Implementation of the Early-Onset Sepsis Risk Calculator at a Community Level I Nursery.

The objective of this retrospective cohort study was to decrease the frequency of laboratory draws and the number of neonates receiving empiric antibiotics who are born to mothers with chorioamnionitis from 100% to 50% 6 months following implementation of the sepsis risk calculator (SRC) at a level 1 community nursery. Data were compared pre- and post-implementation of the SRC using the Fischer's exact test. The rate of intravenous (IV) antibiotic use decreased from 93% to 7% (P < .0001). The rate of blood culture collection decreased from 100% to 46% (P < .0001). With implementation of the SRC, administration of IV antibiotics, laboratory draws, and IV placement significantly decreased without increasing rates of early-onset sepsis in our patient population. Our study demonstrated that the SRC can be effectively and safely implemented at a level 1 community-based newborn nursery, resulting in a decrease in unnecessary medical treatment without negative patient outcomes.

Implementing Mitigation Strategies in Early Care and Education Settings for Prevention of SARS-CoV-2 Transmission - Eight States, September-October 2020.

The Head Start program, including Head Start for children aged 3-5 years and Early Head Start for infants, toddlers, and pregnant women, promotes early learning and healthy development among children aged 0-5 years whose families meet the annually adjusted Federal Poverty Guidelines* throughout the United States.† These programs are funded by grants administered by the U.S. Department of Health and Human Services' Administration for Children and Families (ACF). In March 2020, Congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act,§ which appropriated $750 million for Head Start, equating to approximately $875 in CARES Act funds per enrolled child. In response to the coronavirus disease 2019 (COVID-19) pandemic, most states required all schools (K-12) to close or transition to virtual learning. The Office of Head Start gave its local programs that remained open the flexibility to use CARES Act funds to implement CDC-recommended guidance (1) and other ancillary measures to provide in-person services in the early phases of community transmission of SARS-CoV-2, the virus that causes COVID-19, in April and May 2020, when many similar programs remained closed. Guidance included information on masks, other personal protective equipment, physical setup, supplies necessary for maintaining healthy environments and operations, and the need for additional staff members to ensure small class sizes. Head Start programs successfully implemented CDC-recommended mitigation strategies and supported other practices that helped to prevent SARS-CoV-2 transmission among children and staff members. CDC conducted a mixed-methods analysis to document these approaches and inform implementation of mitigation strategies in other child care settings. Implementing and monitoring adherence to recommended mitigation strategies reduces risk for COVID-19 transmission in child care settings. These approaches could be applied to other early care and education settings that remain open for in-person learning and potentially reduce SARS-CoV-2 transmission.

Safety and Health Innovation in Preschools: A Total Worker Health Pilot Project.

OBJECTIVE: The primary objective of this study was to evaluate quality of work life in early childhood education (ECE) centers and implement a total worker health (TWH) pilot project with a small sample of ECE teachers. METHODS: An evidence-based strategic planning process to make policy, system, and environmental (PSE) changes related to TWH was implemented with six ECE centers. A pre-post design with mixed-methods was used to evaluate the impact. RESULTS: Baseline findings suggest that there are significant disparities related to quality of work life among ECE teachers compared with the national population. After implementation of the pilot project, ECE centers averaged 4.7 PSE changes. Qualitative data informed facilitators and barriers to implementation of TWH-related changes. CONCLUSIONS: This pilot project reflects an evidence-based participatory approach to assessing and improving the well-being of ECE teachers.

From Clinic to Classroom: A Community Health Center-Based Program to Assist Families in Accessing Pre-K in New York City.

Medical homes are an underused resource to promote enrollment in high-quality early education in urban areas. This report summarizes a newly implemented, unique, and replicable community health center-based outreach program designed to help families apply to and enroll in Pre-K programs in the South Bronx region of New York City.

