Caring for Our Children: National Health and Safety Performance Standards
xxiv New and Significant Changes
Most of the 3rd Edition CFOC Standards have had some
changes. Below are those standards and appendices that
are new in the 3rd Edition or have had significant updates/
changes to the content since the 2nd Edition.
Standard Ratios for Large Family Child Care.
Lowered ratios for infants and toddlers to be more in line
with small family child care.
Standard Minimum Age to Enter Child Care
NEW. Recommends healthy full-term infants can be safely
enrolled in child care settings beginning at three months of
age. Reader’s Note: This standard reflects a desirable goal
when sufficient resources are available; it is understood that
for some families, waiting until three months of age to enter
their infant in child care may not be possible.
Standard Background Screening. Changed termi-
nology from background checks to background screening.
Standard First Aid and CPR Training for Staff.
Updated to be in compliance with the American Health As-
sociation’s 2010 recommendations on CPR.
Standard Early Childhood Mental Health Consul-
tants NEW. Recommends consultants engage with a mini-
mum of quarterly visits, and outlines experience, knowledge
base, and role of the mental health consultant.
Standard Early Childhood Education Consultants
NEW. Recommends consultants engage with a minimum
of semi-annual visits, and outlines the experience, knowl-
edge base, and role of an education consultant.
Standard Coordinated Child Care Health Pro-
gram Model NEW. Provides guidelines for coordinating
care, including eight interactive components.
Standard Monitoring Children’s Development/
Obtaining Consent for Screening NEW. Defines the role
of caregivers/teachers in monitoring a child’s development,
and includes policies on developmental screening, and
sharing observation with parents/guardians.
Standard Transitioning within Programs and
Indoor and Outdoor Learning/Play Environments NEW.
Recommends ensuring positive transitions for children when
entering a new program and beginning new routines or
activities within existing program.
Standard Limiting Infant/Toddler Time in Crib,
High Chair, Car Seat, etc. NEW. Guidelines to specific
limit of time children should be confined in equipment.
Standard Limiting Screen Time - Media, Com-
puter Time NEW. Provides specific limits outlined by age
group and recommends what screen time is allowed be free
of advertising. Also includes two exceptions.
Standard Supervision Near Bodies of Water.
Adds concept that supervising adult is within an arm’s
length, providing, “touch supervision.”
Standard Discipline Measures. Enhanced with
information on positive behavior management and very
limited use of time-out.
Standard Handling Physical Aggression, Biting,
and Hitting. Enhanced with more guidance on biting.
Standard Preventing Expulsions, Suspensions,
and Other Limitations in Services NEW. Includes recom-
mends procedures and policies for handling challenging
behaviors to minimize expulsions.
Standard Using Physical Restraint. Updates
language on what a care plan should cover for the rare ex-
ception of a child with a special behavioral or mental health
issue that may exhibit a behavior that endangers his/her
safety and others.
Standard Staff Modeling of Healthy and Safe
Behavior and Health and Safety Education Activities.
Enhanced with examples in the area of nutrition and physi-
cal activity.
Standard Routine Health Supervision and Growth
Monitoring. Updated to include tracking BMI.
Standard Active Opportunities for Physical Activ-
ity NEW. Includes number, type, and frequency of physical
activity by age group.
Standard Protection from Air Pollution while
Children are Outside NEW. Recommends frequency of
checking air quality index.
Standard Caregivers’/Teachers’ Encouragement
of Physical Activity NEW. Recommends staff promotion
of children’s active play throughout the day.
Standard Safe Sleep Practices and SIDS/Suffo-
cation Risk Reduction. Updated with new information on
inappropriate infant sleeping equipment, pacifier use and
Standard Swaddling NEW. Recommends that
swaddling is not needed in child care settings.
Standard Pacifier Use NEW. Follows current
American Academy of Pediatrics’ recommendations and
recommends written policy on use.
Standard Toothbrushes and Toothpaste. Includes
addition that toothbrushes should be replaced at least every
three to four months.
Standard Procedure for Changing Children’s
Soiled Underwear/Pull-Ups and Clothing NEW. Outlines
procedure consistent with and complimentary to the diaper
changing procedure.
Standard Hand Sanitizers NEW. Describes ap-
propriate use of hand sanitizers as alternative to traditional
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