HEALTH AND SAFETY TRAINING,
FAMILY CHILD CARE HOMES AND
LARGE CHILD CARE HOMES
Speaker 1:	(singing)

David:	Hello and welcome to our overview for childcare providers, in family childcare homes and large family homes. On this program we're going to talk about your career as a childcare professional. Plus we'll meet some experts, who will show us proper ways to provide high quality care to the families and children, who depend on you each day. I want to remind you that to be a licensed family, childcare home, or large childcare home, you need to follow the requirements that are explained in this book. 

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Licensing Requirements
for Family Child Care Homes and
Large Child Care Homes
Oklahoma Department of Human Services
Oklahoma Child Care Services

This program's designed to take you through some of the topics, that you're responsible for knowing. Again, use the requirement book to give you details on each of the topics, we cover. 	
Here's how this training's going to work. I'm going to show you a series of video tapes, that we previously developed. Each tape will introduce you to someone who's an expert, in a particular field. By the time you finish viewing this tape, you'll be better prepared to provide high quality care, to children. We'll be discussing, safeguarding your home to prevent injury, health-related issues including the importance of immunizations, transporting children safely, how to spot signs of child abuse, Sudden Infant Death Syndrome, Shaken Baby Syndrome, fire safety and behavior and guidance. 	
Our first topic, is making a home safe for children. Shelli Stephens-Stidham met us sometime back and showed us the best way to look for everyday hazards, that can be a danger to children. When we made this tape, we were preparing a program geared specifically to caregivers who work with infants and toddlers. Throughout this video Shelli refers to infants and toddlers but please know, that everything that applies to the infants and toddlers, also goes for all young children. Remember to refer to your requirement book, for details. David:	With us, is Shelli Stephens-Stidham. You're with the Oklahoma State Department of Health. 
Shelli S.:	That's right. 
David:	We appreciate you joining us. 
Shelli S.:	Well thank you, I'm glad to be here today. 
David:	Tell our viewers a little bit about what you do, at the department of health. 

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Shelli Stephens-Stidham
Injury Control Division
Oklahoma State Department of Health

Shelli S.:	I'm the director of the Injury Control Division. What we do is, collect information on certain types of injuries. Then we develop programs to help prevent those injuries from ever occurring. 
David:	Good. Well can you tell us a little bit about what we can do to make a childcare home, or center, less dangerous? 
Shelli S.:	David, the fact is that any place that's not child proof can be potentially deadly to an infant, or a toddler. There are a lot of things in a household that we look at everyday and we don't give a second thought to but they can easily injure, or even kill a child. For example, children can be poisoned by household chemicals, like cleaners or soaps. They can be poisoned by medicines. They can strangle on the cords that hang down from the curtains, or the mini blinds, or the electrical cords that go to the TVs and the stereos. They can suffocate from a plastic bag. A plastic trash bag, or something like that. Then they can choke, on the small objects that might be left laying around, or even food. 
David:	A lot of things to think about. 
Shelli S.:	A lot of things. Shelli S.:	Making the environment safe is probably one of the most, critical steps in infant and toddler issues and the best way to do that, is to explore it from their perspective. Today, I'm going to get down on my hands and knees and I'm going to crawl around on the floor of this childcare home. We're going to look at everything from a baby's point of view, or a toddler's point of view. 
David:	Is this something a provider needs to do, everyday? 
Shelli S.:	No you don't have to do it everyday because I'm not sure your knees would take it but it's important to do it, at least once. It's important to remember that as children become more mobile, infants become more mobile, they start exploring their environment. One of the ways that they do that is they start putting things in their mouth. It's important not to have anything within their reach, that they can put in their mouth. What will happen is they can put it in their mouth, they'll swallow it and it becomes lodged in their throat and it obstructs the air way. 	Some of the small objects that we need to be concerned about are balloons, buttons, small balls, rubber bands. When you have children of mixed ages in your care, you need to make sure that some of their toys that might have small parts, aren't within reach of infants and toddlers. You need to be sure and check around the trash can to make sure that nothing choke-able missed the can, like this pull tab from an aluminum can for example, or a pull tab from a disposable bottle, or diaper. Choking dangers are greatest for kids under the age of two. 
David:	I'm holding a no-choke testing tube from Lakeshore Learning. Shelli can you tell me a little bit about how we use this? 
Shelli S.:	Sure. If there's an object that is small enough that will fit into this cleanly, like this balloon does. Then that means it's small enough for a child, they could swallow it and choke on it. You don't want to have something like this, within their reach. Such as this, rubber band, this cap from a magic marker fits in there. This Lego toy, all of these objects you need to keep out of reach of children. Now this scrub brush doesn't fit in there, so that would be safe for them. 
David:	We've often heard it said, that a child shouldn't put something smaller than their fist in their own mouth but-
Shelli S.:	You shouldn't have anything smaller than a child's fist, around. That's true. Now come on Dave, we've got other places to go. Electrical cords are an extreme danger. Not only do they pose the risk of electrical shock but cords that are hanging and dangling down, from items like, this clock, or this lamp. The child could pull on it and pull the object down on top of them. I see some other household items here that could be potentially hazardous for children, infants and toddlers. Things like this need to be put up and out of reach. Of course, your licensing representative will remind you about any uncovered outlets. 	
Household items that could pose a strangulation risk also need your attention. Like these cords from the mini blinds, they need to be fastened up and out of reach, for children. Another thing you should never do, is tie pacifiers to children's clothing, or put it around their neck to be worn like a necklace because they can strangle like that. 
David:	Right. 
Shelli S.:	We also need to be on the lookout for plastic bags, like trash bags, or dry cleaning bags, or the bags that you use in food preparation. If a child gets it up against their nose, or their mouth, they can suffocate. You know David, one of the most encouraging trends that we've seen in childhood mortality, is the reduction in deaths due to poisoning. Even though, poisoning isn't a major cause of death, it's still an important cause of hospitalizations and medical visits. Young children are especially dependent on older people for what goes into their mouth, so most of the poisonings we see in this age group, are caused by overuse or misuse of medication. If you got a child in your care that's taking medication, you need to read the directions very carefully and make sure that you only give them the appropriate dose. 	
It's also important to communicate with any parents as to any reactions that might occur from the children taking the medication. Now toddlers are most at risk of unintentional poisonings. At this age, their curiosity far exceeds their ability to assess any risk. Again, they don't benefit from any poison preventioning labeling, or education. They're entirely dependent on older people to safe guard their environment, put the poisons up and out of their reach. 
David:	One thing a lot of us have probably been guilty of and that's leaving something out and thinking, "Oh I'll put this up in just a minute." That's not a good idea, is it? 
Shelli S.:	You need to put it up immediately, otherwise it could end up in the child's mouth by mistake, later on. Another thing that they need to remember is you need to keep the Poison Control Center's telephone number, by the telephone. 
David:	Shelli you went out to the Poison Control Center recently and we shot some tape, while you were out there. Let's go ahead and roll that tape right now, for our viewers. 
Shelli S.:	This is the Oklahoma Poison Control Center and with me is Lauri Gormley who works here as a Pharmacist, who specializes in poison information. Lauri can you tell us a little bit about the center and what are some of the services, you guys provide? 
Lauri Gormley:	Sure. Well if anyone ever thinks that anybody has been exposed to a poison, or has gotten into some pills, or absolutely has any questions about snake bites, plants, anything. They can give us a call, it's a state-wide service, were open 24 hours, seven days a week. If you ever even think something's happened, where a person has been exposed to something, definitely call us. Shelli S.:	What age group do you get most of your calls about? 
Lauri Gormley:	Usually about fifty percent of our human exposures, are for children under the age of six. It's because they're exploring, they're crawling around, they're looking for things. We sometimes tell parents, or daycare providers, "Don't get mad at kids who get into things," because that's their way of learning about the world. Just to keep things up and out of their reach, if you don't want them into it. Shelli S.:	What type of calls do you get most? 
Lauri Gormley:	Probably our most common call, are cleaning products. That's because they're so easily accessible. Bleach for instance, people call us and they're frantic, crying, they're so upset if a kid's drank a little bit of bleach. Luckily as with most of the calls that we get, we're able to monitor that at home, tell people what to do and go from there. Their kids are usually just fine. There are some things where you don't see anymore warning symptoms, where the kids aren't crying, or anything. You still need to call us because something could be going on inside. 
Shelli S.:	Again if somebody is watching a child and they suspect that they may have ingested something that they shouldn't, what should they do? 
Lauri Gormley:	Give us a call at the Oklahoma Poison Center. 

