A Mixed-Methods Study of Early Childhood Education and Care in South Korea: Policies and Practices During COVID-19.

This study of South Korea's response to COVID-19 has three purposes. First, it uses document analysis to examine policies, strategies, and resources offered by the South Korean government and public organizations to support young children and families during the first 6 months of the pandemic. Next, it uses open-ended surveys with 30 directors of early childhood institutions to explore institutional-level supports and needs during the pandemic. Finally, it looks at the discrepancies between stated policies outlining the South Korea's response to COVID-19 and the lived experiences of early childhood educators as a route to arriving at recommendations for education policymakers and other stakeholders. To that end, we reviewed government documents (n = 84) containing early childhood education-related responses to Covid-19 established by the Ministry of Education, the Ministry of Health and Welfare, and other relevant government sectors. An online survey with 17 kindergarten and 13 child care center directors was also analyzed. Using content analysis, the findings revealed that the government's policies and guidance for Early Childhood Education and Care (ECEC) as well as the institutional supports for children and families were overall comprehensive in its scope. The analysis, based on the five tenets of the Whole Child approach, also indicated that the government's policy responses and services for ECEC focused mainly on the 'Safe' and 'Supported' tenets, while 'Challenged' was given the least amount of consideration. The survey responses demonstrated different measures taken by kindergartens and child care centers highlighting the separate nature of 'education' and 'care' in South Korea, while also indicating limited resources for supporting children's psychological well-being and for children and families in need. This overview provides a foundation for further discussion and research on the impact of Covid-19 on ECEC in South Korea and beyond.

Effects of nurse-led child health service in child-care centers: A survey study.

There are relatively few initiatives to promote children's health and prevent disease in Korean child-care centers. The purpose of this study was to describe the effects of the nurse-led child health service in Korean child-care centers. A total of 9664 parents and 3892 teachers at child-care centers and 49 nurses completed self-administered questionnaires. Parent satisfaction, teacher satisfaction, and nurses' self-evaluation were surveyed. Case-management reports of children were collected over 5 years. Dental problems were ranked high among children across 5 years in the study. Most parents perceived nurse-led child health service as being useful. Overall, teachers' satisfaction scores were statistically significantly higher for home child-care centers compared to public or private child-care centers. Increasing the need for the nurse-led child health service was ranked the highest item by nurses, whereas the health management of teachers was ranked the lowest. The nurse-led child health service in Korean child-care centers induced positive outcomes, including the satisfaction of parents, teachers and nurses.

Participatory capacity building for improving quality of childcare centers in Thailand.

INTRODUCTION: Childcare centers (CCCs) with good quality standards can be effective in reducing the risk of diseases being easily spread from person to person. The aim of the present study's program, adapted from a method used by the United Nations Development Program, was to increase the capacity of local administrators(s) and heads of CCCs to improve quality standards. METHODS: This study was quasi-experimental, with a one group pretest-post-test design. In this study the authors describe the effects and impacts of the program in Chonburi Province in eastern Thailand. Six LAs and 48 CCC heads were trained regarding (1) knowledge of the Thai Department of Health quality standards, (2) implementation and assurance and (3) program evaluation. The program consisted of three sequential participatory workshops. Effects at the center level were increased overall knowledge of quality standards of CCCs (QCCC), and developed skills of improvement plans. The impact at the center level was CCCs achieving the QCCC. At the child level it was the reduction in the period prevalence of three diseases and two symptoms. RESULTS: The significant (p<0.05) effects and impacts at the center level were increased overall knowledge of QCCC in LAs and CCC heads and increased overall managerial skills of CCC heads. At the child level, the period prevalence of chickenpox and diarrhea symptom were reduced. CONCLUSION: Participatory capacity building is an appropriate way to enhance the managerial skills of LAs and heads of CCCs for improving quality of CCCs to meet the local authority and the Ministry of Public Health quality standards.

