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Health and Medical Supervision

Medical officer of health recommendations, inspections

Staff must implement any recommendation or instruction from a medical officer of health about the health or well-being of a child receiving care in a child care centre and record it in the daily written record.

For example, child care centres must comply with local public health requirements for hand washing, sanitation, food storage and preparation.

A copy of any report made by the local medical officer of health or the local fire department must be kept on the premises of the child care centre. Another copy must be sent immediately to the ministry’s program advisor for the centre.

Food storage on shelves

REGULATION

Section 32 of Ontario Regulation 137/15 - General

CONNECTIONS TO HOW DOES LEARNING HAPPEN?

Health and safety recommendations help to ensure children’s overall well-being, including their physical and mental health and well-being.

Taking measures to protect children’s health in all areas can have lifelong impacts. Being responsive to children’s varied physical and emotional states helps children feel safe and secure. Helping children to recognize their varied physiological, biological, emotional states and rhythms supports their developing self-regulation abilities.

Enabling children to interact with their natural environment, including through open-ended materials, allows children to deepen their exploration and make meaning of the world around them.

Sleep Policies and Supervision

Every licensee shall ensure that a child who is younger than 12 months is placed for sleep following the recommendations set out in Public Health Agency of Canada’s (PHAC) “Joint Statement on Safe Sleep: Preventing Sudden Infant Deaths in Canada”. The only exception is if the child’s physician recommends otherwise in writing.

Every licensee shall ensure that for children who regularly sleep at their child care centre or home child care location they oversee:

  • Direct visual checks are made periodically on each sleeping child by being physically present beside the child and looking for indicators of distress or unusual behaviour
  • There is enough light in the sleep area or room to make direct visual checks
  • There are written policies and procedures about sleep that include:
    • Children will be assigned to individual cribs or cots as required in Ontario Regulation 137/15
    • Parents will be consulted about a child’s sleeping arrangements when the child is enrolled and at any other appropriate time
    • Provide that parents of children younger than 12 months and children who regularly sleep at the child care are told that their child must be placed for sleep according to PHAC’s recommendations, and know the child care’s policies. Any significant changes in a child’s sleeping patterns will be communicated to parents and change the way the child is supervised during sleep
    • Details about how to make direct visual checks, how often and to document them. For children in home child care, the licensee shall consider parents’ input, the sleep environment and the proximity of the sleeping area to the child care provider.

Every licensee shall ensure that, in each child care centre that has a separate area or room for sleeping, there is a system in place to immediately identify which children are present in the area or room.

Electronic sleep monitoring equipment must be,

  • able to detect and monitor the sounds, and if applicable, video images of every sleeping child
  • actively monitored by employees
  • checked daily to ensure proper functioning.

Electronic sleep monitors cannot replace direct visual checks.

REGULATION

Sections 33.1 of Ontario Regulation 137/15 – General

CONNECTIONS TO HOW DOES LEARNING HAPPEN?

To nurture children’s healthy development and well-being, it is important to find ways to support each child’s varied physiological and biological rhythms and needs for active play as well as rest and quiet time. Consider:

  • How can your program support children’s varied physiological and biological rhythms?
  • How can your program provide a flexible context that respects children’s choices and needs?

First-aid

Keep a first-aid manual and first-aid kit in an easily accessible location. All staff should know where it is. Check the contents regularly to replenish it or replace out of date products.

Countertop with first aid kit highlighted

SAMPLE FORM

Monthly First Aid Kit Inspection

REGULATION

Section 34 of Ontario Regulation 137/15 - General

Immunization

Each child not in attendance at a school must be immunized as recommended by a local medical officer of health. Any exception must be based on the parent’s sincerely held convictions based on religion or conscience or a medical reason, set out by a doctor.

Immunization records or exemptions must be kept in each child’s file.

A statement of conscience or religious belief or medical reasons must be submitted using the forms below. Exemptions made before August 29, 2016 expire on September 1, 2017 unless a new form is submitted before that date.

STANDARDIZED MINISTRY FORMS

Statement of Medical Exemption

Statement of Conscience or Religious Belief

Filing cabinet with drawer labelled children’s records highlighted

REGULATION

Section 35 of Ontario Regulation 137/15 - General

Child illness and accident

Staff must observe each child when they arrive to look for any signs of illness. A child who appears to be ill must be separated from other children and their symptoms noted in the child’s records.

When a child is separated from other children because of suspected illness, a parent must be contacted to take the child home as soon as possible. If the parent cannot take the child home or if the child needs immediate medical attention, the child must be examined by a qualified physician or nurse.

When a child is injured, an accident report describing the injury and any first aid provided must be given to the child’s parent.

REGULATION

Section 36 of Ontario Regulation 137/15 - General

CONNECTIONS TO HOW DOES LEARNING HAPPEN?

Observing the children and how they are doing supports their well-being and helps to ensure that measures are in place to act in cases where their well-being is compromised.

