The CCHP-CCHC eNews is a bi-monthly newsletter that provides timely information about resources, reports, and research that inform the work of Child Care Health Consultants (CCHCs) working to improve the health and safety of children in early childhood education settings in California. Past issues are available at http://www.ucsfchildcarehealth.org/html/healthline/enews.htm

Greetings

The CCHP-CCHC eNews will have a new schedule starting in January, 2010. You will receive the eNews every other month beginning in January. To keep you informed on the latest health and safety materials, we will also send an announcement of updated or new CCHP publications during the months that you do not receive the eNews. As always, we look forward to your comments, questions and suggestions. If your contact information changes, please make sure that you update your information in the CCHP-CCHC database here: http://ucsfchildcarehealth.org/listserve/subscribe.html

Announcements

New CCHP Publications
The November/December issue of Child Care Health Connections has been posted to the California Childcare Health Program Website: www.ucsfchildcarehealth.org. You will find several articles about coping with the current H1N1 pandemic: H1N1 Influenza Guidance for Child Care Programs, Immunizations for the Flu Season, What to Eat and Drink When You Stay Home Because of the Flu, Preventing the Flu Mini-Poster and What is H1N1 and How to Prevent It for parents. The articles titled: Helping Toddlers Develop Self Control and Sibling Jealousy are also in this issue.

To help you find articles by topic, please see the new Index of 2009 Newsletter Articles (PDF; 27.6KB; 1p) We are also happy to announce the posting of new translations in Farsi and Chinese:
Farsi documents: www.ucsfchildcarehealth.org/html/healthline/Farsi.html
Chinese documents: www.ucsfchildcarehealth.org/html/healthline/Chinese.html

Cribs Recalled, Risk of Suffocation and Falls Cited
The U.S. Consumer Product Safety Commission (CPSC), in cooperation with Stork Craft Manufacturing Inc., of British Columbia, Canada, recently announced the voluntary recall of more than 2.1 million Stork Craft drop-side cribs, including about 147,000 Stork Craft drop-side cribs with the Fisher-Price logo. The recall involves approximately 1,213,000 units distributed in the United States and 968,000 units distributed in Canada.

CPSC urges parents and caregivers to immediately stop using the recalled cribs, wait for the free repair kit, and do not attempt to fix the cribs without the kit. They should find an alternative, safe sleeping environment for their baby. Consumers should contact Stork Craft to receive a free repair kit that converts the drop-side on these cribs to a fixed side.

The cribs' drop-side plastic hardware can break, deform, or parts can become missing. In addition, the drop-side can be installed upside-down, which can result in broken or disengaged plastic parts. All of these problems can cause the drop-side to detach in one or more corners. When the drop-side detaches, it creates space between the drop-side and the crib mattress. The bodies of infants and toddlers can become entrapped in the space which can lead to suffocation. Complete detachment of drop-sides can lead to falls from the crib. To see this recall on CPSC's web site, including pictures of the recalled product, please go to: www.cpsc.gov/cpscpub/prerel/prhtml10/10046.html.

Pregnant Women and H1N1
The CDC has issued recommendations for workplace infection control and prevention strategies related to pregnant women who work in child care. The key message for employers and employees in work settings where pregnant employees are likely to be exposed to 2009 H1N1 is to take every precaution to prevent infection. For more information, www.cdc.gov/h1n1flu/guidance/pregnant-hcw-educators.htm. The CDC is urging all pregnant women to get vaccinated against H1N1 because they are at high risk for complications from the illness. Some women are reluctant to get the vaccine because they fear the mercury-containing preservative, Thimerosol. The pre-filled, single dose form of the vaccine does not contain Thimerosol. www.fda.gov/BiologicsBloodVaccines/Vaccines/QuestionsaboutVaccines/ucm186102.htm

Resources

Online Training on School-Based Dental Sealant Programs
The National Maternal and Child Oral Health Resource Center (OHRC) has made the Ohio educational unit, School-Based Dental Sealant Programs in Ohio, available to anyone in the country. Although targeted to programs in Ohio, much of the information is applicable nationwide. The modules provide detailed guidelines for infection control in school-based programs; discuss tooth selection and assessment for dental sealants; review the dental sealant application process; and provide information about program operations, with an emphasis on the specific requirements that apply to programs funded by ODH.

