Want to know more?

• What is a child care health consultant?


• A Child Care Health Consultant (CCHC) is a trained health professional who helps caregivers in recognizing and promoting health and safety of children, families and caregivers in child care. A health consultant should have experience with children and understand child care settings.



• Early Childhood Mental Health Consultants (ECMHC's) work with issues relating to social/ emotional health, wellness and development. Programs with problems related to children's behavior, child abuse, family stress and caregiver stress will benefit from this type of consultation.

• What background and knowledge do child care health consultants have?
• A child care health consultant (CCHC) is a health professional trained on child care health and safety issues. CCHC's are often registered nurses, pediatric nurse practitioners, and pediatricians or family practice physicians with an emphasis on pediatric care or special needs. Nutritionists, physical therapists and other types of specialized health professionals can also serve as consultants on particular health and safety issues.



• The National Training Institute for Child Care Health Consultants provides ongoing training opportunities for individuals to learn how to train health professionals on becoming child care health consultants. For more information on their program click: http://nti.unc.edu/.

• What knowledge and/or contacts to experts does a child care health consultant need?
• National health and safety standards for out-of-home child care.
• How child care facilities conduct their day-to-day operations.
• State child care licensing requirements (varies by state).
• Disease reporting requirements for caregivers.
• Immunizations for children.
• Immunizations for caregivers.
• Injury prevention for children.
• Caregiver health, including occupational health risks for caregivers.
• Oral health for children.
• Nutrition for children.
• Including children with special health needs into a child care program.
• Recognition and reporting requirements for child abuse and neglect.
• Community health and mental health resources for child, parent, and caregiver health.
• How to work collaboratively with caregivers and families.
• Principles of child development.

• How can child care health consultants (CCHC's) help my caregiver and improve my child's health and safety while in child care?
Listed below are a few of the valuable services a CCHC can provide:


Evaluating caregivers' and parents' needs for health and safety training	Example: The CCHC visits a program at outdoor play time and notices that caregivers only put sunscreen on fair skinned children. She talks to the caregivers about this and discovers that a few parents of children with brown skin don't provide sunscreen because they don't feel that it's necessary.
Teaching a session at parents' night	Example: The CCHC shares current information about skin cancer and its prevention. She helps all adults understand that just because skin doesn't burn easily doesn't mean that it should be left unprotected.
Teaching caregivers about health and safety issues	Example: The CCHC does an on-site training for caregivers and demonstrates how to handle blood and other bodily fluids (Called Standard Precautions).
Meeting on-site with caregivers about health and safety	Example: A caregiver wonders if the facility's location (near a freeway) means that a child with asthma should not play outside. The CCHC connects the program and the parents with health department authorities, who come out to measure pollution. There are days when air is unsafe for the child with asthma, so all the children play indoors on those high pollution days. The caregiver learns where to call every day to hear about pollution alerts.
Observing caregiver's daily routine and providing helpful hints	Example: The CCHC makes recommendations on better handwashing because the children don't scrub long enough - they're taught to sing the whole ABC song once their hands are sudsy, and before they start rinsing.
Helping to manage the care of children with special health care needs	Example: A child that uses a wheelchair is now enrolled in the program, and the CCHC, in this case the child's physical therapist, visits during lunch time to offer ideas about how the caregiver can make adjustments so that the child can eat at the table with the other kids.
Providing telephone advice to caregivers about health and safety	Example: A family home caregiver wonders if a 2 year old with diarrhea should be sent home. Since the child doesn't have fever or other symptoms of illness, and Mom reported that the child ate lots of fruit over the weekend, the CCHC tells the caregiver that it's probably not contagious. However since the caregiver can't keep up with the frequent diaper and clothing changes and still provide good care to the other children, the CCHC advises the caregiver that if the child doesn't respond to a diet change, that he should be picked up after lunch.
Providing referrals to caregivers and parents about community services that are needed for a child	Example: A three year old's language development is a concern, and the family is connected with free screening services through the school district.
Developing or updating health care policies and procedures for a child care program	Example: The CCHC helps the caregiver develop a policy on bringing food from home after a child who has food allergies had a reaction from homemade birthday treats.
Reviewing health records of children and caregivers	Example: The CCHC checks all records to make sure both children and caregivers are up to date on all immunizations.
Working with the caregiver and parent if a child needs physical therapy services while the child is in child care	Example: The CCHC helps the parent obtain on-site therapy visits by calling the family's insurance company (with the parent's permission) several times. The parent had called, but got nowhere until a medical professional got involved.
Consulting with a child's health provider about medication	Example: A child has allergies and may have need for an Epi-Pen®. The CCHC, with parent permission, clarifies medication authorization and emergency plans with the child's health care provider. The CCHC reviews plan with caregivers and parents. Note: This authority to train on specific medical procedures will vary among states. Please See Medicine Section for more information.
Interpreting standards or regulations and providing technical advice	Example: The CCHC demonstrates how to install a car seat safely for the appropriate age of child.