Nutrition practices in nurseries in Poland - initial results of nationwide study

Background: Rational nutrition of infants and toddlers is essential for their normal growth and development, and for the development of proper nutritional habits. It should be preceded by proper planning. Objective: The aim of the study was to evaluate of the planning and organization of nutrition in nurseries. Material and methods: In the research conducted within the program "Eating healthy, growing healthy" (EHGH), 128 crèches from all over Poland participated. The nurseries were attended by 8182 children under the age of 3. The research was carried out between 2015 and 2016. Data on the organization and quality of nutrition were collected through direct interviews with directors and / or staff responsible for feeding in crèches. In addition, analysis of the decade's menu of the participating institutions (128 menus) and daily inventory reports (1280 documents) were analyzed. The data were analyzed for the total number and the type (public and non-public) of institution. The program Statistica Version 13.1 was used. Results: Half of the surveyed DCCs planned in the menu whole grains, nearly all of them served fresh vegetables and fruits to the children, and every third added them to every meal. The most common drink during the meal was compote. Access to water between meals was offered to children in majority of the DCCs. The quality of diet was differentiated by the type of nursery: depending on the type (public vs non-public), the differences in salting and sweetening meals have been shown. Public DCCs had a much lower average amount of money allocated per day to feed a child compared to non-public, most of these managed own kitchens and did not employ a dietitian. Despite the higher nutritional rates in non-public crèches, some errors in nutrition planning have been observed. Conclusions: Higher average amount of money allocated per day to feed a child in non-public nurseries did not provide adequate nutrition. There is a need to publish standardized, understandable and practical recommendations in nutrition of children in nurseries. Adopting such recommendations in daily practice in all public and non-public crèches should improve the nutrition of children.

The South African universal preschool year: a case study of policy development and implementation.

BACKGROUND: South Africa is the first sub-Saharan African country to legislate, fund and implement free preschool education. Human rights and restitution were at the forefront of the political struggle for democracy in South Africa. Levelling the playing fields by improving the school readiness of children disadvantaged by the racist policies of Apartheid is essential to the transformation of South African society. METHODS: A review of published and unpublished documents on Grade R was undertaken, and access and enrolment data come from the National Department of Basic Education's Education Management Information System (EMIS). RESULTS: A decade after initiation in 2005, 79% of 5-year-olds was enrolled in a preschool class; the vast majority of them in free public schools. Grade R is near universal and on track to becoming compulsory. It is part of the Foundation Phase (Grades 1-3) of schooling, falling under the Department of Basic Education, but also part of a broader national strategy to improve early child development under the direction of an Inter-Departmental Steering. Evaluations demonstrate wide access to Grade R and high uptake, especially in the poorest areas. However, the quality of Grade R provision in these areas is not up to standard because of low levels of funding; inadequate training, supervision, remuneration and retention of Grade R teachers; insufficient learner support materials; and inadequate monitoring and quality assurance. CONCLUSIONS: Lack of quality, amongst other factors, contributes to a widening school performance gap between children from more and less privileged areas. Quality of Grade R as well as earlier learning and subsequent years of schooling must be improved to achieve South Africa's aim to reduce poverty and inequality through, amongst others, parent and family involvement, learning in the home and preschool preparation.

India's integrated child development services scheme: challenges for scaling up.

BACKGROUND: India had around 158 million children under the age of 6 and about 26 million births in 2015. In the same year, India's Integrated Child Development Services Scheme served about 82 million children under 6 years and over 19 million pregnant women and lactating mothers. These 102 million beneficiaries received services in about 1.3 million centres. METHOD: This paper reviews the growth of the Scheme and considers challenges to scaling up quality with equity based on results of large-scale national or multistate studies. RESULTS: The Scheme is associated with decreased malnutrition and better child development. The size and diversity of the country, the policy context, funding mode and lack of community awareness and engagement have hindered scaling up access while the approach to service delivery, low institutional capacity and poor infrastructure have impeded scaling up of implementation quality. CONCLUSIONS: This review illustrates the challenges associated with scaling-up access and implementation quality of a multicomponent, integrated early childhood programme in a large, diverse country. The future success of the Integrated Child Development Services will depend on how well it adheres to quality standards and how well it evolves to address current weaknesses.

Promotion of Preventive Measures in Public Nursery Schools: Lessons From the H1N1 Pandemic.

