Thousands of children spend as many as 12 hours a day in group care. For these children and so many more in shorter programs, teachers and child care providers are the primary guides for children’s health habits. You have an obligation not only to provide a safe and healthy environment but also to teach health practices that prevent illness and promote fitness.
Do you know the right answers to these questions?
What is the single most effective way to prevent the spread of illness in groups of children?
What is the greatest health issue facing American children today?
How much physical exercise do health experts recommend for children?
How is dental health related to general health?
Learn the answers to these and other common questions about staying healthy in a four-pronged approach to children’s health—sanitation, dental care, nutrition, and exercise.

Sanitation
Many infectious diseases including colds, the flu, and gastrointestinal disorders are commonly spread through hand-to-hand contact. Salmonella and E. coli infections—food-related illnesses—often result from poor hygiene.
Why is washing hands so important? Sometimes it feels like I spend my days monitoring children at the sink.
Hand washing is essential to disease prevention. In early childhood classrooms there is always a risk of sharing illnesses because children touch and mouth so many things. Frequent hand washing minimizes the spread of both inconvenient and serious illnesses. The time children spend washing their hands is well worth it.
Scrubbing the hands with soap and rinsing them with water loosens and removes bacteria. Follow this standard procedure.
Wet hands with warm, running water.
Apply liquid soap and lather well.
Scrub all surfaces including the backs of hands, wrists, between fingers, and under fingernails for at least 20 seconds.
Rinse well.
Dry hands on a disposable towel and use the towel to turn off the water.
Throw the towel in a wastebasket.
Should I provide antibacterial soap at the sink for the children to use? Isn’t it better than ordinary soap?
About 75 percent of liquid soaps on the market are labeled “antibacterial,” and the public is quick to try anything that seems to offer protection against disease. Unfortunately, the science behind this marketing boom doesn’t support the claim that antibacterial soap is better.
The antibacterial agents need to be left on the hand surface for about two minutes to be effective. Most people—and especially children—rinse before the chemical can do its job.
It’s possible the bacteria will develop resistance to the agents and leave people vulnerable to greater bacterial threats. (See Texas Child Care, Spring 2003, page 18.)
Some bacteria are beneficial.
Many diseases are caused by viruses and aren’t affected by antibacterial products.
According to the U.S. Centers for Disease Control and Prevention (CDC), using ordinary liquid soap and following proper hand washing procedures is one of the most effective ways to minimize the spread of disease. Antibacterial soaps aren’t necessary—and cost more money.
I’m trying to make my program as green as possible and am considering using washable cloth towels or an electric air blower instead of paper for hand drying. Which is better?
Congratulations on trying to be environmentally sensitive, but don’t do it at the expense of children’s health. Electric air blowers are noisy and frightening to many children—especially toddlers who are just learning the routine of hand washing. Even in programs with the most vigilant supervision, cloth towels are likely to be a shared among several children. And the damp cloth becomes a breeding ground for bacteria. You’re also likely use more water and electricity making cloth towels sanitary than having children use paper towels.
Single-use paper towels are easy for children to use and relatively inexpensive, especially when you buy in bulk. Teach children to use one towel, wipe their hands, use the same towel to turn off the water tap, and throw the towel in the trash.
Our director just announced that we need to develop a sanitation plan in our effort to keep children—and teachers—healthy. What should the plan cover?
A sanitation plan is a written set of procedures that help minimize the impact of communicable diseases through sanitation, disinfection, and basic hygiene.
Make sure your plan includes procedures for cleaning and maintaining these areas:
toilets and toilet learning equipment;
hand washing equipment;
diaper-changing areas; and
pet cages.
In addition, include a plan for
cleaning and sanitizing classroom and playground materials and equipment;
insuring the health of classroom pets; and
teaching, modeling, and practicing sanitation practices with teachers, children, and families.

Dental health
Oral health is a critical component of children’s health care. Tooth decay and loss is painful and can result in impaired speech development, inability to concentrate, poor social relationships, and withdrawal from activities.
How does dental decay happen?
Tooth decay is the result of the interaction between a common bacterium, Streptococcus mutans, with carbohydrates—sugars and starches—in the mouth. The bacteria break down the carbohydrates and produce acids that cause mineral loss from the teeth. Prolonged mineral loss results in a cavity or tooth decay. Poor feeding habits and lack of dental hygiene contribute jointly to tooth decay.
I saw an article that said tooth decay is contagious. Is that possible?
Unfortunately, yes. Every mouth has resident bacteria—yours and the baby’s. You share that bacteria every time you allow babies to put a finger into your mouth and then into their own. It can also occur every time you taste milk or food before feeding, every time you share a spoon or fork, and every time you lick a pacifier to clean it and then put it into a baby’s mouth.
What is baby bottle mouth?
Baby bottle mouth, baby bottle tooth decay, and nursing bottle mouth are all terms that describe the rapid decay of baby teeth in an infant or young child. The decay is caused by frequent exposure of the teeth to liquids containing sugars, including formula, breast milk, soda, and juice. Typically a baby falls asleep while feeding, and the liquid pools in the front of the mouth. The bacteria in the infant’s mouth convert the sugar into acid that causes decay.
Help parents recognize the dangers of this early tooth decay. Watch for early signs including brown spots along the gum line and pain when eating cold, sweet, or hard foods. Help prevent decay by cleaning infant teeth regularly and never allowing a baby to fall asleep with a bottle.
Do I need to clean baby teeth?
Yes, as soon as the first tooth appears. Hold the baby on your lap with both of you facing a mirror. Use a soft, damp cloth and swab the tooth. When more teeth emerge, use a small, soft, wet brush.
How much toothpaste should children use?
Don’t use any toothpaste to clean the teeth of children younger than 2 years. Older children may use a pea-sized amount of fluoride toothpaste. Fluoride is important in fighting tooth decay, but if children use and swallow too much fluoride, their permanent teeth may have white spots on the surfaces.
Do I have to supervise toothbrushing?
Yes. Children who go to the dentist regularly probably receive instruction in brushing and flossing. But you need to provide guidance as children learn to handle the toothbrush and toothpaste. Typically children are able to brush independently by age 8—at about the same time they can tie their own shoes.
To make sure you are teaching the proper procedure, invite a dental hygienist to demonstrate toothbrushing. Remind children to use a vertical, not horizontal, motion.
What should I do if a tooth is knocked out?
Find the tooth and hold it by the enamel or crown. Do not remove any tissue. Put the tooth in a cup of cool milk, and contact the child’s parent to arrange an emergency visit to the dentist.
Are there classroom activities that help children learn about oral health?
The following activities and games can reinforce good dental health.