• Module 1: Background
• Module 2: Infection Control
• Module 3: Tooth Surface Assessment and Selection
• Module 4: Materials and Application Techniques
• Module 5: Operating Effective Programs

www.ohiodentalclinics.com/curricula/sealant/index.html

From Health Legacy, Guide to Safer Children’s Products
Thousands of children’s toys have been recalled recently because of lead paint. But lead is not the only worry. Many other chemicals used in children’s products also pose health risks. Two of these are bisphenol A and phthalates. Both chemicals disrupt hormones in the human body. This guide helps guide the purchase of safer products for children. www.healthobservatory.org/library.cfm?refID=103921

Endocrine-Disrupting Chemicals
New publication from the Learning and Developmental Disabilities Initiative explains in a clear way what the endocrine system is and how chemicals can affect its function. The document is available here: www.healthandenvironment.org/?module=uploads&func=download&fileId=773

PCBs Found in Caulk Used in School Settings, EPA Recommends Testing
Between 1950 and 1978, caulk containing potentially harmful PCBs (polychlorinated biphenyls) was used in many buildings, including schools. Although PCBs were banned in the United States in 1978, contaminated caulk still exists in older buildings that have not had the caulk replaced. As caulking ages it can break down into dust containing small amounts of PCBs, which can fall to the ground and on windowsills, and get into a building’s ventilation system. PCB bioaccumulation in children can damage immune, reproductive, nervous, and endocrine systems. The Environmental Protection Agency is recommending that schools test brittle, aging caulk and remove it if it contains PCBs. The EPA has developed a Schools Information Kit on PCBs, available here www.epa.gov/pcbsincaulk/caulkschoolkit.htm.

Tips for Holiday Safety From the Home Safety Council
Holiday lights and electrical decorations can create fire hazards and electrical shock risks if they are not handled properly. The Home Safety Council recommends precautions to take while decorating for the holidays.
www.homesafetycouncil.org/safety_guide/sg_holiday_w001.aspx

New Website Provides Information on Safety Alerts and Product Recalls
A new program will deliver critical, time-sensitive information on recalled and defective products to parents and educators across the country. Many of the products recently recalled were items commonly used in ECE settings, including cribs, strollers and pacifiers. Created through a partnership between Consumer Reports, the National Parent Teacher Association (PTA) and the National School Boards Association (NSBA), the School Safety Alert program features a Web site that includes news and videos on the latest safety alerts and product recalls impacting children, including products used in ECE settings. For instance, there is a video on crib safety and another on use of safety gates. The Web site will alert parents, and providers to dangers so that they can remove potentially dangerous products from their homes and programs. Consumer Reports will feature the information as a micro site on its main Web site and the PTA and NSBA will distribute and help promote the online resource to their millions of members. To access the Web site, go to www.consumerreports.org/schoolsafety.

Reports

New CLASP Report on Promoting Stable, Quality Infant/Toddler Care
CLASP announces the release of A Tool to Examine State Child Care Subsidy Policies and Promote Stable, Quality Care for Low-Income Babies and Toddlers. This tool provides a policy framework that lays out child care subsidy policies-ranging from simple to substantial changes-that can be implemented to better support babies and toddlers and their families. Users can download and save a copy of this tool, then fill in the appropriate columns with their state's current policies and opportunities for change. In addition, links are included to online resources and examples of state policy initiatives. Assistance in using this tool is available from CLASP. This tool is the first in a series that will be published to help states chart their own progress toward improving child care for babies and toddlers, as part of CLASP's Charting Progress for Babies in Child Care project. The tool is available at: www.clasp.org/projects.

Evidence-Based Practice for Autism Treatment
The National Autism Center has recently published a report that analyzes treatment options for children with Autism Spectrum Disorder. This report covers a broad range of applied treatments and identifies the level of scientific evidence available for each. It includes 775 research studies — the largest number of studies ever reviewed. [Free registration required.] www.nationalautismcenter.org/affiliates/reports.php

Research

More U.S. Children Diagnosed With Autism
A study in Pediatrics in November reports that one in every 91 children ages 3 to 17 has an autism spectrum disorder. Prompted by the Pediatrics study, the Centers for Disease Control and Prevention is announcing not-yet published results of a second study. It finds 1 in 100 8-year-olds has an autism spectrum disorder. Officials cite increased awareness, a broader definition of autism and more diagnoses in younger children as possible explanations for why the new statistics are 50% higher than the previous U.S. estimate of 1 in 150 children.

Kogan, M. D., S. J. Blumberg, et al. (2009). "Prevalence of Parent-Reported Diagnosis of Autism Spectrum Disorder Among Children in the US, 2007." Pediatrics 124(5): 1395-1403.