Nursery schools serve as reservoirs of transmission of infectious diseases, and teachers should be able to implement and monitor hygiene measures to prevent them. The aim of the present study was to assess the compliance of nursery school teachers on promoting preventive interventions and to identify associated factors, during the novel H1N1 influenza pandemic. A secondary objective was to evaluate their knowledge and vaccination status regarding the novel virus. A cross-sectional study was performed, with the use of a predesigned anonymous, questionnaire, and distributed to all public nursery teachers of Athens, Greece. General etiquette practices were highly acceptable to over 92% of teachers. Those with longer teaching experience promoted simple preventive measures, such as hand washing and use of hand sanitizer, more often while older children were more likely to familiarize with them. However, teachers presented inadequate knowledge concerning the novel virus and their vaccination rates with the pandemic vaccine were unacceptably low (1.1%). Our study showed that promotion of simple preventive measures is feasible and may contribute to the prevention of outbreaks in nursery schools, although knowledge gaps and fear concerning the pandemic vaccine highlight communication issues.

[Hygienic principles of the design of the space and architectural environment of kindergartens].

In the article there are considered current requirements for the design of the architectural environment of preschool institutions. These requirements provide conditions ofpreservation and promotion of health ofpreschool children. Among them are: the association of rooms according to a functional purpose; division of children collectives according to the age; rational placement of main rooms for the prevention ofpenetration of noise and pollution; ensuring convenientfunctional connections between different premises and group rooms and the parcel ofpreschool institutions; optimal solution of the light mode; rational air and thermal mode. There are made proposals for the expansion of the list of hygienic principles of the design of buildings of kindergartens: provision of conditions for realization of physical activity of children, the safe use of electronic educational equipment, and the creation of the barrier-free environment. There was established the insufficiency of areas of group rooms for the realization of voluntary motor activity of children in modern kindergartens and the need of the revision of the standard of the area of the group room per one child.

Systematic dissemination of a preschool physical activity intervention to the control preschools.

For public health interventions to have a meaningful impact on public health, they must be disseminated to the wider population. Systematic planning and evaluation of dissemination efforts can aid translation from experimental trials to larger dissemination programs. The Study of Health and Activity in Preschool Environments (SHAPES) was a group-randomized intervention trial conducted in 16 preschools that successfully increased the physical activity of preschool age children. Following the completion of the research study protocol, the intervention was abbreviated, modified and implemented in four preschools that participated as control preschools in the original research study. The purposes of the current study were to describe the process of refining the intervention for dissemination to the control preschools, and to assess the acceptability of the resulting abbreviated intervention delivery. Five overarching behavioral objectives, informed by process evaluation, data from the original trial and collaboration with intervention teachers, were used to guide the implementation. Teachers in the dissemination classrooms reported high levels of acceptability, potential for sustainability of the program, and positive results in knowledge, skills, and child outcomes. Researchers can include a systematic approach to dissemination of effective intervention elements to the control participants in experimental studies to inform future dissemination efforts and begin to bridge the dissemination gap.

Systematic review of the relationship between childcare educators' practices and preschoolers' physical activity and eating behaviours.

The role of childcare educators is important given that 81% of preschoolers living in developed countries receive childcare outside their home. Since children learn by observing and imitating others, childcare educators may play a role in promoting healthy eating behaviours and physical activity in young children. Six databases were searched for quantitative peer-reviewed, English or French primary studies reporting the correlates, predictors or effectiveness of childcare educators' practices on preschoolers' healthy eating and physical activity behaviours. Risk of bias was assessed using the Quality Assessment Tool for Quantitative Studies. Fifteen articles were included in this review: 10 measured physical activity levels and five assessed eating behaviours. The quality score was rated as low for eight of these articles, and as moderate for the remaining seven. Two of four cross-sectional studies reported a positive relationship between educators and children's behaviours. Eleven intervention studies reported significant favourable effects of interventions. Educators may play a positive role in promoting healthy behaviours in children, but this is mainly based on a small number of intervention type studies of low or moderate quality. The influence of specific components of educators' practices on children's healthy eating and physical activity behaviours remains inconclusive.