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Oklahoma Poison Control Center
Oklahoma City: 271-5454
Statewide: 1-800-222-1222

Shelli S.:	Lauri, about how many calls do you all get here?
Lauri Gormley:	I think a lot of people are surprised to find out that we get over a hundred and fifty calls, a lot of days but around a hundred and fifty, per day. For children less than six years of age, last year we got over eighteen thousand calls. Another thing that a lot of people are surprised to find out is, that the way the poison center works to help you. One, that we're here for you but I think people are surprised that over seventy-five percent of our calls, we keep at home. Our goal to help you out and we're conservative in that. We're not going to keep you at home if it's a risk for the child. Most of the time, we can handle a call at home properly by the people letting us know, what they got into, how much, when it happened. 	
We can tell you what to do, what to watch for and keep kids at home. That's how we save you money, that's how we save the state money. It's also been found in surveys, that in areas that wouldn't have a poison center, about seventy-five percent of people are going to get help usually in an emergency room. Which makes sense because if you think about it, if you're sitting there and you're scared to death, that your kid ... People will think that their kid is going to die and they're going to be all right but they're scared. They're going to get help from the emergency room, so it's good that poison centers are here to keep them at home and help them. 
Shelli S.:	That's a valuable service, in itself. 
Lauri Gormley:	Mm-hmm (affirmative). 
Shelli S.:	Who answers the phone here?
Lauri Gormley:	Everybody that works here at our center, is a pharmacist, or we have one lady that's in nursing school. Poison centers are staffed by nurses, pharmacists or doctors, in Oklahoma. That's a national thing. Sometimes they have people that'll be with a certified specialist. I think that it's misunderstood, that sometimes people think it's volunteers but we all have a medical background. 
Shelli S.:	I see a lot of materials here, so evidently you guys do more than just answer the telephone. What are some of these things? 
Lauri Gormley:	Yeah that's one of my favorite parts, about my job. Is that I go out and I talk to kids and adults, about poison prevention. These are a few things that we have available. This is a brochure, or some lesson plans that are for pre-K through third grade and are available by just calling the poison center. We also have a home checklist which is good for anybody because I mentioned, that you need to keep kids away from the poisons. This will help you do that. It goes through each room and helps you poison proof it, real quickly. We also have brochures, First Aid for Poisoning. We have one on plants and then one called, "Perilous Partners," which is about snakes and spiders and chiggers and ticks. Which are all poisons and can cause problems or lead to diseases. 	These are helpful for a lot of people. You can get those by calling the poison center. We take out with us a board. This goes through the different ways that people are exposed to poisons. The most common ways are on the skin, which would include a spider bite, or a snake bite. People swallowing a poison, then they also can sometimes get it in their eyes and by breathing something in, or inhaling it. All of these things are some general first aid, which is mentioned in the First Aid for Poisoning, on how to handle those exposures. The pictures on this board are some common things that people can be exposed to as well. 
Shelli S.:	Lauri I see a lot of household products over here and a lot of them look alike.
Lauri Gormley:	Yeah, these our are lookalikes. A few of them at least. It's easy to see for adults, especially ... This is something that looks alike. They'll clean their kitchen sink with Comet and then they'll have some pizza, or some spaghetti and they'll sprinkle it with this. Luckily, they usually don't get sick, it just tastes real bad. There's some other lookalikes here and it's easy to see how kids could mistake Gatorade for Mr. Clean. As well as a real common one, the most mistake is bleach, for water. That shows how easily things can happen, especially with kids who can't read and who don't know. Shelli S.:	I see something else here that I've had in my cabinets before and that's the syrup of ipecac.
Lauri Gormley:	Mm-hmm (affirmative). This should be in everyone's household. It's recommended to actually have one bottle, for every child under the age of five. If you use this, sometimes you'll need to use it on a couple of kids because you don't know who got what. What it does, is it causes people to throw up. What I like to tell people about this and make sure they understand is, "Don't automatically give this." If somebody gets into something you always need to call us before giving this, or call the doctor because there are times you don't want to give it. Such as if you swallow something that burns like bleach, it'll burn coming up. For oily substances, they have a tendency to slip to the lungs and it's called aspiration but you increase that, by making them throw up. If it's in their stomach, they're going to be okay. That's another instance where you don't want to give it. Like I said, always call us before giving it but make sure you have some. 
Shelli S.:	What type of information are callers expected to give when they call you? 
Lauri Gormley:	When they call, we'll ask them for the child's age, the child's weight, what they got into, how much they got into, when it happened. We'll also ask for the person's name who's calling and their telephone number. It's not because we're being nosy but like I said earlier, we want to make sure they're okay. We usually ask them to call us back but if they happen to forget, which can happen easily in a daycare because you're so busy. Then we'll give them a call and make sure everything's all right. I always tell people that if we do go to the emergency room, take the substance with you, as well as the child. We've had cases where people show up at the emergency room and they're so scared, that they even forget to bring their kids. 
Shelli S.:	That could be a problem. 
Lauri Gormley:	The substance and the kid, when you go to the hospital. 
Shelli S.:	Lauri this has been fascinating and very helpful. Every call you guys get, you're potentially saving someone's life. 
Lauri Gormley:	That's right, that's why we remind everybody, please give us a call. No matter what you think a kid has gotten into, even if you don't know for sure. We also want to remind everybody that it is required that you have the Oklahoma Poison Center sticker, posted in the childcare centers and home. The last reminder is, keep everything up and out of reach. 
Shelli S.:	Thank you. 
Lauri Gormley:	Thanks. 
David:	Shelli there's one last area we do need to cover, in discussing choking and the young children. 
Shelli S.:	That's right. David, it's ironic that even things that children are meant to consume, can be dangerous. Every year in this country, we have about seventy-five people die from choking on food and around foods and those that are pliable and can form to the airway, are probably the most dangerous. Let's look at some potentially hazardous foods. Hot dogs, round hard candies, popcorn, grapes, nuts and watermelon seeds, are some of the leading culprits in choking related incidences. If you're going to serve hot dogs and grapes to young children. What you need to make sure you do, is cut them length-wise and then cut them in smaller pieces. 	
David, safeguarding your environment means a change in your perspective, it means that you need to start looking at things from an infant or toddler's point of view. You also need to remember that there's nothing more important than your constant, undivided attention. If you prepare your environment before the kids have arrived, then you don't have to worry about it and you can spend your time, having fun. 
David:	Shelli, thanks so much for visiting with us about this topic today, we really appreciate it. 
David:	Our next expert, is Diane Rudebock. An assistant professor at the University of Central Oklahoma. Diane is going to address health related issues, including the importance of immunization. All of the topics Diane will discuss, are found in your requirement book. 
David:	Diane, tell us a little bit about your current position at UCO and your background, with health inspection.

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Diane Redebock
Assistant Professor
University of Central Oklahoma