Low Lead Levels Harming Children
Researchers say the toxic effects of lead on the central nervous system of young children are obvious even below the current so-called safe level of lead in the blood (10 mcg/dl). They found that blood lead levels at 30 months showed significant associations with educational achievement, antisocial behavior and hyperactivity scores five years later. Lead levels between five and 10 mcg/dl were associated with significantly poorer scores for reading (49% lower) and writing (51% lower). At levels greater than 10 mcg/dl children were almost three times as likely to display antisocial behavior patterns and be hyperactive than the children with the lower levels of lead in their blood. The study authors argue that these data suggest that the threshold for clinical concern for lead should be reduced to 5 mcg/dl.

Chandramouli, K., C. D. Steer, et al. (2009). "Effects of early childhood lead exposure on academic performance and behaviour of school age children." Arch Dis Child 94(11): 844-848.

New Research on SIDS
A study from Germany finds that breastfeeding has a protective effect against SIDS at all ages in the first year of life. The SIDS rate in breastfed babies is half the SIDS rate in babies who were never breastfed and/or who were not exclusively breastfed.

Vennemann, M.M., T. Bajanowski, B. Brinkmann, G. Jorch, K. Yucesan, C. Sauerland, E.A. Mitchell, and the GeSIDS Study Group. Does breastfeeding reduce the risk of sudden infant death syndrome? Pediatrics, 123: e406-e410, 2009.

Recent research shows that very few primary care physicians are providing SIDS risk reduction counseling to new mothers. This research underscores the importance of educating parents about safe sleep practices in child care settings.

Eron, N.B., K.M. Dygert, C. Squillace, N.J. Webster, A. Andiranos, E.G. Crockett, and L. Consenstein. The physician’s role in reducing SIDS. Health Promotion Practice, online first, published July 20, 2009.

Community-Associated MRSA on Plastic Objects Can Survive and Infect Skin for Over Two Months
Research presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy in September, 2009, finds that the most common strain of MRSA can survive on hard plastic surfaces and be transferred to skin for up to two months. In the study, MRSA could transmit for longer time periods from non-porous surfaces such as plastic building blocks and vinyl, than from porous surfaces, such as bed sheets. The researchers advise that if MRSA is present in an environment, attention should be paid to disinfecting hard surfaces such as hard plastic toys.

Desai, R. (2009). Survival and Transmission of Community-Associated Methicillin-Resistant Staphylococcus aureus from Fomites paper presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy. From www.icaac.org/index.php?option=com_content&view=article&id=123:studying-the-spread-of-ca-mrsa-from-objects-to-skin&catid=9:newsroom.

Alcohol-Based Hand Sanitizer for Children Under Six: Benefits Outweigh Risks
Ethanol-based hand sanitizers have the potential to cause toxicity. This study examined all exposures to hand sanitizers in children younger than 6 years reported to a regional poison information center between 2000 and 2007. Only 4% of cases of exposure to hand sanitizers (including ingestion, dermal, ocular and inhalation exposures) developed any symptoms and all were reported to be minor. The authors report that normal use of hand sanitizers in an adult-supervised setting would not be expected to result in toxicity, although if the child gains access to a large quantity, ethanol poisoning can occur. The benefits of illness prevention far outweigh the potential for ethanol poisoning.

Mrvos, R., & Krenzelok, E. (2009). Pediatric Ingestions of Hand Sanitizers: Debunking the Myth. Pediatric Emergency Care, 25(10), 665-666.

Children at Risk in the Child Welfare System: Collaborations to Promote School Readiness
A new research report finds that very young children in the child welfare system can be helped to overcome early trauma and acquire skills necessary for success in school, if they get early assessment and appropriate interventions. Findings include:

• A significant number, perhaps half, of these young children experienced developmental delays.
• In a significant number of children, these developmental problems were unrecognized by caseworkers and caregivers.
• Despite the availability of early care and education (ECE) center-based programs such as Head Start, children who qualified often were not enrolled.

Read the: Children's Express summary or the Full report from the Catherine E. Cutler Institute for Child and Family Policy at the University of Southern Maine.

The Future of Children’s Latest Publication, Preventing Child Maltreatment
Contributors to this volume present the best available research on policies and programs designed to prevent child abuse and neglect. They examine a gradual shift in the field of child maltreatment toward prevention and explore how insights into the risk factors for maltreatment can help target prevention efforts. They assess whether programs such as community-wide interventions, parenting programs, home-visiting, drug and alcohol treatment, and school-based educational programs on sexual abuse, can prevent maltreatment. They also explore how the Child Protective System might take a more active role in prevention. Accompanying the journal is an Executive Summary and two related Policy Briefs. http://futureofchildren.org/futureofchildren/publications/journals/journal_details/index.xml?journalid=71

Early Rapid Weight Gain Raises Child's Metabolic Risk Ractors
Young children who gain more weight relative to height between 6 and 24 months have higher metabolic risk factors by age 4 than their normal weight peers.