Psychometric properties of the Young Children's Participation and Environment Measure.

OBJECTIVE: To evaluate the psychometric properties of the newly developed Young Children's Participation and Environment Measure (YC-PEM). DESIGN: Cross-sectional study. SETTING: Data were collected online and by telephone. PARTICIPANTS: Convenience and snowball sampling methods were used to survey caregivers of children (N=395, comprising children with [n=93] and without [n=302] developmental disabilities and delays) between the ages of 0 and 5 years (mean age±SD, 35.33±20.29 mo) and residing in North America. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The YC-PEM includes 3 participation scales and 1 environment scale. Each scale is assessed across 3 settings: home, daycare/preschool, and community. Data were analyzed to derive estimates of internal consistency, test-retest reliability, and construct validity. RESULTS: Internal consistency ranged from .68 to .96 and .92 to .96 for the participation and environment scales, respectively. Test-retest reliability (2-4 wk) ranged from .31 to .93 for participation scales and from .91 to .94 for the environment scale. One of 3 participation scales and the environment scale demonstrated significant group differences by disability status across all 3 settings, and all 4 scales discriminated between disability groups for the daycare/preschool setting. The participation scales exhibited small to moderate positive associations with functional performance scores. CONCLUSIONS: Results lend initial support for the use of the YC-PEM in research to assess the participation of young children with disabilities and delays in terms of (1) home, daycare/preschool, and community participation patterns; (2) perceived environmental supports and barriers to participation; and (3) activity-specific parent strategies to promote participation.

Validation of environmental content in the Young Children's Participation and Environment Measure.

OBJECTIVE: To evaluate the concurrent validity of the environment content in the newly developed Young Children's Participation and Environment Measure (YC-PEM). DESIGN: Cross-sectional study. SETTING: Data were collected online. PARTICIPANTS: Convenience and snowball sampling methods were used to survey caregivers of children (N=381; 85 children with developmental disabilities and delays and 296 children without developmental disabilities and delays) aged 0 and 5 years (mean age, 36.49±20.18 mo). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The YC-PEM includes an assessment of the effect of environment on children's participation for 3 settings: home, daycare/preschool, and community. Pearson and Spearman correlational analyses were used to examine the concurrent validity of the YC-PEM environmental content according to a criterion measure, the Craig Hospital Inventory of Environmental Factors-Child and Parent Version (CHIEF-CP). The YC-PEM and the CHIEF-CP items were first mapped to the International Classification of Functioning, Disability, and Health-Children and Youth Version to identify items for pairwise comparison. RESULTS: We found small to moderate negative associations for 51 of 66 pairwise comparisons involving CHIEF-CP and YC-PEM environment items (r=-.13 to -.39; P<.01). Significant associations were found for items in all 5 International Classification of Functioning, Disability and Health-Children and Youth Version environmental domains. CONCLUSIONS: Results lend further support for the use of the YC-PEM for valid caregiver assessment of the physical, social, attitudinal, and institutional features of environments in terms of their effect on young children's participation within the home, daycare/preschool, and community settings.

Oral health determinants and caries outcome among non-privileged children.

The study aimed at identifying oral health determinants that are present in early childhood, are amenable to change and for which there is evidence of their modulation of the rate of caries progression in a sample of non-privileged children. The null hypothesis was that determinants associated with the child's institutional environment as evidenced by nursery policies significantly influenced the child's oral health. The sample was formed by 2,511 Brazilian 1-5-year-olds. Caries severity and activity were recorded. Parents were interviewed and nurseries answered a questionnaire. According to the case status d1efs, the final multilevel model (generalized linear mixed model) identified significant associations with determinants such as bottle-feeding the child during the night on demand, not assisting the child in toothbrushing, ensuring visit to the dentist in case of troubles with teeth only (p < 0.0001) and intake of sugary products 2-4 times daily at nursery (p = 0.026). The likelihood of caries outcomes was associated with determinants related to nursery policies, not promoting preventive oral health care for children of mothers with 4 years of education (OR = 2.14; p < 0.0015) and <4 years of education (OR = 2.6; p = 0.0010), as well as consumption of sugary products 2-4 times daily for children of mothers with 4 years of education (OR = 3.35; p = 0.0010) and <4 years of education (OR = 4.07; p = 0.0063). In conclusion, determinants related to parental negative practices and to nursery policies significantly influenced children's oral health. Of particular interest was the identification of determinants considered amenable to change in connection with nursery policies towards oral health.