Diane Rudebock:	I am an assistant professor at the University of Central Oklahoma in Edmond and I coordinate the community health program there. What that entails, is I teach quite a few classes on the control and prevention of disease and focus on, prevention and health. We are in the department of kinesiology and health studies. 
David:	What is kinesiology? Diane Rudebock:	Kinesiology is the movement of the body, or studying movement of the body. We are in the P.E department and we have the health-related sections of the P.E department. 
David:	Great. Why don't you walk us through a few of the things, we need to know about running a healthy, family, childcare home. 
Diane Rudebock:	Sure. I for quite a few years, inspected childcare facilities at the city county, health department. Through that, had experience working with providers and childcare professionals, on what to look for. One of the things I need to remind people to do is to refer to the requirements. The requirements are very clear and it's helpful, when you refer to the requirements. The family, childcare home is a little bit different than a childcare center in that, the people live in the home and the home becomes their business. It's important because families are in their homes but then yet, it's a professional environment as well. Germs stay in those homes so what we want to have, is that balance of health. 	
If you think of it in maybe, three circles. The child is a circle, the adults is another circle and the environment, is a circle. Where those three circles come together, that's the important thing to focus on when we think about health. The child comes in everyday from their own home environment into the home. Then of course, the adults, or the providers come in from either outside, if they're an assistant provider, or they're there in their home with their family. Then the environment of the home, changes. It's important to think about, "How can we prevent the spread of disease in that way?" 	It's important to have good general health of the family. The licensing requirements refer to that, as far as the family members themselves, how they're supposed to be in good health and free of disease. 
David:	Let's talk a little about when a family first enrolls a child in home care. What are some of the things we need to know?
Diane Rudebock:	I think that there are some important things to remember, as a childcare provider. One of those, is to talk with a parent, about what's normal for that child. Also, how that child acts when they're ill. The other thing that's important to focus on, would be their immunization record. It's important to write down the immunizations that they have and also, the immunizations that they might need. In a childcare home we want to think about, when a new child comes in you're also bringing in a new batch of germs. That you introduce to the other children that are in care. It's important to evaluate that child to make sure that they're healthy and the things that the parent, wants to be notified about. It's especially important for infants, that the parent be notified of different things that happen during the day, with infants, especially if they become ill. 
David:	What about situations when a parent shows up with a child who's sick?
Diane Rudebock:	I think one of the best things that a childcare home provider can have, is a policy on how they want to handle children who are ill because obviously, that is going to happen sometimes. If the parent knows up front and the childcare home provider is aware and they have it written down, then it becomes more clear. It depends on the degree of illness. Some children maybe, are not feeling that well but maybe they're not contagious. You have to think about the children, who are present. If you can actually have the facilities to separate that ill child away from the group. Most of the time, children who are ill do need more care. The childcare provider has to be aware of that. She may not be able to provide, the attention that a sick child needs. 	
It is important to keep that child separate from the rest of the group. What we know about germs is that, you're exposed to germs once and then you may not get ill. Then if you have repeated exposures, you are more likely to get ill. Some children are more likely to get sick. Maybe their immune system, is not as strong. Maybe they're just getting over an illness. It's important to have policies and refer to the requirements on the administration of medication. There are obviously some times when it would be very important for a child who is ill, not to be in care. The parent and the caregiver can evaluate that. If the child is contagious with a disease ... Maybe the physician has said, "They should not be in care for 24, 48 hours." Then the caregiver needs to know about that. 	
It's important also to have a sheet, or some way that you can inform the parents of what's happened during the day. Especially if the child has been sick. The parents need to know if they're napping more, not eating as well, didn't take their medication. All these things are important in the care of ill children. I think again, the requirements have some specific things about that. 
David:	Thank you Diane. Is there one thing that stands alone as the most important safety issue, in a childcare home? 
Diane Rudebock:	I think, that is washing your hands. I cannot say enough, how important hand washing can be. What we know about hand washing, is that it does prevent the spread of germs but it also prevents a lot of diarrhea type illnesses, just hand washing alone. As a matter of fact, there's an actual way that we suggest that you wash your hands. It would be a fun way, to show you that. If you've not ever experienced, the real, true way, to wash your hands. What do you say? 
David:	Let's go do it. 
Diane Rudebock:	It's important for children and caregivers to wash their hands. There are certain times that you want to focus on hand washing. For a caregiver, that's before food preparation and also before feeding children and then after diapering and after toileting, or going to the bathroom themselves. After cleaning up any kind of bodily fluids, or things like wiping noses. It's a important time to wash your hands. Then after feeding, or handling pets. With children what we focus on, we focus on them washing their hands before they eat and then also, after they go to the bathroom. 	
When you come to this hand wash area, you want to make sure that you have soap and paper towels here. It's important to have warm water, simply because you're a little bit more inclined to wash your hands. Work up a nice lather. The soap is what combines with the dirt, to get that off your hands. You want to wash your wrists, your hands. A good way to remember how long to wash your hands is to sing Happy Birthday, two times. Work up a nice lather, hold it under the water, get all the soap off. Wash your wrists, push up your watch, move around your rings. It's important as you reach for the paper towel, to dry your hands with the paper towel and then, turn off the faucet with that paper towel. 	
Another important thing to remember is that the kitchen, is not the place where you want to wash your hands after you've changed a diaper. When you're selecting an area where you're going to change diapers, it's important to focus on several things. You want to select an area that is away from your food prep. You want your supplies available and close to water. Then, it's always important to refer to the requirements for these specific things. 
David:	Diane thank you. You've given us a lot of information today. Is there a closing thought you could leave us with? 
Diane Rudebock:	Actually, there are a couple of things. I think it's important for childcare providers to think of this as an equation. To make a decision, to make healthy choices, for good hygiene and then also, to put those things into action. Practicing good health behaviors. The most important thing that a childcare provider can practice, is washing hands. If I had to say one thing that they could remember and also for the children. Would be to wash your hands, wash your hands, wash your hands. 
David:	Now let's look at your responsibility in transporting children. You may drive children to and from school, on special trips, or maybe you'd only put a child in the car for emergency reasons. In any case, you need to know how to safely transport children in vehicles. 	We're here at the Midwest City Fire Department with Captain Jerry Lojka public education officer. Captain Lojka thanks for joining us today. Before we get too far into this, how important is it to keep a child strapped in all the time? Say I just want to go around the corner, get something at the store. Is it critical that I strap my child in every time? 

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Captain Jerry Lojka
Public Information/Education Officer
Midwest City Fire Department
Midwest City, Oklahoma

Capt. Jerry L.:	It's essential. Most people feel that because we're just going around the corner, nothing happens but statistically we know that most serious accidents that occur, where children are injured. Occur in a residential situation, not on a freeway. 
David:	What are the common mistakes that people make, with regard to child seat safety?
Capt. Jerry L.:	Some of the most common things that we see are that most parents don't take the time to read their manual. This would go for caregivers also. They need to understand what kind of seat belt system they have in their car and then follow those recommendations. The next thing is, is that they don't attach the car seat properly to the vehicle. It's too loose and they don't understand how to tighten it. The third thing is, is they don't properly attach the child to the car seat. With all three of those factors playing into it, it's like the child is not restrained at all. 
David:	Captain it seems like there are dozens of types of car seats available. Could you help us understand what types are actually available to the consumer?
Capt. Jerry L.:	Yes, it can be confusing. We have four different types of car seats that are here. I'll begin first with, the Infant Only. Those are designed to carry infants in the rear-facing position only. Then we move to, the Combination type Seat, that can be used for either a rear-facing infant, until they reach their designated weight and age. Then they can be turned, forward facing. The next one is, for toddlers only, that will never be used in a rear-facing position. Then we have a, Booster Seat, so that once they've outgrown the toddler seat, that they can move to a booster seat. Prior to the time that they go into a seat belt system. 
David:	All right Captain Lojka if you could please, show us how to secure the child's seat in a mini-van, for example. 
Capt. Jerry L.:	Be happy to. In this particular car seat, we're fortunate that we have two belt pads, so that we don't actually have to use the base in there. 
David:	What's a base?
Capt. Jerry L.:	Well some of these car seats that are carriers also, will have a base attached to them, or they must be attached to the base, when we place them in the car. In this particular instance we don't have to have one because it has an additional belt path on the car seat itself. One of the most important things we need to remember when we attach the car seat, is to put the carrying handle in its down position. That's the way they're designed. With the baby out of the car seat, we will attach it to the vehicle. Being careful to make sure that the belt goes through the belt path and because there is a void between the car seat and the seat itself, it will give it an opportunity for this to slide down. 	
We have to put something in there to stop it from doing that. It can be a rolled up towel, or it can be a flotation device that we refer to as a noodle. Then we put our weight in the car seat, pulling the belt as tightly as we can, so that this is very snug. If you can't move the car seat more than one inch, side to side, then you'll know that the car seat is securely attached. David:	All right now that we've secured the car seat, let's bring baby Shuley in for a ride. All right? 
Capt. Jerry L.:	Okay. This is a hot summer day and baby Shuley is very tired and we might get her in the car seat, without waking her up. We need to understand that sometimes we'll wake them up and they do get upset. It's important that we carefully put the harness over her head and that we attach it properly and that we move the harness clip, up to her armpit level, so that it's securely attached and it will hold her in. There should not be more than one finger width that we can put between her shoulder and the harness itself. Now she's safe and ready to go for a ride. 
David:	Joan thanks for letting us use Shuley for our demonstration today. 
Joan:	You're welcome. 
David:	Captain, now let's take a look at the passenger automobiles. Are there any difference in securing a car seat in a passenger car, as opposed to a van?
Capt. Jerry L.:	The principals are the same but sometimes it's more difficult in a car, than it is in a van because of the confined space of a backseat. One final note about vans, the middle bench in the center position, is the safest place to install a car seat. Just like is the rear seat, in the center position of a passenger vehicle. That's where were going to install this car seat. This is a forward-facing car seat. We want you to understand that there will be circumstances where the bench seat, the rear seat, is not going to be conducive to installing it in the center position. You will have to put it, in an outboard position. We're fortunate this time to be able to put it in the center position. 	
Once we have put the belt through the proper belt path, the only way that we can get this belt tight is to put your weight in the vehicle. You can see here it's not very loose but once we put our weight in it, then it becomes very loose. As we pull all of the slack out of the car's safety seat belt and then we take our weight out of it, it's very tight. We have no side to side movement. It's critical that the car seat doesn't move anymore than one inch side to side and we shouldn't have much movement, forward to rear. 
David:	All right Captain you've shown us how to put car seats in both forward and rear facing, what's the difference? 
Capt. Jerry L.:	The critical part about making the decision as to when we change from rear faced to forward facing is that, the child who is an infant, needs to stay rear facing until they are one year and twenty pounds. One of the important factors to remember is that these different slots are placed in here so that when the child is rear facing, that these harness straps are at or below the child's shoulders. Once we've turned them around, so that they're forward facing. Then we want to move these straps to the top part, so that it's at or above, the infant's shoulders. Remember it's one year and twenty pounds. One of the important things that we haven't talked about much, is this locking clip. The only way that you can be sure to understand, when to use a locking clip and when not to use one, is to read your owner's manual for your vehicle.	So that you'll know what kind of restraint system you have in your car. Always read the instruction manual that always comes with the car seat. That's the only sure way to know. 
David:	Got to read them both in conjunction. 
Capt. Jerry L.:	You have to read them both. 
David:	One thing I've noticed Captain in this day and age, of sports utility vehicles and station wagons and vans. There's a lot of wasted cargo space, in the back. Can't we just put the kids in back some way? 
Capt. Jerry L.:	We really can't ever transport children, without having them securely installed in a seat belt or a car seat. Those cargo areas are not designed to hold children safely. Studies have indicated that when a vehicle is either hit from the side, or the rear that those children are ejected from the vehicle, or become a projectile within the vehicle. When they strike the interior of the vehicle, it's like not being in the car at all. It's very dangerous for them. 
David:	Captain you've covered a lot of information for us today and we appreciate that. Can you help us by identifying the key elements that we need to remember about child seat safety? 
Capt. Jerry L.:	Some car seats will never work in some cars. Compatibility issue is very important. 
David:	After our first visit to the fire department, we had some specific questions about booster seats, so we went back to the Midwest City Fire Department and asked Captain Lojka to explain the proper use, of a booster seat. 
Capt. Jerry L.:	We've spent a fair amount of time, talking about car seats in general but those are for the younger children. What we'd like to do is focus at the moment on booster seats for the older children, so that we can show you some important features about the installation. The most important thing we need to remember is that our purpose in putting them in a booster seat, is to raise them up off of the vehicle seat, so that the belt does not ride on their belly but it's low over the hips. All booster seats are designed to hold this down, so that it will stay over their hips. The shoulder portion of the belt, goes across their chest and across their collar bone, so it's not down over here, over their arm, or up here on their neck or face. A proper fit with a booster seat is as important, as properly installing, a regular car seat. 
David:	Are there other resources that people can consult, to answer further questions they may have?