Corvalan, C., Uauy, R., Stein, A. D., Kain, J., & Martorell, R. (2009). Effect of growth on cardiometabolic status at 4 y of age. Am J Clin Nutr, 90(3), 5.

Effects of Child Abuse on Adult Health
Child abuse is associated with an increased risk of poor physical health in adulthood. The magnitude of the risk is comparable to the association between child abuse and poor psychological outcomes. However, studies often fail to include a diverse group of participants, resulting in a limited ability to draw conclusions about the population of child abuse survivors as a whole. Important methodological improvements are also needed to better understand potential moderators.

Wegman, H. L., & Stetler, C. (2009). A meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood. Psychosom Med, 71(8), 805-812. DOI: 10.1097/PSY.0b013e3181bb2b46.

Providing Instructions to Parents and Teaching Children in the Classroom Increases Booster Seat Use
Sixty elementary schools in Minneapolis were asked to participate in a study to evaluate the most effective education method to increase booster seat knowledge and use in kindergarten-age children. School personnel selected one of the following interventions: (1) written information, (2) parent education class and a free booster seat, or (3) student education and a free booster seat. Twenty schools participated, with 132 parents completing the telephone interview 3 to 6 months post-survey. Providing instructions to parent groups and teaching children in the classroom, along with providing an incentive booster seat, was shown to increase booster seat use. Providing information only was found to be ineffective. Pediatric and school nurses should focus their injury prevention efforts beyond written materials. Results indicate that presentations for children and their parents, along with incentives, can result in changes in behavior.

Philbrook, J. K., Kiragu, A. W., Geppert, J. S., Graham, P. R., Richardson, L. M., & Kriel, R. L. (2009). Pediatric injury prevention: methods of booster seat education. Pediatr Nurs, 35 (4), 215-220.

Role of Sleep in Mediating Violence-Induced Stress in Children
Millions of children are exposed to various forms of violence every year, resulting-for many of them-in psychological problems, decreased social functioning, and poorer overall quality of their relationships and lives. This article reviews the scientific literature investigating the role of sleep as a key mediator in the pathway between violence-induced traumatic stress and resulting negative health and behavioral outcomes. Based on evidence revealed by this review and general research on how exposure to violence influences child health and development, a conceptual model is proposed that posits sleep's role as an important mediator of health effects and that incorporates other factors believed to shape linkages between exposure to violence and health and behavioral outcomes in children. Recommendations are given for future research to test the proposed model.

Spilsbury, J. C. (2009). Sleep as a mediator in the pathway from violence-induced traumatic stress to poorer health and functioning: a review of the literature and proposed conceptual model. Behav Sleep Med, 7(4), 223-244.

TV Watching Linked to Aggression in Young Children
A study of children from birth to age 3 found aggression increased for each hour they directly watched TV. Researchers said the data showed both direct watching and having a TV on in the house were linked to increased levels of aggression in young children.

Manganello, J. A., & Taylor, C. A. (2009). Television exposure as a risk factor for aggressive behavior among 3-year-old children. Arch Pediatr Adolesc Med, 163(11), 1037-1045.

Increased Risk of Asthma and Wheezing in Children Exposed to Acetaminophen
Epidemiologic studies have identified an increased risk of asthma with acetaminophen use, but the results have been conflicting. This review of the literature sought to quantify the association between acetaminophen use and the risk of asthma in children and adults. The results of this review are consistent with an increase in the risk of asthma and wheezing in both children and adults exposed to acetaminophen. Future studies are needed to confirm these results.

Etminan, M., Sadatsafavi, M., Jafari, S., Doyle-Waters, M., Aminzadeh, K., & Fitzgerald, J. M. (2009). Acetaminophen use and the risk of asthma in children and adults: a systematic review and metaanalysis. Chest, 136(5), 1316-1323.

The CCHP-CCHC eNews is produced by the California Childcare Health Program (CCHP) administered by the University of California, San Francisco, School of Nursing. This publication is made possible by a grant from the Maternal Child Health Bureau.

California Childcare Health Program, 1950 Addison St., Suite 107, Berkeley, CA 94704 800-333-3212 Healthline, www.ucsfchildcarehealth.org