It is important to communicate with parents about what their children are experiencing throughout the day, including their physical, emotional, and mental health.

Daily Written Record 

A daily written record must be kept that includes a summary of any incident(s) affecting the health, safety and well-being of staff or an enrolled child. It must be kept for at least three years. If the incident affects a child, a parent must be notified.

Daily written record book highlighted on top of a bookshelf

REGULATION

Section 37 of Ontario Regulation 137/15 - General

CONNECTIONS TO HOW DOES LEARNING HAPPEN?

The daily written record can also be used to document and help inform educator’s understanding of children’s learning and interpretation.

The daily written record can be a means for learning about how children think and learn. Documenting what children experience throughout the day can support educators to be co-learners alongside children and their families.

Serious Occurrences

Licensees are required to report serious occurrences in the Child Care Licensing System within 24 hours of becoming aware of the incident. The 24-hour window to report a serious occurrence begins as soon as the licensee, delegate, or supervisor becomes aware of the incident. Serious occurrence reports can be submitted or updated by supervisors and home visitors where the licensee has chosen to enrol them in the system. A Serious Occurrence Notification Form must be posted on-site for at least 10 business days, and then kept in a secure location for at least three years.

Licensees must have written policies and procedures about serious occurrences that address, at a minimum, how to identify, respond to and report a serious occurrence.

Licensees must analyse all serious occurrences that occurred in the previous year, document the actions taken in response to the analysis, and keep a record of this analysis.

REGULATION

Section 38 of Ontario Regulation 137/15 - General

CONNECTIONS TO HOW DOES LEARNING HAPPEN?

Reporting serious incidents involving children supports communication between child care centre staff, the Ministry of Education, and parents to help ensure the well-being of all children.

Anaphylactic Policy

Each child care centre and home child care location must have an anaphylactic policy that includes the following:

  • a strategy to reduce the risk of exposure to anaphylactic triggers
  • a communication plan about life-threatening allergies, including anaphylactic allergies
  • An individualized plan for each child at the centre or home child care with an anaphylactic allergy
  • training on what to do if a child has an anaphylactic reaction.

The individualized plan shall be developed with the child’s parent and any regulated health professional involved in the child’s health care that the parents’ think should be involved. The individualized plan describes procedures to be followed if the child has an allergic reaction or another medical emergency.

Training on how to administer an epinephrine auto-injector may be provided by:

  • a physician;
  • a parent;
  • a designate of the local medical officer of health;
  • a certified epinephrine auto-injector instructor/trainer; or,
  • other agencies that may provide training.

The licensee should keep a list of the date(s) each staff member was trained to demonstrate that each person was trained before starting work.

The child’s individualized plan, including emergency procedures for the child, must be reviewed:

  • by all employees before they begin work and at least annually afterwards and
  • by volunteers and students before they begin providing that care or guidance and at least annually afterwards.

Countertop with lists of allergies highlighted

Children with Medical Needs

A “child with medical needs” means a child who has one or more chronic or acute medical conditions which requires additional supports, accommodation or assistance.

Every licensee is responsible for developing an individualized plan for each child with medical needs at their child care centre or home child care. The individualized plan shall be developed with the child’s parent and any regulated health professional the parent thinks should be included. The plan shall include:

  • Steps to reduce the risk of the child being exposed to any triggers or situations that could make a medical condition worse or cause an allergic reaction or another medical emergency.
  • A description of any medical devices the child needs and any instructions on how to use it.
  • A description of the procedures to follow if there is an allergic reaction or another medical emergency.
  • A description of the supports the child needs.
  • Any additional procedures to follow when a child with a medical condition is evacuated or participating in an off-site field trip.

If a child already has an individualized plan for their anaphylactic allergy, and has no other medical needs, no other plan is required.

SAMPLE FORMS

Template for an Individualized Plan for a Child with Medical Needs

REGULATION

Section 39.1 of Ontario Regulation 137/15 - General

CONNECTIONS TO HOW DOES LEARNING HAPPEN?

Consider ways to ensure strong communication with families to support children’s well-being, such as working together with parents to develop a plan that supports the health and safety of children who have life-threatening allergies or other medical needs.

Administration of Drugs and Medications

A parent must provide written consent for their child to receive medication at child care. That consent must have a schedule that sets out the times the drug or medication is to be given and amounts to be administered.

The medication parents bring for their child must be kept in a locked container in the room and inaccessible to children at all times. If it needs refrigeration, the medication must be kept in a locked box in a refrigerator.

Medication can be administered to a child only from the original container or package labelled with:

  • the child's name
  • the name of the drug or medication
  • the dosage of the drug or medication
  • the date of purchase and if applicable, expiration
  • instructions for storage and administration

One person must be in charge of all medications. Medications are dealt with by that person or his/her designate as outlined in licensee’s written procedures.

REGULATION

Section 40 of Ontario Regulation 137/15 - General

SAMPLE FORM

Medication Administration Log