HS28 Medicine administration

Criteria

Medicine (prescription and non-prescription) is not given to a child unless it is given:

• by a doctor or ambulance personnel in an emergency or
• by the parent of the child or
• with the written authority (appropriate to the category of medicine) of a parent.

Medicines are stored safely and appropriately, and are disposed of, or sent home with a parent (if supplied in relation to a specific child) after the specified time.

Documentation required

1. A record of the written authority from parents for the administration of medicine in accordance with the requirement for the category of medicine outlined in Appendix 3.

   Appendix 3: Categories of medicine for criterion HS28

2. A record of all medicine (prescription and non-prescription) given to children attending the service. Records include:
   • name of the child
   • name and amount of medicine given
   • date and time medicine was administered and by whom and
   • evidence of parental acknowledgement. Related to clause 46 (1)(b) of standard.

Rationale/intent

The criterion aims to uphold the health and safety of children by ensuring that children are given proper care, and that medication is not administered inappropriately by services.

Amended May 2015.

Guidance

Medicines must be stored out of the reach of children, but still be easily accessed by an adult if needed in an emergency. Some medicines may require refrigerated storage.

Services must take note of the expiration dates of any medicines and ensure that they are not administering medicines that have passed their use-by date. Service supplied medicines that have expired must be disposed of appropriately – check with a pharmacist about the best way to do this. Parent-supplied medicines should be sent home for disposal.

The different categories of medicines have different parent authorisation requirements, as set out in Appendix 3. For categories (i) and (iii), parent authorisation must be given at enrolment of the child at the service. Category (ii) medicines require daily parental authorisation. For category (i) medicines, services must be specific about what products they will use (including brand names).

Appendix 3: Categories of medicine for criterion HS28

Documentation guidance

Administration

Every service must keep a record of all medicine (prescription and non-prescription) given to children when attending the centre, regardless of whether it is administered by a staff member or by the child’s parent.

The record of medicine administered to children should be kept for 2 years.

Keeping a record of medicine administration demonstrates that the service has fulfilled its duty of care. That the child needing medicine has been given the right dose of the right medicine at the right time.

It is a useful record for both parents and medics in the event of a child experiencing an adverse reaction or sudden-onset illness.

The recording of category (i) medicines administered in relation to injuries as required by criterion HS25 will meet this requirement for those medicines.

Authorisation and acknowledgement

The written authority for categories (i) and (iii) medicines is on the enrolment form so must be kept for 7 years. For category (ii) medicines, the written authority should be kept for as long as the child is receiving that medicine.

Parental acknowledgement of the medicine having been given to their child must also be recorded. Category (i) and (ii) medicines require daily parental acknowledgement, whereas parental acknowledgement may be obtained and recorded weekly or every 3 months for category (iii) medicines whose dosage does not change.

Things to consider

Centres must ensure that during cooking activities children are closely supervised if they are to have access to the fridge and, if possible, any medicines are stored out of the reach of children.

HS29 Medicine training

Criteria

Adults who administer medicine to children (other than their own) are provided with information and/or training relevant to the task.

Documentation required

A record of training and/or information provided to adults who administer medicine to children (other than their own) while at the service.

Rationale/intent

The criterion aims to uphold the health and safety of children by ensuring that medication is given to children only by people with the necessary knowledge and skills.

Guidance

Adults at the centre need to feel confident and capable of providing the necessary support to children when medication is administered. Because educators/staff do not generally have medical training, some form of training or information is required so they can do this. First aid courses do not commonly cover the correct administration of medicine, so this will not usually be sufficient.

An example might be insulin injections for diabetics, EpiPens for anaphylactic shock, or the use of asthma inhalers with a spacer. Work together with the child’s family to find the best way of providing the training needed for staff in these situations.

Training could be provided via a conversation/demonstration/written information by any of:

• the parents
• the child’s GP or practice nurse
• a public health nurse
• a pharmacist
• a foundation or society for example Asthma and Respiratory Foundation NZ.

For common medicines administered by mouth (such as antibiotics), the level of information needed will be minimal.

Documentation guidance

Keep the record of training for the duration of the child’s enrolment or the staff member’s employment, whichever is longer. This record should be kept with the child’s enrolment records.

HS30 Children washed when soiled

Criteria

Children are washed when they are soiled or pose a health risk to themselves or others.

Rationale/intent

The criterion aims to uphold the health and wellbeing of children by requiring services to use the body wash facilities as appropriate.

Guidance

It might be necessary to wash a child:

• at nappy change time – sometimes wipes are not enough
• if a child has vomited over themselves or another person
• if a child has a toileting accident
• if children become wet or dirty during play.

Washing practices should be consistent with the requirements of PF26 Body wash facilities.

PF26 Body wash facilities

Consider the child’s need for privacy. Respectful interactions between the adult and child are important.

Staff protection and child protection policies need to be kept in mind.

Regional Public Health provides guidelines for washing soiled children including suggested spill kit contents.

Washing down – Regional Public Health | Health New Zealand