Healthy apple program to support child care centers to alter nutrition and physical activity practices and improve child weight: a cluster randomized trial.

BACKGROUND: North Carolina Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) resources improve child body mass index (BMI) when the resources are introduced by nurses to child care providers, and offered with workshops and incentives. In San Francisco, public health and child care agencies partnered to adapt NAP SACC resources into an annual "Healthy Apple" quality improvement program (HAP). METHODS: This cluster randomized controlled trial pilot-tested integration of the HAP with bi-annual public health screenings by nurses. All child care centers that participated in Child Care Health Program (CCHP) screenings in San Francisco in 2011-2012 were offered routine services plus HAP in 2012-2013 (CCHP + HAP, n = 19) or routine services with delayed HAP in 2014-2015 (CCHP + HAP Delayed, n = 24). Intention-to-treat analyses (robust SE or mixed models) used 4 years of screening data from 12 to 17 CCHP + HAP and 17 to 20 CCHP + HAP Delayed centers, regarding 791 to 945 children ages 2 to 5y, annually. Year-specific, child level models tested if children in CCHP + HAP centers had greater relative odds of exposure to 3 index best practices and smaller Autumn-to-Spring changes in BMI percentile and z-score than children in CCHP + HAP Delayed centers, controlling for age, sex, and Autumn status. Multi-year, child care center level models tested if HAP support modified year-to-year changes (2013-2014 and 2014-2015 vs 2011-2012) in child care center annual mean Autumn-to-Spring BMI changes. RESULTS: In 2011-2012, the CCHP + HAP and CCHP + HAP Delayed centers had similar index practices (<15% of children were exposed to a physical activity curriculum, staff joining in active play, and drinking water pitchers) and annual BMI changes. In 2013-2014: 60% of children in CCHP + HAP centers were exposed to the 3 index practices vs 19% in CCHP + HAP Delayed centers; Mean (SE) child BMI percentile (-2.6 (0.9), p = 0.003) and z-score (-0.08 (0.03), p = 0.007) decreased more in CCHP + HAP vs CCHP + HAP Delayed centers. In 2014-2015, after all centers were offered HAP, the index practices and BMI changes were improved for all centers vs 2011-2012. CONCLUSIONS: Integration of the HAP with existing public health nursing services was associated with significantly more children exposed to best practices and improvement in child BMI change. The results warrant continued integration of HAP into local public health infrastructure. TRIAL REGISTRATION: ISRCTN18857356 (24/04/2015) Retrospectively registered.

Parent Website Engagement and Health Equity Implications in a Child Care-Based Wellness Intervention.

OBJECTIVE: To evaluate demographic differences in parent website engagement in a child care-based wellness intervention. DESIGN: Parent-reported demographic characteristics and observed website engagement were averaged by child care centers participating in the web-based intervention arm of a cluster randomized controlled trial of wellness interventions. SETTING AND PARTICIPANTS: Parents of preschoolers in 17 Maryland child care centers. MAIN OUTCOME MEASURES: Website engagement: (1) webpage views, (2) average time on webpage, and (3) intervention activity completion. INTERVENTION: Parents received access to a website containing content on wellness-promoting topics (eg, parenting, nutrition, physical activity) and their child care center's activities. ANALYSIS: Cross-sectional differences in website engagement by demographic characteristics were assessed using ANOVA. RESULTS: Centers with a high proportion of parents who identified as other than non-Hispanic White and had less than a bachelor's degree had significantly fewer webpage views, and completed significantly fewer intervention activities compared with centers with parents who were predominantly non-Hispanic White and had more than a bachelor's degree. CONCLUSIONS AND IMPLICATIONS: Demographic differences in parents' child care center website engagement represent disparities that could contribute to health inequities in parents' access to wellness-promoting material. Future efforts could identify factors that eliminate demographic disparities in parent engagement in web-based interventions.

Transfer of Antimicrobial-Resistant Escherichia coli and Resistance Genes in a Child Care Center.