A comparison on inclusive practices for children with special needs in faith-based kindergartens in Hong Kong.

This qualitative study aimed to examine the inclusive practices implemented in three faith-based kindergartens in Hong Kong. A questionnaire was used to collect information about school backgrounds, students' special needs, teacher training, special education services, curriculum design, school policy, parental involvement, and challenges faced by these schools when implementing their inclusive practices. The primary focus of this study was the influence of faiths on the provision of inclusive services for children with special needs. The results indicated that faiths, along with other factors, have played a significant role in contributing to the inclusive education services provided to children in these schools.

Is something better than nothing? An evaluation of early childhood programs in Cambodia.

This study evaluated the relative effectiveness of home-based, community-based, and state-run early childhood programs across Cambodia. A total of 880 five-year-olds (55% girls) from 6 rural provinces in Cambodia attending State Preschools, Community Preschools, Home-Based Programs, or no programs were assessed twice using the Cambodian Developmental Assessment Test. Controlling for baseline differences, children who participated in any early childhood programs performed significantly better in posttest than those of children who did not participate in any programs. Children in State Preschools scored significantly higher than those in either Community Preschools or Home-Based Programs; scores did not differ as a function of attending Community Preschools or Home-Based Programs. The results indicate that some preschool experience is better than none at all.

Changing nonmainstream American English use and early reading achievement from kindergarten to first grade.

PURPOSE: This study had 2 principal aims: (a) to examine whether children who spoke Nonmainstream American English (NMAE) frequently in school at the end of kindergarten increased their production of Mainstream American English (MAE) forms by the end of first grade, and (b) to examine concurrent and predictive relations between children's NMAE use and reading skills. METHOD: A longitudinal design was implemented with 49 children who varied in their spoken NMAE production in kindergarten. Word reading, phonological awareness, and receptive vocabulary skills were measured at both time points. RESULTS: Analyses indicated that most children significantly increased their production of MAE forms between the 2 time points; however, this change was not associated with change in letter-word reading and phonological awareness skills. Regression analyses showed that NMAE use in kindergarten contributed significantly and independently to the variance in word reading in first grade, even after accounting for phonological awareness (although word reading in kindergarten was the best predictor of word reading in first grade). CONCLUSIONS: The findings extend previous reports of a significant relation between NMAE use and reading among young children. Theoretical, research, and educational implications of the findings are discussed.

Predictors of second language acquisition in Latino children with specific language impairment.

PURPOSE: This study evaluated the extent to which the language of intervention, the child's development in Spanish, and the effects of English vocabulary, use, proficiency, and exposure predict differences in the rates of acquisition of English in Latino children with specific language impairment (SLI). METHOD: In this randomized controlled trial, 188 Latino preschoolers with SLI participated in a small-group academic enrichment program for 12 weeks and were followed up 3 and 5 months later. Children were randomly assigned to either a bilingual or an English-only program. Predictors of English growth included measures of Spanish language skills and English vocabulary, use, proficiency, and exposure. Performance on English outcomes (i.e., picture description and narrative sample) was assessed over time. A series of longitudinal models were tested via multilevel modeling with baseline and posttreatment measures nested within child. RESULTS: Children demonstrated growth on the English outcomes over time. The language of intervention, Spanish skills, English vocabulary, and English use significantly predicted differences in rates of growth across children for specific measures of English development. CONCLUSIONS: This study underscores the role of the child's first language skills, the child's level of English vocabulary development, and level of English use for predicting differences in English acquisition in Latino preschoolers with SLI. These factors should be carefully considered in making clinical decisions.