Example of a case where consultants helped with a behavior issue:

Lauren (a 16 month old toddler) has been in a licensed family child care program since the age of 9 weeks. Lately Lauren's behavior seems unusually willful and aggressive. The caregiver calls her child care health consultant (CCHC), who inquires about diet, sleep, health problems and the child's routine and any disruptions in the normal routine in the child care program. There are no "red flags" that show a cause for these behaviors, other than the addition of new summer fruits to Lauren's diet. These fruits have been introduced one at a time, and with plenty of communication between the caregiver and the parents. There have been no obvious allergic reactions, but to be sure, CCHC recommends that Lauren be seen by her regular health care provider. Lauren's health care provider doesn't find any health problems, and suggests that her temperament and limited vocabulary may be causing the aggression. The caregiver and the CCHC agree that the motive for Lauren's behavior is probably that she's going through a phase of development where she's focusing on independence and will grow out of it. However, after a couple of weeks, Lauren's negative behavior increases; other children are getting hurt because Lauren is biting, hitting and throwing toys. The caregiver calls the CCHC again about the continuing behavior. The CCHC recommends that the caregiver meet with the parents and consider having an early childhood mental health consultant (ECMHC) be part of the meeting. The parents agree to cover the cost of the ECMHC fee. Prior to the meeting, the ECMHC gathers these facts in separate phone conversations with the mom and the caregiver: Lauren is indeed aggressive in some situations but has developing social skills. She shows a lot of initiative for a child her age and is learning to share and take turns. From both phone conversations, the ECHMC hears that the child care program offers high quality care, and that the caregiver is loving and attentive. She does a good job in meeting the needs of each child in her family child care home. The children seem safe, comfortable and appropriately busy with games and activities. Lauren's Mom is pregnant with twins and is anxious for her child to become toilet trained before the new babies arrive. In addition, since Mom is in her first trimester and fearful of miscarriage, she is no longer willing to play with her active child on her lap - breaking a long standing routine. Since Mom plans to quit her job once the twins are born and not use the child care program for Lauren, she hasn't told her caregiver about the pregnancy. She's afraid that the caregiver will ask Lauren to leave immediately because of the behavior problems and lack of long term income from their family. Even though Mom had requested it, the caregiver has not seen signs that Lauren is ready to toilet train, so the caregiver has not been willing to push her to start during the day. The caregiver is not willing to start the parents' ideas of using animal crackers and candy to reward toilet use. At the suggestion of the ECMHC, Mom told the caregiver about her pregnancy. The caregiver was a bit upset and angry that the mom had not shared the news earlier. Mom called the ECMHC back to let her know that the caregiver was not happy with her. Observations of the ECMHC: The parents and the caregiver would all benefit from better communication. Secrecy and anger are not good for a healthy parent / caregiver relationship. Disagreements between adults affect children. Lauren, at one and a half years of age, is is too young to understand the "you're a big girl now" message that she's hearing from her parents. The following plan develops during a meeting with both parents, the caregiver and the ECMHC: Everyone agrees to keep the lines of communication open now that they have the facts. Assuming that Lauren's aggressive behavior lessens, Lauren will remain in the child care program until 1 month after the twins come home from the hospital. After that, if the caregiver has an opening, Lauren will come on a drop–in (hourly fee) basis to give Lauren a chance to play with her friends and to give Mom a bit of a break. Dad will change his schedule so that he can pick Lauren up from child care most days. He will spend more time every evening playing with his "active little girl." Once she's worn out and sleepy, Mom will hold her and snuggle with her; but Dad will lift her into bed and tuck her in. This new routine will be well established before the twins arrive and should help Lauren adapt to her siblings. Mom realizes that pushing for early toilet training is not working and she accepts that she will have 3 children in diapers for a while. The caregiver agrees to try to encourage Lauren to have bowel movements on the toilet if she shows any signs of readiness. The caregiver will make sure that Lauren gets extra attention while she's in child care. Lauren will be invited to do jobs that will prepare her for being a Big Sister: Picking out books and songs for the group. Bringing a diaper bag for the infant's diaper change. Washing her hands with less assistance. Lauren's parents and caregiver will teach her appropriate words to use when she feels mad or frustrated. The results: The parents spent $100 for the ECMHC's services and felt that it was money well spent - it really reduced stress. The ideas worked! Lauren stayed in care, and Mom and the caregiver went on to become a support system for each other. Mom referred a friend who took Lauren's space, and Lauren often attended the caregiver's program when another child was absent. This gave Mom a break, and the caregiver some needed extra income.


• How to find a child care health consultant (CCHC):
To find a CCHC in your area, contact:


• Child Care Resource and Referral programs are another good source. To find your local program, call Child Care Aware at (800) 424-2246 or go click - http://www.childcareaware.org/en/ . Child Care Resource and Referral programs may also have ideas about where to find funding for child care consultation services.