[NO AUDIO]
SAFEKIDS Coalition
Oklahoma city
405-271-7233
Tulsa
918-494-7233
Midwest City Fire Department
405-739-1355

Capt. Jerry L.:	Absolutely the SAFEKIDS Coalitions throughout the state, have this information. The Midwest City Fire Department would be more than happy to assist people and if we can't help them directly, we can point them in the right direction. 
David:	Folks statewide could give you a call. Is that right? 
Capt. Jerry L.:	You bet. 
David:	Those numbers are posted for our viewers right now, too. Thank you so much, really appreciate your time and everybody here at the Midwest City Fire Department. Thanks so much. 
Capt. Jerry L.:	My pleasure. Thank you. Remember to take the time.

[NO AUDIO]
Take the Time...
Car Seats Save Lives
 
David:	I want to remind you again, to look in the requirement book for the specific requirements, regarding these training topics. Our next presenters cover serious information that reminds us how critical you are, as a caregiver. If you spend any amount of time as a childcare professional there's a good chance, that you'll run into a situation where you suspect child abuse, or neglect. When you have a concern that a child is being abused, or neglected you have a legal obligation, to report the suspicion. All you have to do is report the suspicion to the Child Welfare Division. OKDHS will determine whether abuse, or neglect has occurred. Norma Eaves from the Child Welfare Division visited our studio a while ago. Through the use of some volunteer children and a professional makeup artist, she showed us some examples of what child abuse might look like. 

[NO AUDIO]
Norma Eaves
Child Welfare Investigator

Norma Eaves:	Today, we have a makeup artist assisting us, by illustrating injuries on children. The location of these injuries can help identify possible accidental and abuse related injuries. First of all, let's discuss the locations of typical, accidental injuries on children. These areas include: forehead, shins, forearms and thighs. Let's take a look at a child. Forehead, forearms and shins. When you think about accidental injuries, you must take into consideration the age and mobility of the child. The areas of typical abuse related injuries include: eyes, cheeks, ears, areas just above the knees, genitals, middle of the back, buttocks, upper thighs, calves and abdomen. Again, let's look at a child. Cheeks, thighs, abdomen and stomach area. 	It is more difficult to bruise an area of the body, where there are large masses of soft tissue. Bruises in these areas are more likely to be abuse related. In addition to the location of the injury the shape of the injury can be a clue to what was used to inflict the injury. Thus, identifying abuse related injuries. For example, if a child has been struck with force with an extension cord, belt, board, hand or fingers, a distinct mark, or impression will be left. Here are examples of real child abuse situations. 	
Remember the age and development of the child, is very important in assessing whether the injury is accidental, or abuse related. For example, if a three month old child comes into your care with bruises on his face and mouth, it is highly unlikely, these are accidental injuries. Let's talk about behaviors and characteristics of children, which might indicate abuse or neglect. Extremely fearful behavior. For example if a child ducks, when you move your hands around them, they may be fearful of being harmed. Extremely aggressive, demanding or rageful behavior. Some abused children, display these behaviors as they are starved for attention and desperately seeking it. They also may be imitating the behavior of their parents. 	
Overly compliant, or passive behavior. These children may allow other children to take things away from them, or go along with whatever is suggested. This may be a result of trying to avoid a violent assault. Extremely dependent behavior. These children may cling to staff and have difficulty separating from them. Keep in mind the age and development of the children to determine, normal, dependent, behavior. Role reversal behavior. Watch for children who assume the role of parent, of the other children. They may also comfort and nurture the other children. Extreme lags in development. These may be the result of emotional deprivation, or nutritional neglect. Indiscriminately friendly behavior. Many abused children are so hungry for affection, they are inappropriately friendly with strangers and play mates. 	
Multiple explanation of injuries. If a child offers more than one explanation of what did, or didn't happen to cause the injury. This could be a clue that the injury is abuse-related. It is important to note that behavior and characteristics alone, are not necessarily an indicator of abuse or neglect in a child. You must look at the whole picture. What are reporting requirements in Oklahoma? Health care professionals, teachers and anyone who has reason to believe that a child has been abused is required to report the matter, promptly to Child Welfare, in their local department of human services, county office, or to the statewide child abuse hotline. By calling, one eight hundred, five, two, two, three, five, one, one. Yes, this does include, the owners, operators and staff, of all childcare centers in homes. 	
It is important to remember you do not have to know all the facts. You do not have to have all of the answers. If you suspect child abuse or neglect, you have to report the incident to child welfare. Let child welfare do the investigation and make the decisions. Failure to report suspected child abuse, or neglect in Oklahoma, can result in criminal charges being filed against you. It is natural for you to be concerned about your obligation to report. It is likely you will have questions about what you have seen and heard. Do not hesitate to contact Child Welfare services, or daycare licensing for guidance. What is the definition of child abuse? 	
In Oklahoma, it is defined as harm or threatened harm, to a child's health or welfare, by a person responsible for the child's health or welfare. Harm or threatened harm, may occur through non accidental physical, or mental injury, sexual abuse, or neglect. A child means a person under eighteen years of age. Physical abuse is non-accidental injury, to a child. Physical injury, means temporary or permanent damage, or impairment to the body. Mental injury means an injury to the child's intellectual, or psychological capacity. It is the result of a pattern, of cruel acts or statements, made to the child or in the child's environment. This could include a child, who is exposed to domestic violence. Sexual abuse includes, rape, incest, lewd, or indecent acts, or proposals and sexual exploitation. 	
Neglect is indicated when the parent, or person responsible for the child fails to act in a prudent or responsible manner, to provide for the health and general welfare of the child. Long term neglect could cause serious harm, to a child. Examples would include, inadequate clothing, food, shelter, medical care, or supervision appropriate to the child's age, or development. Please remember, Child Welfare is here to assist you with difficult situations. 