Food stains
(ages 3 and older)
Ask a building supply store to donate white ceramic tiles for this activity.

Here’s what you need:
white ceramic tiles, glazed on one side and unglazed on the other, one for each child
staining foods like jelly, ketchup, and cola
bowls for the foods
scissors
paper towels
toothbrushes, one for each child
toothpaste

1. Prepare for the activity by cutting paper towels into 3-inch squares. Put small amounts of the staining foods into bowls.
2. Give each child a tile, a paper towel square, and a toothbrush.
3. Invite children to dip the paper into one of the food bowls and smear that food on the unglazed side of the tile.
4. Let the children use toothpaste on their brushes to clean the tile. Talk about the crevices that trap food and encourage bacteria to grow.
5. Repeat the experiment on the glazed side of the tile. Explain that the glaze works like smooth tooth enamel to protect the teeth from stains and decay.

Weakened tooth enamel
(ages 4 and older)
This activity requires a diagram of tooth structure, like the one at left. You might also ask a dentist to supply a poster.

Here’s what you need:
hard-boiled, white-shelled egg
vinegar
tall, clear container

1. Introduce the activity by sharing a diagram of tooth structure. Point out the outer covering or enamel and its function in protecting the tooth structure.
2. Talk about how weak or broken enamel allow bacteria to access nerve endings and blood vessels.
3. Invite children to observe the effects of acid (vinegar) on an egg shell in the same way bacteria weaken teeth.
4. Place the hard-boiled egg in a clear container. Cover the egg with vinegar.
5. Invite the children to handle the egg daily for three to five days. Note that the shell softens and becomes rubbery.
6. Talk about which surface—hard or rubbery—better protects the egg inside the shell.
Variation: Use clean chicken bones in place of the egg. The bones will begin to soften overnight.

Fluoride strong
(ages 4 and older)
Check your local supermarket or drug store for the fluoride rinse needed for this activity. You can choose from a number of oral rinses made by toothpaste and medical products manufacturers.

Here’s what you need:
2 hard-boiled, white-shelled eggs
3 bowls
2 cups vinegar
1 cup of fluoride rinse solution
timer

1. Pour the fluoride rinse solution into one bowl.
2. Place an egg in the solution. Set the timer for five minutes and allow the egg to soak undisturbed.
3. Pour 1 cup of vinegar into each of the other two bowls.
4. Place the untreated egg into one bowl and the fluoride-treated egg into the other.
5. Invite the children to observe and comment on the reactions. The untreated egg will bubble in the vinegar as the acid attacks the minerals in the egg shell. The treated egg will be protected against the action of the vinegar.
6. Talk with the children about how fluoride helps protect their teeth just as it did the egg shell.

Brush away the stain
(ages 4 and older)
Invite children to discover the staining properties of cola drinks and the effectiveness of toothpaste and a toothbrush for removing stains from teeth.

Here’s what you need:
hard-boiled, white-shelled eggs
large bowl
dark-colored cola drink
toothbrushes
toothpaste

1. Place the hard-boiled eggs in a large bowl.
2. Cover the eggs with cola and leave overnight.
3. The next day, ask the children to describe the changes in the egg color.
4. Invite the children to use toothpaste on a brush to scrub the eggs clean. Reinforce the concept that brushing teeth removes the same kinds of stains.

Floss it
(ages 4 and older)
The Nova Scotia Dental Association recommends this activity that highlights the effectiveness of dental floss. You’ll need an adult helper.

Here’s what you need:
latex glove
1 tablespoon chunky peanut butter (or another sticky, chunky food)
toothbrush
toothpaste
dental floss

1. Ask an adult helper to put on the latex glove and hold the hand with fingers pointed upward and close together.
2. Explain to children that the fingers represent teeth that sometimes catch and trap food in the space between the teeth.
3. Ask the helper to spread the fingers of the hand. Smear peanut butter between the fingers and deep into the crevices. Tighten the fingers again.
4. Invite one child to brush the glove with toothpaste. Remind the helper to hold fingers together tightly.
5. After the brushing, show that there are still chunks of peanut butter on the glove.
6. Use a length of dental floss to dislodge food from between the fingers.
7. Encourage children to compare the effectiveness of the two tools. Encourage them to use both tools for the most thorough tooth cleaning.

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