Several reports describe antimicrobial-resistance transfer among children and the community in outbreak situations, but transfer between a child and a care giver has not been examined in child care facilities under normal circumstances. We investigated the transfer of antimicrobial-resistance genes, resistant bacteria, or both among healthy children and teachers. From 2007 to 2009, 104 Escherichia coli isolates were obtained from four teachers and 38 children in a child care center. Twenty-six cephem-resistant isolates were obtained from children in 2007 and 2008. In 2009, cephem-resistant isolates were detected in children as well as a teacher. Nalidixic acid-resistant isolates from the same teacher for 3 years showed low similarity (<50%) to each other. However, an isolate from a teacher in 2007 and another from a child in 2008 showed high similarity (87%). Pulsed-field gel electrophoresis revealed 100% similarity for four isolates in 2007 and one isolate in 2008, and also similarity among seven isolates carrying the virulence gene (CNF1). This study yielded the following findings: (1) a gene for extended-spectrum ß-lactamase was transferred from a child to other children and a teacher; (2) a nalidixic acid-resistant isolate was transferred from a teacher to a child; and (3) a virulent bacterium was transferred between children.

Building Blocks for Healthy Children: Evaluation of a Child Care Center-Based Obesity Prevention Pilot Among Low-Income Children.

OBJECTIVE: To assess the impact of a multilevel nutrition intervention for low-income child care environments, staff, and center-enrolled children. DESIGN: A cluster-randomized, controlled trial conducted among eligible centers. Staff and parent self-report surveys and objective field observations at baseline and follow-up were conducted. SETTING: A total of 22 low-income child care centers (enrolling ≥ 25 2- to 5-year-old children). PARTICIPANTS: Children aged 18-71 months; 408 children and 97 staff were randomized into intervention (208 children and 50 staff) and waitlist-control groups (200 children and 45 staff). Retention rates were high (87% for children and 93% for staff). INTERVENTION(S): A 6-session, 6-month director's child nutrition course with on-site technical support for center teachers. MAIN OUTCOME MEASURE(S): Center nutrition/physical activity environment; staff feeding styles, dietary patterns, and attitudes about food; child food preferences and dietary patterns. ANALYSIS: Covariance regression analyses to assess the intervention effect, adjusting for clustering within centers. RESULTS: Significant intervention effects were found for the center nutrition training/education environment (b = 3.01; P = .03), nutrition total scores (b = 1.29; P = .04), and staff-level prompting/encouraging feeding styles (b = 0.38; P = .04). No significant intervention effects were found for child-level measures. CONCLUSIONS AND IMPLICATIONS: Curriculum-driven training and implementation support improved nutritional policies and practices and staff-child interactions during meals. Future research could extend the intervention to families and the evaluation to children's dietary behaviors and weight changes.

Transfer of Antimicrobial-Resistant Escherichia coli and Resistance Genes in a Child Care Center.

Several reports describe antimicrobial-resistance transfer among children and the community in outbreak situations, but transfer between a child and a caregiver has not been examined in child care facilities under normal circumstances. We investigated the transfer of antimicrobialresistance genes, resistant bacteria, or both among healthy children and teachers. From 2007 to 2009, 104 Escherichia coli isolates were obtained from four teachers and 38 children in a child care center. Twenty-six cephem-resistant isolates were obtained from children in 2007 and 2008. In 2009, cephem-resistant isolates were detected in children as well as a teacher. Nalidixic acid-resistant isolates from the same teacher for 3 years showed low similarity (<50%) to each other. However, an isolate from a teacher in 2007 and another from a child in 2008 showed high similarity (87%). Pulsed-field gel electrophoresis revealed 100% similarity for four isolates in 2007 and one isolate in 2008, and also similarity among seven isolates carrying the virulence gene (CNF1). This study yielded the following findings: (1) a gene for extended-spectrum ß-lactamase was transferred from a child to other children and a teacher; (2) a nalidixic acid-resistant isolate was transferred from a teacher to a child; and (3) a virulent bacterium was transferred between children.

