Health and safety in the early childhood classroom: guidelines for curriculum development.

A great deal of attention has been given to childhood health and safety over the past decade, and for good reason. Rates of childhood overweight are on the rise (Krebs et al., 2003) and childhood injuries remain unacceptably high (National Safe Kids Campaign, 2003). In response to these and other threats, different groups and government agencies in the United States have taken steps to advance a healthier and safer environment for young children. Some of these steps include creating an index for tracking childhood well-being (Foundation for Child Development, 2004), conducting a nationwide longitudinal study to better understand the threats to childhood health and well-being (National Children's Study, 2004), and establishing national health objectives to promote a healthier society (U.S. Department of Health and Human Services, 2000a). In addition, medical organizations have issued recommendations aimed at controlling specific health threats, such as those associated with overconsumption of soft drinks (Taras et al., 2004) and obesity (Krebs et al., 2003).

Early childhood teachers have a variety of health and safety resources to draw upon, including information about and educational programs dealing with such issues as fire safety (Cole, Crandall, & Kourofsky, 2004), obesity (Huettig, Sanborn, DiMarco, Popejoy, & Rich, 2004), and dental hygiene (Alkon & Boyer-Chu, 2004). In addition, early childhood teachers can take advantage of Internet resources and fact sheets provided by such organizations as the Centers for Disease Control and Prevention (2004) and the National Safe Kids Campaign (2004a).

On the other hand, teachers may face a number of challenges when attempting to incorporate health and safety resources into the curriculum. In some cases, the resources may not be age-appropriate or may not meet the needs and interests of children in a particular classroom. Other teachers may believe they lack the time or background knowledge to properly understand or implement activities aimed at promoting health and safety practices among young children. Consequently, teachers need guidelines to help them select and develop health and safety educational activities for their classrooms. This article will share three guidelines--defining health and safety concepts, establishing a rationale for a health and safety curriculum, and identifying theoretical perspectives to guide a health and safety curriculum--that the authors followed in developing and implementing a preschool health and safety curriculum that has been used by early childhood trainers and teachers across three states in the southeastern United States (Bales, Coleman, & Wallinga, 2004).

Defining Health and Safety Concepts

Because health is a complex concept, it is important to first examine its meaning. Four themes are especially relevant to the early childhood classroom (Pollack, 1994).

The Whole Child. The first theme is that health is a holistic concept involving more than just a physical state. A child's social, cognitive, and emotional skills also must be considered. Consider a situation in which two children have similar cognitive skills but different social skills. While one child may possess the social skills to seek adult guidance before engaging in new activities, the other child may be impulsive and rarely seek outside input before rushing into situations. Although possessing similar cognitive skills, the second child may be more likely to face health and/or safety problems.

Long-term Considerations. It also is not enough to consider health in the short term. A long-term view is more appropriate. For example, one child may appear to be in good health. However, she seldom participates in active outdoor play and she prefers to eat junk food over food with greater nutritional value. In contrast, another child of the same age may have diabetes, but she engages in exercise, selects highly nutritious foods, and follows her doctor's orders regarding the regulation of her insulin. Of the two children, it is difficult to say who is at greater risk for future health problems. Although the child with diabetes certainly has health issues, her willingness and ability to manage her condition may place her in a more healthy state later in life than the child who, while without a health condition currently, seems to be adopting an unhealthful lifestyle.

A Continuum of Health. Another theme is that health exists along a continuum. That is, daily pressures, short-term illnesses and injuries, and exercise and eating habits can change with time, thereby altering our overall well-being. It is therefore important to make periodic assessments of our health status. It even can be argued that such assessments themselves are part of a healthy lifestyle, since they can help us toward changing unhealthful or unsafe behaviors.

Life Choices. A final theme is that life choices influence our health. In short, the quality of our health often results from the personal choices we make about whether or not to engage in risky behavior, consume fatty foods, practice poor hygiene, manage stress, and exercise. Healthy people learn not to depend upon fads to guide their health choices, but rather to seek out resources that will allow them to make informed decisions. This is why health education is so important in the early years. Establishing healthful and safe patterns of behavior is, like most other things, easier when they are learned and practiced during the early years.

Establishing a Rationale for a Health and Safety Curriculum

Few of us in the early childhood field have an extensive background in health and safety sciences. Therefore, it is important that we integrate our professional knowledge of early childhood development and education with that from the fields of pediatric health care and safety. One approach by which to accomplish this goal is to document the need for an early childhood health and safety curriculum. Our review of the literature revealed four areas that we chose as the focus of our health and safety curriculum.

