Keeping yourself and your staff members healthy is essential in preventing infection and illness among the children in your care, and regular physicals and immunizations are an important part of health and safety.

Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care recommends that anyone working 40 hours per month or more in a childcare facility undergo a physical examination performed by a physician or certified registered nurse practitioner before starting employment. After the initial pre-employment physical, caregivers should undergo physicals every two years thereafter, unless their health care provider recommends assessment more frequently.

At a typical staff physical, a doctor or nurse practitioner will take a health history, conduct a physical examination, administer vision, hearing, and dental screenings, and update immunizations. Some health problems the provider will look for include:

• Vision loss or impairment.
• Hearing loss or impairment.
• Respiratory problems, such as asthma, emphysema, or airway allergies.
• Heart, blood pressure, or other cardiovascular problems.
• Gastrointestinal problems, such as an ulcer, colitis, or obesity.
• Endocrine problems, such as diabetes or thyroid disorders.
• Emotional problems or addictions, such as depression, alcohol or drug dependency, or difficulty handling stress.
• Neurological problems, such as epilepsy.
• Musculoskeletal problems, such as lower back pain, arthritis, or limitations on activity.
• Skin problems, such as eczema.
• Immune system problems.

The health care provider also will assess the person for behaviors that might lead to future health problems such as smoking or poor eating habits.

The U.S. Centers for Disease Control and Prevention (CDC) recommends that every childcare worker be screened for tuberculosis (TB), a contagious bacterial disease that infects the lungs. If a person tests negative for TB the first time, they should be retested after one month and every two years thereafter. If a person tests positive for TB, he or she may have the disease and should be checked by a doctor. The CDC also recommends that in family home childcare settings, all persons aged 12 years and older who are present while the children are there should receive TB tests even if they are not providing childcare.

The Americans with Disabilities Act (ADA) requires employers to make accommodations for people with disabilities, so having any of the above problems does not necessarily mean that a person will be denied employment in a childcare facility. However, the health care provider should complete a checklist that identifies any health problems or disabilities that might prevent a person from adequately and safely caring for a child. These problems should be taken into consideration by the center director when assigning responsibilities.

Recommended Immunizations

Adults working in childcare centers are more likely than other adults to be exposed to numerous infectious diseases. Before caring for children, a person should confirm what diseases he or she was exposed to in childhood and any childhood immunizations that were given. If vaccination information is unavailable, a health care provider can administer blood tests that can determine whether a person is immune to certain infectious diseases.

Immunizations that are important for childcare workers to receive include:

Influenza The flu vaccine is administered yearly and targets the type of flu the CDC expects to be most prevalent that year.

Measles/mumps/rubella (MMR) The MMR vaccine contains weakened forms of the measles, mumps, and rubella viruses. Once the vaccine is administered, the person's immune system remembers the virus and fights against it the person comes in contact with the virus again. Unless they have had all three of these diseases, caregivers should receive the vaccine to provide immunity against future infections. Having had only mumps or only measles does not necessarily protect against future infection, so if you have any questions about your immunization status, contact your health care provider.

Tetanus/diphtheria (Td) Caregivers should have completed a primary series of tetanus vaccinations and should receive a booster immunization every 10 years or after an injury. The tetanus booster is often administered with the diphtheria vaccine.

Pertussis and Polio Most child caregivers should have received the vaccine for these diseases in childhood.

Hepatitis A & B Most child caregivers should receive vaccination for hepatitis B.
Hepatitis A vaccination is routinely recommended for child caregivers who live in parts of the southern and western U.S. where the infection is more prevalent.

Chickenpox If you never had chickenpox or you are unsure of whether you are immune, a vaccination can be given to protect you from this disease. People who contract chickenpox as adults may be at risk for serious complications of the disease.

RESOURCES

Complete information on staff physicals, health assessments, and immunizations can be found in Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care, Second Edition. The complete text can be found on the website of the National Resource Center for Health and Safety in Child Care, nrc.uchsc.edu/CFOC/index.html. Or contact: National Resource Center for Health and Safety in Child Care, UCHSC at Fitzsimons, Campus Mail Stop F541, PO Box 6508, Aurora, CO 80045-0508; 800-598-KIDS.

Staff physicals section: nrc.uchsc.edu/CFOC/HTMLVersion/Chapter_1.html#1018233