[NO AUDIO]
Child Abuse Hotline
1-800-522-3511

It is vital that you remember that as caregivers of children, you are an important link in providing for the health and safety of the children, for whom you provide care. 
David:	The safety and protection of children is everyone's legal obligation. Remember, when you suspect child abuse or neglect, it's your duty to report it. Our next topic, is Sudden Infant Death Syndrome. Otherwise referred to as SIDS. This topic can cause anxious feelings among childcare providers and parents alike. There are numerous practices that can greatly reduce, the chances of a Sudden Infant Death. Pat Damron the past SIDS program coordinator, at the Oklahoma State Department of Health, helped us understand what SIDS is and ways to reduce the chance, of Sudden Infant Death Syndrome. 	You're with the Oklahoma State Department of Health. What's your position there? 

[NO AUDIO]
Pat Damron
Coordinator, SIDS Program
Oklahoma state Department of Health

Pat Damron:	Yes, I'm the coordinator of the SIDS Program. Our program provides support and education, for any kind of SIDS issues that may occur in the state of Oklahoma. 
David:	What is SIDS? 
Pat Damron:	SIDS stands for, Sudden Infant Death Syndrome. The definition of SIDS is the unexplained and sudden death, of an infant under the age of one year. 
David:	What do we know about the victims of SIDS? 
Pat Damron:	Well there are some things that we do know. We know that generally, infants died between the ages of two and four months. That's when we see the peak of deaths. Then after six months, it begins to go down and decline but we can still have a definition of SIDS, deaths up to one year. The other thing that we know is that these are generally healthy babies, that these are full term babies. Sometimes people think that these are sickly babies but they're not generally. The other thing that we know is that these babies ... Generally we see a higher rate of boys dying of SIDS than girls. We also see a higher rate of SIDS in the winter months. We can't predict SIDS and we can't prevent SIDS. We don't know what causes SIDS, so we don't have the ability to do that. 	
The other thing is, is that we will generally see, that the baby dies within seconds. Sometimes parents will say, "I didn't hear them cry out. Did they suffer?" They die within seconds, there doesn't seem to be a struggle, in that respect. The other thing is that, sometimes people will think that these babies have suffocated and this is not a suffocation. This is a different kind of death.
David:	Does the research help us in any way to help lower, or minimize the risk of Sudden Infant Death Syndrome? 
Pat Damron:	Well as I mentioned, we really don't know what causes SIDS but there are some tips that we can have present, within a home, or within a daycare setting that would lower the risk of a child dying of SIDS. I'd like to take you to a sleeping area where I could show you some of those things. 	This is a good example of the sleep environment that we're looking for. First of all, it has a firm mattress. The other thing that we're looking at is that the mattress does not have any space between the rails and the mattress itself. There's no space that the baby's face can get down in there and get suffocated. The other thing that we don't want to see and what we would call, a bad surface, would be a water bed, a bean bag chair, anything where a baby can get their face into a pocket and not be able to breathe properly. The other thing is, is that we don't want any stuffed animals, in here with the baby while the baby's trying to sleep. Like she doesn't have any now. Again, so that the baby can't get their face up there with something, that they couldn't breathe properly. 	
The other thing is that, we don't want the room too hot. A lot of times with babies, we think we need the room, hotter than it needs to be. If you're comfortable, the baby's comfortable. Then we want a smoke free environment. We don't want an environment where anyone's smoking, or there's passive smoking going on. This makes a higher risk for SIDS. The last thing and the thing that ... The reason that we're seeing and we feel that we're seeing a decline in SIDS is because of, back to sleep. That is an initiative that we're seeing all worldwide, on putting babies on their back to sleep. This will not prevent SIDS a hundred percent but what we're seeing is a very drastic reduction in SIDS, by putting babies on their backs. 
David:	We asked Pat to describe what to do, if an occurrence of SIDS takes place in a childcare home. She said the first thing to do, is call 911. Pat then went on to explain, what would happen next. Pat Damron:	First the EMT would arrive, the Emergency Medical Technicians. Then, the police would arrive and sometimes this is hard on people because they will come in and start a criminal investigation. They don't know what they are walking into. Then at that point, we also will have the ME or the Medical Examiner come and they will be the one that will examine the child and pronounce the death. One of the things also that we need to remind people, is an autopsy will be done. This is the only way that we can verify if this is SIDS, or not, or if the child died of something else. 
David:	Before we finished our discussion about SIDS with Pat, I asked her about the guilt that a childcare provider might feel, after experiencing such a tragedy. She had some helpful advice. 
Pat Damron:	I think it's important for a provider to remember, that as long as they've given the best care possible to that child, that they have no reason to feel guilty. Nothing is probably going to take away the inevitable sorrow that a provider's going to feel in losing a child but one of the things that they have to try to remember, or hopefully will remember, is that no one knows what causes SIDS. No one can predict SIDS and there's no way to stop SIDS. The other thing is that we do have, support available. 
David:	Pat Damron, thanks so much for visiting with us today. We really appreciate it. 
Pat Damron:	Thank you for having me. 
David:	Those numbers that Pat mentioned, are on your screen, right now. 

[NO AUDIO]
SIDS Information & Support
Oklahoma State 
Department of Health
SIDS Program
405-270-4471
1st Candle/SIDS Alliance
1-800-221-7437
www.firstcandle.org

David:	Another all too familiar tragedy, is a situation you need to be made aware of. Shaken Baby Syndrome can result in severe injury or death. Doctor John Stuemky the head of Pediatric Emergency at Children's Hospital in Oklahoma city, spent some time with us to explain how to identify Shaken Baby Syndrome and what to do. He also continued our discussion about child abuse. 
David:	This is Doctor John Stuemky. He leads a team of health professionals at the Emergency Room at Children's Hospital here in Oklahoma City. Doctor thanks so much for taking time to talk to us today, about child abuse. 
Dr. John S.:	You bet David, good to be here. 
David:	Now our audience is made up primarily of childcare providers. I'd like to start the discussion by talking about the procedures that someone needs to follow, if child abuse is suspected. 

[NO AUDIO]
Dr. John Stuemkey
Chief of General Pediatrics
Oklahoma Children's Hospital