Measles Outbreak in a Child Care Center, Cook County, Illinois, 2015.

BACKGROUND: During January-February 2015, Cook County Department of Public Health led an investigation of a measles outbreak predominantly affecting infants at a child care center who were too young for routine immunization with measles-mumps-rubella (MMR) vaccine. METHODS: Measles cases and contacts were investigated by Illinois public health officials. Cases were isolated for 4 days after rash onset. Exposed healthcare workers and child care center staff were required to provide documentation of receipt of 2 doses of MMR vaccine or laboratory evidence of immunity to return to work. Susceptible contacts were actively monitored for 21 days after exposure and provided postexposure prophylaxis (PEP) if certain criteria were met. RESULTS: Fifteen confirmed measles cases were identified; 12 (80%) occurred in infants who were attendees of a child care center. Clinical misdiagnosis of 1 case allowed for continued transmission within the center. Twelve (86%) of 14 exposed infants at the child care center were diagnosed with measles; no other attendees or staff were infected. Five cases visited outpatient pediatric clinics during their infectious period, exposing 33 infants. Six exposed child care center staff and 3 healthcare workers did not have documentation of immunity available and were excluded from work until this was obtained. No healthcare-associated transmission was identified. Ninety-one contacts were actively monitored and 20 received PEP. CONCLUSIONS: This outbreak underscores the vulnerability of infants to measles, the need for early consideration of measles in susceptible patients presenting with a febrile rash illness, and the importance of immunity among individuals working closely with infants.

Effects of the Caregiver Interaction Profile Training on Caregiver-Child Interactions in Dutch Child Care Centers: A Randomized Controlled Trial.

BACKGROUND: Previous studies underscore the need to improve caregiver-child interactions in early child care centers. OBJECTIVE: In this study we used a randomized controlled trial to examine whether a 5-week video feedback training can improve six key interactive skills of caregivers in early child care centers: Sensitive responsiveness, respect for autonomy, structuring and limit setting, verbal communication, developmental stimulation, and fostering positive peer interactions. METHOD: A total of 139 caregivers from 68 early child care groups for 0- to 4-year-old children in Dutch child care centers participated in this RCT, 69 in the intervention condition and 70 in the control condition. Caregiver interactive skills during everyday interactions with the children were rated from videotape using the Caregiver Interaction Profile (CIP) scales at pretest, posttest, and follow-up 3 months after the posttest. RESULTS: Results at posttest indicate a significant positive training effect on all six caregiver interactive skills. Effect sizes of the CIP training range between d = 0.35 and d = 0.79. Three months after the posttest, caregivers in the intervention group still scored significantly higher on sensitive responsiveness, respect for autonomy, verbal communication, and fostering positive peer interactions than caregivers in the control group with effect sizes ranging between d = 0.47 and d = 0.70. CONCLUSIONS: This study shows that the quality of caregiver-child interactions can be improved for all six important caregiver skills, with a relatively short training program. Possible ways to further improve the training and to implement it in practice and education are discussed.

What's for lunch? An analysis of lunch menus in 83 urban and rural Oklahoma child-care centers providing all-day care to preschool children.

