Fall Newsletter September 2005
In this issue
  • Giving Advice to Families on Quality Child Care- Anne Broussard
  • Toilet Training Readiness- Anne Broussard
  • Systematic Childhood Injury Prevention Program- Annelee Gallegos
  • New Child Safety Website Education for Parents- Jamie McDonald
  • AAP and MOMS Collaborative- Pam Pimentel
  • Oral Health Matters During Holiday Times- Diane Limbo
  • Greetings!


    • Phyllis Agran, MD, MPH, FAAP – California Chapter 4, AAP Injury Prevention Program Executive Director
    • Jamie McDonald, MPH, CHES – Program Director
    • Deborah Monfea – California Chapter 4, AAP Executive Director
    • Annelee Gallegos – Health Educator
    • Bethi Luu – Administrative Assistant

    Additional Newsletter Contributors:

    • Anne Broussard - Child Care Coordinator for the County of Orange
    • Pam Pimentel, RN, Executive Director - Maternal Outreach Management Systems (MOMS)
    • Diane Limbo, RN, CPNP - Director of Health Integration for Healthy Smiles for Kids of Orange County

    Giving Advice to Families on Quality Child Care- Anne Broussard

    Parents, family and friends often ask early childhood professionals about selecting good quality child care. The American Academy of Pediatrics (AAP) has standards for child care. The AAP website, AAP brochures and the AAP book, Caring for Your Baby and Young Child Birth to Age 5 contain detailed information.

    The research shows that the most important components of quality are the educational level of the provider, the child to staff ratios, and the size of the group.

    According to AAP Guidelines, there should only be three children under the age of two years for every adult and only six infants in the total group. Toddlers should have a 4:1 ratio and only 8-10 in the group; and preschool age children should have a ratio of 8:1 with only 16 in the group. This is the ideal situation and it is far better than what the State allows in the licensing regulations.

    Parents should observe the staff with the children. Does the staff appear to enjoy caring for them? Do the children appear to be happy? Is the noise level in the child care area comfortable? Do the adults and the children talk with others often? Are the children encouraged to talk with each other? Is the television watching time limited to short periods? Parents should also look at the space where the children play. Is it clean, cheerful, and well ventilated? Is the equipment well maintained? Is the indoor space large enough? Parents should be allowed to come and visit anytime. They should also be allowed to have full access to all of the areas that the children use during the day.

    AAP offers a comprehensive document called "Caring for Our Children National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs," that is the most rigorous health and safety standards established for young children.

    (You may reproduce this article for your patient families and refer them to the AAP website and booksotre. For the book, Caring for Your Baby and Young Child Birth to Age 5,visit http://www.aap.org)

    Toilet Training Readiness- Anne Broussard

    Bowel and bladder control are necessary social skills. Teaching children to use the toilet takes time, understanding, and patience. The important thing to remember is that you cannot rush children into using the toilet. There is no set age at which toilet training should begin. The right time depends on each child's physical and psychological development. Between 18 and 24 months, children often start to show signs of being ready, but some children may not be ready until 30 months or older.

    Each child must also be emotionally ready. He needs to be willing, not fighting or showing signs of fear. If the child resists strongly, it is best to wait for a while. Stress in the home may make learning this important new skill more difficult. Sometimes it is a good idea to delay toilet training in the following situations: the family has just moved or will move in the near future, the family is expecting a baby or have recently had a new baby, there is a major illness, a recent death, or some other family crisis. It is best to be relaxed about toilet training and avoid becoming upset. Remember that no one can control when and where a child urinates or has a bowel movement except the child.

    Advise parents to try to avoid a power struggle. Most children achieve bowel control and daytime urine control by 3 to 4 years of age. Even after the child is able to stay dry during the day, it may take months or years before she achieves the same success at night. Most girls and more than 75% of boys will be able to stay dry at night after age 5. It is best to use proper terms to describe body parts, urine, and bowel movements that will not offend, confuse, or embarrass the child or others. Ask the parents what terms they use at home. Treat bowel movements and urination in a simple, matter-of-fact manner. The AAP book, Guide to Toilet Training, provides additional information available from the bookstore at http://www.aap.org.

    If any concerns come up before, during, or after toilet training, talk with each family individually and ask them to talk to their pediatrician. Often the problem is minor and can be resolved quickly, but sometimes physical or emotional causes will require treatment. Pediatricians are trained to identify and manage problems that are more serious.

    (You may reproduce this article for your patient families.)

    Systematic Childhood Injury Prevention Program- Annelee Gallegos

    Hello, my name is Annelee Gallegos and I am the Health Educator for our Systematic Childhood Injury Prevention Program (SCIPP). SCIPP is designed to increase the quality, consistency and efficiency of injury prevention counseling and education by health care professionals through:

    • Implementation of an integrated system for injury prevention counseling in various health care settings
    • Injury prevention educational presentations and technical support for both providers and patients
    • development and dissemination of culturally and linguistically appropriate injury prevention tools and materials to support patient counseling and education

    As a member of the California Chapter 4, AAP you may become a site at no charge. You will receive a combination of injury prevention materials, services and resources for children 0 - 5 years delivered to your office by our SCIPP staff. Resources are in English, Spanish and Vietnamese and include:

    • Age/developmentally appropriate parent brochures
    • Injury prevention DVD or video
    • Car seat and pool safety posters to post in your office
    • Parent handouts on car seats and pool safety
    • Promotional magnets to give to your parents, promoting our web site parent pages
    As a SCIPP site you are also recognized on the California Chapter 4, AAP Injury Prevention Program website (www.ockeepkidssafe.org), as well as in our quarterly newsletter.