Dr. John S.:	Sure. It is important for daycare workers, child health providers, child care providers to know their law and the procedures to follow in their locale, in their state. Every state is slightly different but there are common denominators, of dealing with this. If a daycare worker truly suspects abuse and neglect then they're obligated by law, to report it to their appropriate authorities. That may be a child abuse hotline, that may be their local Child Welfare offices. Certainly every daycare, childcare provider should have a number, know the number to call, so indeed they can make that report of suspicion. 
David:	Doctor doesn't the law require providers to report child abuse? 
Dr. John S.:	Oh yes it does but I want to stress that it's what your reporting as a suspicion of child abuse. I think a lot of people become confused, with that term. I think that can be intimidating to a lot of folks because they say, "Gee I'm not sure I know what it is," or "Do I have to prove it and do I have to investigate it?" I think the important thing is to recognize that, the way the statue is written and in most states and certainly in Oklahoma. It's the suspicion of abuse and neglect. If you, in your job, profession as a childcare provider, if you have a reasonable suspicion of abuse or neglect, then the law requires you to report that suspicion. It's also important to recognize that the law doesn't require you to have to show it. You have satisfied the legal requirements, if you've just reported that suspicion. 	That suspicion is reported to Child Welfare. Child Welfare is expected to investigate. The results of that investigation is made available to the district attorneys office. Now in many states and many arenas if the suspicion comes out of a daycare center, then usually that state's agency relating to licensing of daycare, childcare providers, is involved in the investigation. I think that should make it an easy process for any person to do. You pick up the phone and say, "Gee I'm concerned."
David:	It's the reporting of the suspicion, that's the important thing. 
Dr. John S.:	Oh absolutely. All you're going to be asked is, "Gee why are you concerned?" It's perfectly all right to be concerned. In fact, we want that. The law recognizes also that sometimes, you'll have concerns, that it really isn't abuse. That's also okay because you'll never get into trouble, for reporting a suspicion of abuse. Even if you're wrong. That was recognized up front when the reporting legislation was passed. "Yes there's going to be erroneous reports."
David:	Right. 
Dr. John S.:	That's perfectly okay. The whole purpose is to protect the child and to provide services to families. The childcare provider has no responsibility in investigating. It's just a matter of reporting suspicion. The law protects you from any retribution, by virtue of making that report, even if you're wrong. 
David:	Most injuries caused by child abuse, are pretty easy to spot. Bruises, burns, broken bones and so forth but I'd like to talk for just a minute about something that may not show outward symptoms. That's Shaken Baby Syndrome. Could you please tell us a little bit about what Shaken Baby Syndrome is and how those injuries are caused? Dr. John S.:	Oh you bet. Unfortunately it's more common, than many people think. It's a major cause of death and morbidity in children, particularly under two and half years of age. We see approximately one to two such children a month, in this very emergency department. Not infrequently, these children may be brought in from childcare facilities. The cause is almost universal. A principal care taker losing control with the child. They've had it. They become very frustrated. Usually the child's crying, gets on their nerves. They may be under stress from other things and then they just lose it, with the child. They grab the child, usually by the chest, or around the arms and violently shake the child.	I have to stress that it's a very violent shaking. We're not talking about playful shaking with a baby. Which while we may not advise it, we have no evidence that, that causes harm. This is a very violent act and the extent of the violence is such that, even were a lay person happened to walk by and observe this while it was in progress, they would, not knowing anything about it, would immediately recognize that this was a violent act. That this child was being truly assaulted. They lose control and it's usually because of the baby's crying that gets on the nerves, and they've had it. 	
Sometimes they're not even aware of how much they've lost control, with their baby at that point in time. During early development, a baby's head is relatively heavy and the neck muscles are weak. The brain and the connecting tissue, are very fragile. That's soft and I've often used the analogy of a developing baby's brain, being like jello. When the jello is shaken, little slits and tears can occur in the jello. This makes the brain very likely, to be severely injured if the baby is shaken. When a baby's head is shaken, the force of the brain, moving back and forth, or a sudden impact from being thrown or dropped, may cause the delicate blood vessels between the skull and the brain, to tear. 	
This bleeding may occur inside and outside the sections of the brain. This of course, can result in severe brain damage, or even death. If death is avoided, the brain damage may prevent the baby from seeing, or walking, or talking, for the rest of their life. Even the slightest injury can cause permanent brain damage and physical impairment. That may not become impairment, til later on in life. It only takes one time, or just a few seconds to hurt a baby for the rest of its life. 
David:	It sounds like these injuries are happening too frequently, who's responsible?
Dr. John S.:	Well, the principle caretaker or what we call, the primary caretaker. Usually mom or dad, or as not uncommon, mom and boyfriend. One of those two, tends to be the primary perpetrator, most of the time. Certainly it can happen in other places. Anyone that takes care of a child, particularly if they're under stress and have a short fuse and a short temper, can lose it, so to speak. The most common is either the parents, or a common factor is the mom's boyfriend, not infrequently. David:	What are some of the signs, or symptoms that a childcare provider might look for? 
Dr. John S.:	That's an excellent question because sometimes it can be hard to recognize. It may not be recognizable at all but usually it may present with a child being incredibly irritable or fretful. The child being almost unable to be consoled. On the other hand, the child may be eating poorly. The childcare provider can simply note a drastic change in the way the baby acts. If the childcare provider really knows their baby, then when the child comes in and is a mark change in behavior, obviously they can be concerned about it. The findings that may present even more dramatically, the child may have an episode of not breathing, we call it Apnea episodes. The child may turn blue which we call, Cyanosis. 	The child may have a seizure. This type of activity, or symptomatology, or symptoms might result in the childcare provider calling an ambulance, or calling help in that sense. The symptoms can be subtle. Sometimes the child just appears ill. Throwing up, vomiting. A lot of times the child may have a bulging soft spot, a bulging fontanel. If the baby is less than nine, or ten months of age and the fontanel hasn't closed. There can be a wide variation of symptoms. Some of the symptoms may be, simply those symptoms of what you would otherwise suspect to be a sick child. In which case, then the childcare provider's concern about that would be expressed to the parents, or that sort of thing.
David:	Doctor you've covered a wide range of symptoms here but they don't all mean that Shaken Baby Syndrome has occurred, do they? 
Dr. John S.:	Oh gosh, no. Obviously, that can be difficult. The main thing is that the childcare provider knows their child, knows their baby. Because other illnesses can have the same symptoms. It is important to know that and also to have, know who you will call if the child's ill. If the child suddenly has a seizure, or quits breathing, or turns blue, then we hope the childcare provider will know what to do in those set of circumstances. Rendering immediate first aid and calling 911. On the other hand if the child is ill, is vomiting, is sick, is terribly fretful, or fussy then the childcare provider needs to get ahold of the parents, so that child can have medical care. Indeed it may be an illness, certainly other than Shaken Baby's. All these symptoms are caused more commonly, by things other than Shaken Baby, thank goodness. David:	Doctor childcare providers do very rewarding work but it can also be frustrating sometimes. What do you say to a childcare provider that becomes so frustrated, they want to act out their frustration with the baby? 
Dr. John S.:	Well certainly that can happen and babies can cry and babies can be irritable and they poop, and they throw up. They do things sometimes more often and they can get to anybody. The most important thing, is if you can recognize yourself that, "Gee, that baby's really irritating me," take a break. Walk out of the room, even if the baby's still crying, crying won't hurt the baby. Take a deep breath, count to ten, whatever you like to do. You can leave the situation. Then you could come back and perhaps, walk with the baby. Walk outside, do something different, re-focus. I think the most important thing is to recognize that the baby's getting to you. Give yourself a break in that situation, if you can. In an environment where another relative or caretaker, or someone else in the home can watch after the baby. That's also a reasonable thing to do. 	
Babies can get on peoples' nerves and that can happen with anyone. The most important thing is simply to recognize it. Whatever you do, don't shake the baby. 
David:	Are there any other resources available for a childcare provider that wants to learn more about this? 

[NO AUDIO]
Oklahoma Child Abuse Hotline
1-800-522-3511

Dr. John S.:	Oh yes there are. Certainly you can contact your local, Child Welfare agencies. Additionally, your local childcare licensing agencies will have information about this. Many states have available, emergency medical services for children. Programs available, or resource center. Which also has information that can be shared. 
David:	Doctor Stuemky thank you so much for visiting with us about this important topic and the staff here at Children's Hospital ER. Dr. John S.:	You bet. Happy to be here. 
David:	Thanks so much. 
Dr. John S.:	Thank you David. 
David:	Now we turn our attention to fire safety and prevention. By preparing in advance, you can make your family childcare home, or large childcare home safer and ready, in case fire breaks out. Major Otis Greenhoward from the Oklahoma City Fire Department spends some time with us, to show us how to be prepared for fire. 	
This is Major Greenhoward from the Oklahoma City Fire Department. Major thanks for joining us. Can you tell us about your role in educating people about fire prevention and fire safety? 