BACKGROUND: More than half of 3- to 6-year-old children attend child-care centers. Dietary intakes of children attending child-care centers tend to fall short of Dietary Reference Intakes (DRIs). OBJECTIVE: Our aim was to examine macro-/micronutrient content of child-care center menus, compare menus to one third of DRIs, and determine menu differences by population density. METHODS: A stratified, random, geographically proportionate sample of Oklahoma child-care centers was obtained. Child-care centers providing all-day care for 2- to 5-year-old children were contacted to complete a telephone questionnaire and asked to send in that month's menus for the 3- to 4-year-old children. Overall means and standard deviations of the nutrient content of 5 days of lunch menus were calculated. Comparisons were made to both the 1- to 3-year-old and 4- to 8-year-old DRIs. One-sample t tests compared mean nutrient content of lunches to one third of the DRIs for the overall sample and urban/rural classification. Independent t tests compared nutrient content of urban and rural lunches. PARTICIPANTS/SETTING: One hundred sixty-seven child-care centers were contacted; 83 completed the study (50% response). RESULTS: Menus provided statistically significantly insufficient carbohydrate, dietary fiber, iron, vitamin D, and vitamin E. Calcium was higher than the 1- to 3-year-old DRI, but lower than the 4- to 8-year-old DRI. Folate was higher than the 1- to 3-year-old DRI, but not different from the 4- to 8-year-old DRI. Sodium was higher than the DRI for both age groups. Thirty-four child-care centers (41%) were classified as urban and 49 (59%) as rural. Urban menus provided less than the 4- to 8-year-old DRI for folate, but rural child-care center menus did not. CONCLUSIONS: Oklahoma child-care center menus appear to provide adequate protein, magnesium, zinc, vitamin A, and vitamin C, but may be deficient in key nutrients required for good health and proper development in preschool-aged children. These issues can be addressed by including food and nutrition practitioners in the process to ensure child-care center menus are a useful resource and nutritionally appropriate for preschool children.

Espaço do berçário: contribuições de um programa de acompanhamento / Organization of child care space: contributions of a monitoring program / Espacio de la guardería: contribuciones de un programa de seguimiento

Este estudo investigou as contribuições de um programa de acompanhamento com educadoras, baseado na abordagem pikleriana, para a organização dos espaços do berçário e para a interação educadora-bebê. Foi realizado um estudo de casos múltiplos com seis educadoras de berçário de duas creches públicas, que participaram de seis encontros individuais. Seis meses após o término do acompanhamento, as educadoras responderam a uma entrevista, cujas respostas foram examinadas por meio da análise de conteúdo qualitativa. As educadoras relataram mudanças na organização do espaço físico, dos móveis e objetos, bem como uma melhor qualidade da interação educadora-bebê, percebida ao propiciar autonomia e dar mais atenção individualizada nos momentos de cuidados. Os resultados sugerem que o acompanhamento possibilitou mudanças na organização do berçário, que puderam apoiar a interação educadora-bebê e contribuir para a promoção do desenvolvimento infantil

The present study investigated the contributions of a monitoring program for educators based on the Piklerian approach for the organization of child care spaces and for the child-educator interaction. Six educators of two public child care center participated in six individual meetings. Six months after the end of mentoring, the educators were interviewed and the answers were examined through qualitative content analysis: child care space characteristics and educator-child interaction. The educators reported changes in the organization of the physical space, furniture and objects. The teachers also reported a better quality of the educator-child interaction, perceived in their own attitudes providing autonomy, organizing space based on children needs, as well as giving more individualized attention to them in times of care. The results suggest that monitoring could make changes in the child care organization that could support the educator-child interaction and contribute to the promotion of child development

Este estudio investigó las contribuciones de un programa de seguimiento con educadoras, basado en el enfoque pikleriano, para la organización de los espacios de guardería y para la interacción educadora-bebé. Se realizó un estudio de casos múltiples con seis educadoras de dos guarderías públicas, que participaron de seis encuentros individuales. Seis meses después del término del seguimiento, las educadoras respondieron a una entrevista, cuyas respuestas fueron examinadas por medio del análisis de contenido cualitativo. Las educadoras relataron cambios en la organización del espacio físico, de los muebles y objetos, así como una mejor calidad de la interacción educadora-bebé, percibida al propiciar autonomía y dar más atención individualizada en los momentos de cuidados. Los resultados sugieren que el seguimiento posibilitó cambios en la organización de la guardería, que pudieron apoyar la interacción educadora-bebé y contribuir a la promoción del desarrollo infantil