The Science Behind the American Public Health Association/American Academy of Pediatrics National Health and Safety Guidelines for Child-Care Programs

Abstract

THE DEVELOPMENT OF THE APHA/AAP STANDARDS In 1992, the American Public Health Association (APHA) and the American Academy of Pediatrics (AAP) published the long-awaited Caring for Our Children—National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs.1 This publication was the product of a 4-year effort involving many experts in child health and safety and day-care providers. The standards document provides a national consensus on approaches to reducing diseases and injury and promoting prevention among children and providers in group-care settings. Consumer protection initiatives are needed because market-place forces are inadequate to ensure a health environment for children in child care. Over the past two decades, a growing number of investigators have documented the increased occurrence of infectious diseases2-4 and injuries,5-7 and missed opportunities for health protection and promotion in child care.8 Despite the tendency to focus on reports of negative health outcomes, children and families thrive in early childhood programs that provide safe, nurturing care and developmentally appropriate education. Day-to-day excellence in child care depends on committed, well-educated care givers who work in a child-friendly and staff-friendly environment. In the US, good child care is limited. Few parents can afford the full cost of care. Most lack the knowledge, skills, or objectivity to critically evaluate the care they choose for their children. Convenience, availability, and affordability motivate parents when they choose child care. Parents are pressured to meet occupational expectations, and tend to overlook significant risks in their children's child-care arrangements. Even parents who are pediatricians (who are expected to be well-versed in child development, health, and safety) ignore hazards and poor quality when rating convenient and available child-care arrangements (Aronson S, unpublished data).