[NO AUDIO]
Major Otis Greenhoward
Oklahoma City Fire Department

Maj. Otis G.:	Well David, I've been on the Oklahoma City Fire Department for over twenty years. Currently, I'm assigned the prevention office and the public education section, where we deal with the public. We go out and educate the public on fire safety issues. Currently, I coordinate a program which is called the OKC Fire Smart Kids Club. Which deals with childcare homes, as well as daycare centers. Whether it's small, or large. They cater to the pre-k age children. That's our message to those homes, to make them safe. 
David:	We do have some requirements that are available in your requirement books. You're going to want to be aware of those requirements and be in compliance with them. Can you tell us about some of the considerations of the home and its physical condition that we need to be aware of?
Maj. Otis G.:	Sure, proper maintenance of a home. Making sure that it's safely wired as well as, not utilizing extension cords as permanent wiring. Also, making sure that the outlets are covered so the children aren't sticking things in there, they may be electrocuted. Things of that nature. Making sure the house is maintained and clean and free of debris. 
David:	Not all family childcare is operated in a house. Are there different considerations for an apartment, or a mobile home?
Maj. Otis G.:	Yes that's correct David. That's why it's very important that you refer to the requirements for the multi-family homes. 
David:	Major we've talked about the main structure. Are there any special considerations for heat sources?
Maj. Otis G.:	Yes. No un-vented heaters. Heating equipment free from debris, free from combustions. What people normally do, is like to store things in those closet areas where those heating equipment is located. As well as guards around hot surfaces and open flames. Such as a floor furnace, as well as a wall furnace. As well as fireplaces. They should have a solid door, glass door in front of it. Keep kids from getting into the fire, where there's throwing objects into the fire as well as, any objects coming outside the fire. 
David:	Major we've talked about fire prevention measures. What about a worse case scenario? You've got a fire, how do we get out? 
Maj. Otis G.:	That is very important. Making sure that you have a way out. Each room, should have two exits. One should lead a pathway outside. None of the exits should be obstructed. Make sure all of the exits, are unobstructed. 
David:	We all know that everyone needs to have working smoke detectors but are there any special requirements for childcare homes? 
Maj. Otis G.:	Yes. A smoke detector should be located on each level of the home. Located at the top of the stairs, as well as, where the children sleep, or where the children play. Make sure that the detector is maintained. If you hear it beeping periodically, that means that the battery is low. The fire department, recommends that you test the smoke detector at least once a month and change the battery at least once a year. 
David:	We've heard of carbon monoxide detectors. Now, what are these and how do they work? 
Maj. Otis G.:	Carbon monoxide detectors are great to have because carbon monoxide is the leading cause of poisoning in America. Carbon monoxide is a tasteless, odorless type of gas which is produced, by combustion as well as any type of fossil fuel that burns. Make sure you check your requirement books to see when they're necessary. 
David:	Major it's required that we have fire drills, to make sure that children are able to get out safely. Can you tell us how important it is to conduct these drills? 
Maj. Otis G.:	They are very important. It's the difference between life and death. The fire drill should be done so that the child as well as the adults, that are overseeing the children, know the exits to get out of that building, in case of a fire. It's very important that they practice it and at least do it quarterly, so that they're familiar with the exits and how it is executed. 
David:	All childcare homes are required to have a fire extinguisher on hand. Can you tell us exactly why that's so important? 
Maj. Otis G.:	It's very important in case a fire occurs. Since kitchens are normally a place where fires may occur, let's go talk about fire extinguishers in the kitchen. 
David:	Major I can see why a kitchen, might be a source for a lot of fires. 
Maj. Otis G.:	Of course, yes. There's a lot of cooking done in this area. You always want to make sure that you have your fire extinguisher located in the kitchen. Make sure that it's accessible to the adults that are cooking. Whatever you do, don't place your fire extinguisher near, or on the stove. The type of fire extinguisher that we recommend, should be an A-B-C, or a B-C. All that stands for is there's the three classes of, fire extinguishers. 'A' class is for ordinary combustibles, such as paper, wood, or clothing. 'B' class fire extinguishers are for grease, or any type of liquid fire. Class 'C' type fires are electrical, energized top fires. If one of these stove tops caught on fire, or if something on the stove caught on fire, you could easily use this.	If this is not available. If it's not available and say you have a grease fire, you can always utilize baking soda, salt the lid, things like that. We don't want you to use water, or flour. When you use those things that's when fire spreads and creates a bigger situation. 
David:	Fortunately most people have never used a fire extinguisher. Is there a preferred method for using it? 
Maj. Otis G.:	Yes there is. Let's go outside and I'll demonstrate to you, how it's used. All right David, this is how we do our fire extinguisher demonstration. Let me take time out to light the fire. As you can tell that's not a very big fire and it's a liquid fire. Could you hold this please? Any time you use a fire extinguisher, David, you should always do two things. Contact the fire department and evacuate the immediate area. Now, we also use the technique, PASS when we demonstrate how to use a fire extinguisher. That's basically, teaching them how to pull the pin, aim the nozzle and squeeze the trigger and sweep, at the base of the fire. 
David:	All right. 
Maj. Otis G.:	We're ready to put it out now. Always approach the fire at eight to ten feet, pulling the pin, aiming the nozzle and squeezing the trigger. David:	Thank you Major, appreciate it. 
Maj. Otis G.:	It's been my pleasure. 
David:	Our final topic today may be the most complicated topic, we discuss. While a fire, or other life-threatening situation is important to prepare for, behavior and guidance is an issue that comes up all day long, every single day. Pam Ramming is an eighteen year veteran in statewide training for childcare providers. She also owned and operated a family childcare home, for six years. Pam has dedicated much of her career to understanding and teaching techniques for positively guiding children, through the day. She sat down with Mitzi Lee a policy and training specialist for Oklahoma Childcare Services at OKDHS to discuss behavior and guidance. 

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Mitzi Lee
Programs Manager
OKDHS Oklahoma Child Care Services

Mitzi Lee:	Pam thank you for talking to us today, about this important topic, behavior and guidance. You have a Bachelors and a Masters in Early Childhood. You also worked in childcare, correct? 
Pam Ramming:	Yes. 
Mitzi Lee:	A childcare center and then actually Pam had her own family childcare home for several years. Most recently Pam has been a trainer and consultant, all over the state. Having trainings and helping providers, with a whole lot of other issues. Not just behavior and guidance. When we think about behavior and guidance, you know your requirements list some things. Some do's and some don'ts and some guidelines for you. Pam it is a broader issue, more about the philosophy of opening your home to children. 