    We currently have over 62 SCIPP sites in Orange County. If you are interested in becoming a SCIPP site, please contact me at: (714) 971-0695 or email me at amgallegos@sbcglobal.net. I look forward to working with you.

    New Child Safety Website Education for Parents- Jamie McDonald

    Helping to prevent childhood injury through public education, the California Chapter 4, American Academy of Pediatrics Injury Prevention Program is pleased to present a new and exciting edition to the "Keeping Children Safe" website (www.ockeepkidssafe.org): the "Keeping Children Safe Parents Page." This new web page for parents is an interactive multimedia approach to educating parents about safety for their newborn to 6 year-old child. "Jack and Jill" (of nursery rhyme fame) lead you to their home. Areas in and around the home are highlighted with small, bouncing balls. When a ball is clicked, it opens a captioned streaming video vignette depicting common child injury risks and how to prevent them. A Spanish version of the "Keeping Children Safe Parents Page" is also available on the site.

    The Parents section is accessed from the home page by clicking the “Parents Page” tab at the top of the home page.

    The "Keeping Children Safe Parents Page" on the Injury Prevention Program website is just one of the many informative and helpful resources found on the site. Print materials in English, Spanish and Vietnamese may be downloaded and printed at no charge; users may browse our Online Injury Prevention Resource Guide, and also may view upcoming events and services in the county via the Events page. "If Jack and Jill sustain head trauma from a fall, travel unrestrained in a motor vehicle, burn down their legendary hill, or can't get up the hill because they are overweight and physically unfit, they're prime candidates to sustain a fatal or cognitive and/or physical disability requiring special education services," says Phyllis Agran, MD Executive Director of the Injury Prevention Program. "To quote Benjamin Franklin: 'An ounce of prevention is worth a pound of cure.' In these times, that is a substantial amount of resources."

    AAP and MOMS Collaborative- Pam Pimentel

    The California Chapter 4, American Academy of Pediatrics (AAP) Injury Prevention Program is collaborating with Maternal Outreach Management Systems (MOMS) to study the effectiveness of the Systematic Childhood Injury Prevention Program (SCIPP) materials. MOMS has been utilizing SCIPP materials since 2002 and based on those materials, has developed an in-home safety assessment tool called the “FIRST” (Family Investment in Relationships, Safety and Trust).

    MOMS will conduct the FIRST tool for 800 mother- baby dyads who receive SCIPP materials. The two hypotheses that will be evaluated are: 1.) FIRST scores will improve significantly at each recurring home visit, regardless of number of siblings and 2.) that families with siblings age 2-5 years will have higher baseline FIRST scores than households with only 1 child. The data will be available for review in early 2006.

    Innovative ways to convey information and educate parents on caring for their children may enhance what can be done in the pediatric office and offer parents the opportunity for more detailed discussion. MOMS home visitation program offers an innovative way to offer anticipatory guidance.

    Maternal Outreach Management System (MOMS) was “born” in 1992. The mission of MOMS is to help women have healthy babies by providing support, health education and access to care. MOMS is a uniquely qualified community-based organization that provides access to prenatal care, health screenings, health education and support services to pregnant and parenting women in under-served communities in Orange County. MOMS has designed a low-cost, high impact alternative to traditional case management and health education using the community-based "Maternal Child Health Worker" medical model. MOMS staff provide a consistent level of support to pregnant and parenting mothers through group classes, home visits, and other contacts that are efficient in these frugal health care times. MOMS programs have a dual focus of “well- woman” care and infant development. During pregnancy, the program focuses on measures to increase the mother's chance of delivering a normal birth weight, full-term, healthy baby. After birth, the focus is on promoting the infant's healthy development by:

    • Establishing medical home
    • Tracking immunizations
    • Promoting nutrition
    • Tracking mother's "well-woman" care
    • Strengthening role of father
    • Screening for achievement of developmental milestones
    • Educating parents on early brain stimulation
    • Modeling positive play behavior
    • Enhancing parenting skills
    • Educating parents on childhood safety

    Oral Health Matters During Holiday Times- Diane Limbo

    “All I want for Christmas is my two front teeth” should not be the holiday song sung by young children who have incurred an injury where their teeth were damaged or lost prematurely.

    During the Christmas season, alert your patients' families to increased risks of burn injuries. Fire places, candles, lights and other ornaments are potential hazards. Here are a few messages to reduce the risk of mouth-related injuries:

    • Biting into a live electrical cord can deliver a high electrical shock. This shock could result in severe burns to the lips and mouth, cause cardiac arrhythmia, or cause internal organ damage
    • All children who receive a significant electric shock, should see a doctor
    • Do not give children under 10 years of age a toy that must be plugged into an electrical outlet
    • Lit candles should be kept high and out of reach of children
    • Avoid decorations that are sharp or breakable, resemble candy or food that may tempt a child to eat them and small removable parts to avoid swallowing or inhaling small pieces
    • Tricycles, scooters and other wheeled toys contribute to falls where there is always a high chance of damage to the mouth and teeth. Make sure the child has an appropriate helmet and wears it each time he or she rides

    Orange County Infolink 2-1-1
    2-1-1 is a telephone number that will have a positive impact throughout the system of health and human services.

    It is a free, accessible 3-digit telephone number that will enable everyone to access the vital community health and human services that they need.

    2-1-1 is to social services, what 9-1-1 is to emergency services.

    Orange County InfoLink 2-1-1

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