Child health and wellbeing

HS21 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.

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 HS21:

• PF2 Premises support effective supervision
• PF10 Heating, lighting and ventilation
• PF11 Outdoor activity space
• C9 Range of experiences.

HS22 First aid qualifications

Criteria

There is an adult present, at all times while children are attending, who:

• 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 access to first aid training is limited due to circumstances beyond the service provider’s control, the service provider must ensure that educators have knowledge of first aid and gain a first aid qualification within 4 months of starting work at the service.

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

Documentation required

1. Copies of current first aid (or medical practising) certificates for adults counting towards this requirement.
2. Where access to first aid training for an educator is limited, a record of the actions taken by the service provider to ensure the educator has knowledge of first aid and achieves a first aid qualification within 4 months of starting work at the service.

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

First aid qualifications

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

First aid qualifications

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

If access to first aid training is limited due to circumstances beyond the service provider’s control, the service provider must ensure that educators have knowledge of first aid and gain a first aid qualification within 4 months of starting work at the service.

To help services correctly apply this condition clause, operational guidelines are available.

Operational guidelines

Documentation guidance

Where access to first aid training is limited, the service provider must record their decision to apply the condition, including:

• their assessment of the educator’s interim first aid knowledge and
• the date of booked first aid training.

There is a template that services can use to record the required information.

The service provider must keep a copy of the educator’s first aid certificate and ensure the certificate is kept up to date.

HS23 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 on to children and likely to have a detrimental effect on them.

Specifically, any child who becomes unwell while attending the service or receiving out-of-school care is 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.

⚐ Out-of-school care must not be provided to children who are absent from school due to illness.

Rationale/intent

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

Amended November 2016.

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. 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. They can react in a variety of ways – they can become confused, distressed, miserable, very quiet, or ‘clingy’.

It is also quite difficult to tell what has caused the illness and whether or not it is infectious. Familiarity with the information in centre-based Appendix 2 of the criteria on infectious illnesses, incubation periods, symptoms, recommended exclusion times from attending the service and so on will be helpful.

Appendix 2: Infectious diseases for criterion HS26

Home-based 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 home that is not their own, the sooner they can be taken home, the better. In order for them to be kept at a safe distance from other children at the home the educator will need a separate area for them that can be easily supervised whilst looking after other children attending. For more information see the guidance for PF14 Isolation area.

PF14 Isolation area

When a child becomes ill in their own home, they will need to be isolated from other children in the home. The educator will need to consider either the other children being picked up or relocated to another educator’s home.

If there are out-of-school care children in the home, a similar process is required so they can be isolated from other children and collected as soon as possible.

It is a good idea for the educator and family(s) to agree when the child is enrolled what will happen when a child is ill or appears to be becoming ill. To enable timely contact, it is vital to have up-to-date contact information for the parents on children’s enrolment records.

Equally it is important to have a shared understanding of what will happen if the educator is sick or becomes ill whilst looking after children in the home.

A policy and procedure that covers exclusion for general or infectious illness for the home-based service will assist educators 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.

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

• Call their parents or emergency contact to either come home or collect them as soon as possible.
• If the educator is at the child’s home, the child may just want to be tucked into their usual bed.
• If a child cannot go home immediately, keep them away from others, perhaps by making a bed up on a couch for them and get the other children involved in an activity as far away as practical while still being able to monitor the child
• 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.

Preventing spread of illness to others

• If other children develop the illness, take a careful look at the hygiene and cleaning routines used at the home:
  • make sure everyone is washing their hands thoroughly before eating and after using the toilet and the educator after changing nappies.
• Wash children and wipe noses with disposable wipes or cloths that are used only once.
• Check that cups and eating utensils are washed thoroughly in hot water.

What happens if the educator becomes ill

If an educator is looking after children in their own home and is ill or becomes ill while children are in their care, they should notify their coordinator. In consultation with parents, the children should be moved to another educator’s home or sent home.

If an educator is working in the family’s home and becomes ill while children are in their care, they should notify their coordinator and the child’s parents.

HS24 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

Educators 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 they took. Educators must also notify their coordinator or the service provider.

It is vital to have up-to-date contact information for the parents on children’s enrolment records.

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. See HS33 Incident notification to the Ministry of Education.

HS33 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, service providers 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 home?
• 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 at the home, 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. Services should plan in advance for this contingency.

HS25 Medicine administration

Criteria

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

• by 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 2.

   Appendix 2: Categories of medicine for criterion HS25

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.

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 the educator if needed in an emergency. Some medicines may require refrigerated storage. Services must ensure that children do not have unsupervised access to the kitchen or the fridge.

It is recommended that family medications and creams are kept separately from first aid supplies used by the educator in their role.

Educators must take note of the expiration dates of medicines and ensure that they are not administering medicines that have passed their use-by date. Educator 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 given to the parents for disposal.

The different categories of medicines have different parent authorisation requirements, as set out in Appendix 2. 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 2: Categories of medicine HS25

The different categories of medicines also have different parent acknowledgement requirements. When category (i) and (ii) medicines are administered, the child’s parent should acknowledge this on the medicines record sheet at the end of each day that the medicine is given. When the same dose of category (iii) medicine is administered on a regular basis, parental acknowledgement may be obtained weekly or every 3 months.

Documentation guidance

Administration

Every educator must keep a record of all medicine (prescription and non-prescription) given to children when attending, regardless of whether it is administered by an educator 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 HS22 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.

HS26 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

Educators need to feel confident and capable of providing the necessary support to children when they administer medication.

Because educators 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 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 that are 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 educator’s employment, whichever is longer. This record should be kept with the child’s enrolment records.

HS27 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 ensuring children who vomit or soil themselves are washed appropriately so that the risk of cross infection for both adults and children in at the service is reduced.

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 over another
• if a child has had a toileting accident
• if children become dirty during play.

Washing practices should be consistent with the requirements of PF18 Body wash facilities.

PF18 Body wash facilities

Consider the child’s need for privacy. Respectful interactions between the educator 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