[NO AUDIO]
Pam Ramming
Child Development Trainer

Pam Ramming:	Mitzi, that's the hardest thing I think most providers, deal with. Is it's changing your home, into your business. Understanding that you're not parenting other people's children. 
Mitzi Lee:	That's right. 
Pam Ramming:	You're providing care for them. It opens up a whole marriott of conflicts and issues and situations, that you have to have some forethought to and be prepared to deal with, as you enter into your new business. 
Mitzi Lee:	I guess it would be common that as a new, family childcare home, you might not think of that, initially. 
Pam Ramming:	Most people come into childcare because they didn't want to leave their own children, with other people. They are providing very good care for their own children and we're switching topics and we're moving, when we start taking care of other people's children. 
Mitzi Lee:	Pam, in starting out of us looking at this journey of behavior and guidance, maybe one of the first things is to think about understanding developmental stages of children, child development, appropriate expectations. 
Pam Ramming:	That's right Mitzi. When we look at the research and we know what happens in childcare, some of the things that are important to focus on and to understand is that children are going to come into your home. It's not an appropriate place to have your grandmother's favorite vase, laying down. Those are the kinds of things that you want to put up and protect. Your home becomes their environment. It is a place for the children to be. When we look at what happens in our home, we have to stage everything appropriate for children. We have to put the children's needs ahead of our own family set up and what's comfortable for our family. 	
We have to put up all of the breakable things. We have to include all those safety plugs and all of the things that licensing reminds us to make sure our environment's safe. As we look at behavior and guidance, we also have to change our expectations of the rules of our household. One of the fastest ways that we know to improve behavior and guidance, is to improve outside play by thirty minutes, first thing in the morning. 
Mitzi Lee:	That's fascinating. Outdoor play really does help with behavior and guidance. Pam Ramming:	When we look at outside play, just the simple fact of putting children outside, under supervision, actively playing for half an hour, first thing in the morning will improve your behavior and guidance by up to thirty, to fifty percent. 
Mitzi Lee:	Who would have thought Pam that outdoor play, actually helps with behavior and guidance? That's an awesome tip. Pam Ramming:	When we see that the outside play has made so much difference, it helps the children with their energy level and it gives them something constructive to do. It's hard to convince everybody that we need to be outside that much though. 
Mitzi Lee:	I know sometimes the issue gets to be, it's too hot, it's too cold. Certainly children being dressed appropriately, having enough water, all those issues but you really do need to have them outside. The payoff is big for you as well. Pam Ramming:	Yes and it also goes to show, how important your outside environment is, as your inside environment is, in your safety proving, planning for children to be outside. 
Mitzi Lee:	We aren't talking about you needing to be an expert in child development but you do need to have that knowledge. Additional training's helpful as well, as it helps with these expectations. 
Pam Ramming:	You're absolutely right Mitzi. When you look across our state, there's lots of training programs that are available. You're licensing worker can give you a list of trainings that are available in your area. There's lots of statewide trainings, there's lots of resources that are available to get that extra level of behavior and guidance training. That anybody who works with children needs, especially somebody who works with very young children. 
Mitzi Lee:	One of the first basic things, be sure you have some knowledge of child development and appropriate expectations with children. Pam Ramming:	Yes. It's very important. 
Mitzi Lee:	Pam another point about behavior and guidance that some people may not really relate to it, is parents are certainly partners in childcare but good parent communication can also help with behavior and guidance. Pam Ramming:	A wise childcare provider once told me that when we ... What happens at my house is between your child and me and anything that is important that affects your family, I will share with you privately. Obviously not in front of your child because those bigger discipline and guidance issues, should be the things that are happening between parents and childcare providers. Perhaps, if we're working on the same topic. We're working on, not hitting, or not using potty words. Some of those kinds of things that everybody needs to be on the same page about. We need to be working together. However all the little, "He hit seventeen times today." We need to monitor that and cut those pieces of information back and provide those in a caring way. 
Mitzi Lee:	You handle it, it's in your environment, you're in charge of that. It pretty much just rests there. You mentioned about consistency. Then I would think that it could be helpful to explore with parents, how they may discipline at home but that can be sticky a little bit, too. 
Pam Ramming:	Very sticky. It's important that you do know what's happening at home and that you're sharing information. Both that the family tells you how they're handling problems and you're sharing how you're going to handle problems. Families a lot of times have discipline techniques that we cannot endorse in childcare. When you look in your licensing book and you see policies, you'll see lots of things that are not appropriate to do with other people's children. When you think about those things and you have those communications with parents, part of your job as a childcare provider, becomes to educate them on the options and the ways of handling situations, that are age appropriate for their child. 
Mitzi Lee:	When you find out how a parent may be handling something, always go back to the requirements. Be sure it is meeting that guideline and then adjust as need be, with input. It is about a parent, being a partner with you. 
Pam Ramming:	Yes and don't be afraid to use your resources. Go back to your licensing worker. Seek out again, back to receiving more education. 
Mitzi Lee:	Pam, behavior and guidance is not just about some things you shouldn't do but you can do some things to help stage it, to prevent some things from happening. Pam Ramming:	You're right Mitzi. I like to talk about the difference between prevention and intervention. It's the whole, you can exercise and keep from having a heart attack, or you can do CPR. Part of behavior and guidance is having a good exercise program. Our exercise program would be how you set up your environment. Having a solid schedule, lots of planning and pre-organization of your materials. Pre-organization of the meals that you're preparing. All of that pre-organization sets the stage for a good day with children. You're less agitated because you haven't got the meat cooked, that you need for lunch when somebody needs you, to help them with their painting project. 
Mitzi Lee:	So planning, really can help. Also being sure your assistant caregiver is on board and on the same page as you, as well as any substitute that might be with the children should you have to be away. 
Pam Ramming:	Following your consistent behavior and guidance plan. Having them using the same words that you're using. It's different to say, "Don't run in the house and use your walking feet." It's two different languages for children. We have to embrace that and make sure everybody's using a consistent language and a consistent consequence, for any behavior that you would have, that needed an intervention, instead of a prevention. 
Mitzi Lee:	Telling children what to do, instead of, "No, don't do this."
 Pam Ramming:	Absolutely. 
Mitzi Lee:	Pam let's focus a little bit on some of the high points that we know from licensing can come up, occasionally. Not all of the time. Punishment, not being associated with food, rest, or toileting. That is a biggie. 
Pam Ramming:	Three hot places. Nobody likes when children have accidents, accidents are messy. The most proactive thing you can do is, re-engage those children to take care of themselves, to clean themselves, to clean up there messes. Which are age appropriate in the expectations that you have. Around food, there's lots of things that children have never experienced before, so they're not going to try and they're not going to eat. We have to offer those things and not enforce that children, eat everything. They need to have some on their plate ... 
Mitzi Lee:	Sample some things. Try it. 
Pam Ramming:	Look at it. It can be on your plate but you don't have to eat everything that's given to you. Not eating your broccoli shouldn't keep you from having your dessert, either.
Mitzi Lee:	That's right, or the flip side of that, "You have done this today and that was an issue, so you don't get snack," or "You don't get dessert," or "You've done this and I'm going to send you to bed." Things that are not appropriate. 
Pam Ramming:	The other thing Mitzi is nap time is always an issue in childcare. Around three and four, children stop wanting to cooperate at that time. That's another huge place that we see, childcare issues is putting kids on their cots when it's not nap time, or forcing kids to stay on their cot way past the right amount of time. Establishing good routines and having a good plan of, "You can read a book. You can listen to some soft music." There's lots of things you can do to be quiet, while other children rest. Not engaging in that power struggle, becomes a hard topic for providers but an important topic for kids. 
Mitzi Lee:	One other thing too, around this eating is that to put a child in a high chair maybe as a time out, or something like that. Certainly a smaller child. That could associate punishment with food, if a younger child eats in that high chair. You need to be careful about that too because children can identify then, I got in trouble and now I'm in the high chair. 
Pam Ramming:	People don't understand what discipline is. Discipline means to teach, it does not mean to punish. People think that by punishing children by using timeout, by using all of these other techniques that we're talking about. That's not what teaching is about. Teaching is about, teaching the appropriate thing that you're expecting of children. There's an a famous NAEYC president who said, "If a child doesn't know how to read. We teach them. If a child doesn't know how to multiply, we teach them. If a child doesn't know how to drive, we teach them but if a child doesn't know how to behave, we punish." It makes us come back and think about, what discipline means and how to go about those techniques. How to teach children, what it is our expectations are and what it is we're looking for, in their behavior. Mitzi Lee:	Timeout has been very popular. It may work with one child and not work with another. It is certainly not the only method, to use. 
Pam Ramming:	It gets so overused. A child should not be spending the majority of their day, in timeout. 
Mitzi Lee:	I'm very glad you brought that up because your requirements are very specific, about the length of time. Pam one other thing, is being careful that chores, or excessive exercise is not used as a method of behavior and guidance. 
Pam Ramming:	Actually, chores are fun for children Mitzi. 
Mitzi Lee:	Well it's responsibility, not punishment. 
Pam Ramming:	Exactly. That's how we should be using it. We should have our chore chart and all of the jobs that we assign children everyday but our children shouldn't be doing our yard work. They shouldn't be cleaning our house for us. They should be cleaning the table, after they've eaten at it. They should be learning personal responsibility at the ages that our children, are in childcare. All those extra jobs and that excessive, exercise and that excessive work, doesn't have a place in our daily routine. 
Mitzi Lee:	It goes back to this cleaning up after yourself. Goes back to this whole teaching philosophy. 
Pam Ramming:	Yes it does. That's what young children in childcare, are at that prime learning age. They're ready to learn all those exciting adult activities that we do. They think doing the dishes is actually fun. Threatening becomes one of those issues that goes along with consistency. That we as women, have a tendency to threaten and threaten and then follow through with what we've asked children to do. One of the key factors of consistency is to ask children, to tell children and then to follow through with the words that have come out of your mouth. 
Mitzi Lee:	One other thing about threatening is, you will not be able to spank children but you would not want to threaten and should not threaten, to spank children. Even though you might not carry that out. 
Pam Ramming:	Absolutely. 
Mitzi Lee:	Pam, a few closing thoughts. Licensing is a partner and a good resource to help with any training, resources, materials, around this subject as well as anything else. 
Pam Ramming:	If I could give you a few final thoughts to the providers out there. The one thing I would say to you is take good care of yourself. Your health, your rest, your well being is not only now important to you and your family, but to the children that you care for and the parents that are dependent upon you for care. The other thing I would always remind families, is that outside play does make a difference. 
Mitzi Lee:	Pam thank you so much. This is an important topic. It's a complicated topic and you have been so helpful. 
Pam Ramming:	Thank you for having me. 
Mitzi Lee:	You're welcome. 
David:	I want to thank all of our guests for helping us illustrate, the important methods for keeping children safe and healthy. Each of them added to our knowledge and we appreciate them. I need to remind you, that you must be very familiar with the requirements, in this book.  

[NO AUDIO]
Licensing Requirements
for Family Child Care Homes and
Large Child Care Homes
Oklahoma Department of Human Services
Oklahoma Child Care Services

Your family childcare home, or large family childcare home, must comply with the licensing requirements. Finally, I want to thank you for watching. We're extremely happy you've chosen to open your homes to children and families. The safety, security and love you provide to them, will help them, as they make their way to adulthood. Keep up the good work. Goodbye.