Unintentional Injuries. Unintentional injuries are the leading cause of death for children over the age of 1 in the United States (Deal, Gomby, Zippiroli, & Behrman, 2000; Grossman, 2000). Children from birth to age 4 are most likely to be hospitalized due to a fall, poisoning, or scalding (Grossman, 2000). In addition, they are most likely to die from drowning, suffocation, or choking, or from injuries resulting from motor vehicle accidents, residential fires, and pedestrian accidents (Deal et al., 2000; Grossman, 2000). For children under age 5, on average, 27.8 percent of all trips to a hospital emergency department each year are injury related (Burr & Fingerhut, 1998). Childhood poisoning also can necessitate emergency medical care. More than half of all incidences of poisoning involve children younger than age 6 (National Center for Injury Prevention and Control, 2001). The top five dangerous substances ingested by children under age 6 include cosmetics, cleaning substances, analgesics, plants, and cold/cough preparations (Litovitz et al., 1997).

Visits to the Doctor. Visits to the doctor are a part of life for young children. Injuries, emergencies, and illnesses often demand medical attention. For example, by age 2, a majority of children (78.4 percent) have made visits to the doctor or health department to complete their immunization series (Children's Defense Fund, 2001). In addition, about 30 percent of children are hospitalized at least once during childhood and about 5 percent experience multiple hospital admissions (Sulkes, 1998). Between 1997 and 2001, about one quarter of all children under the age of 6 had made one or more emergency department visits (National Center for Health Statistics, 2003).

Maintaining a Healthy Body. Even young children can learn simple ways to keep their bodies healthy. Children as young as 3 to 5 can successfully identify behaviors that are unsafe, such as not wearing safety belts, smoking, eating junk food, and not washing one's hands (Jurs, Mangili, & Jurs, 1990; Mobley, 1996). By age 4, children can begin to distinguish between healthful and unhealthful nutritional choices (e.g., drinking milk versus soda; eating fruit versus candy) (Mobley, 1996). And, by age 5, they can identify healthful behaviors (e.g., brushing teeth; washing their hands before eating) (Mobley, 1996).

Dental Care. Tooth decay is one of the most common chronic childhood diseases. It is estimated that by the time they reach 2nd grade, more than half of all children get at least one cavity, a percentage that increases to about 80 percent by the end of high school (U.S. Department of Health and Human Services, 2000b). Some researchers argue that dental care is the most prevalent unmet health need among children in the United States (Newacheck, Hughes, Hung, Wong, & Stoddard, 2000).

Although other issues might be included in an early childhood health and safety curriculum, making a case for addressing the aforementioned issues should be straightforward, especially if you base your arguments on the statistics. Such information helps teachers to justify their focus on health and safety as an educational subject area.

Identifying Theoretical Perspectives To Justify a Health and Safety Curriculum

A closer examination of the above documentation reinforces the importance of two theoretical perspectives that we used to guide the development of our early childhood health and safety curriculum.

Ecological Perspective. An ecological perspective is useful in considering the effect of different environments on children's health and safety (Bronfenbrenner, 1979; Issel, 2004). For example, children living in families with limited incomes are more than twice as likely to have untreated dental cavities as are children from higher income families (Children's Defense Fund, 2001). In addition, poor children are most likely to suffer from unintentional injuries (National Safe Kids Campaign, 2004b).

The classroom environment also must be considered. It is especially important that health and safety activities reflect the skills and interests of the children in each classroom. For this reason, we paid particular attention to the language we used when implementing our health and safety activities. We found that children did not always understand the explanations that teachers first gave for some health and safety concepts. We thus explored with the children how best to rephrase the concepts. Examples of the phrases we found useful when carrying out activities from our Terrific Teeth unit with 4-year-olds are presented in Table 1.

Developmentally Appropriate Practices. Advocates of developmentally appropriate practice (DAP) (Bredekamp & Copple, 1997) remind us that health and safety threats must be approached with children's cognitive, emotional, language, and social skills in mind. Most young children have neither the life experiences nor decision-making skills needed to appreciate or assess threats to their safety. They also lack an understanding of basic health practices. Therefore, we followed six DAP principles when developing our health and safety activities (Kendrick, Kaufmann, & Messenger, 1995).

Principle 1: Use hands-on and concrete learning activities.

Principle 2: Gear activities to the interests and skills of young children.

Principle 3: Integrate health and safety issues into children's daily learning experiences.

Principle 4: Integrate health and safety issues into all parts of the classroom.

Principle 5: Strengthen health and safety skills and concepts through practice.

Principle 6: Involve families, as they play an important role in modeling appropriate health and safety behaviors.

These six principles proved useful in further guiding the development of our health and safety curriculum. For example, activities were spread across all learning centers that children visited throughout the preschool day (Principles 3 and 4). A sampling of some of these activities is presented in Table 2.

Activities also were designed to actively engage children in discussions and hands-on tasks related to their daily lives at home and in the classroom (Principles 1, 2, and 3). In addition, teachers were encouraged to adapt and extend activities to help children with various skill levels practice and consolidate health and safety concepts (Principle 5). Finally, a separate section of family involvement activities was created to support and reinforce the concepts that children were learning in their classroom (Principle 6). A summary of these activities is presented in Table 3.

Conclusion

The principles presented in this article helped us to address the unique health and safety educational needs of young children. The resulting curriculum provided us with a better appreciation of the opportunities that we in the early childhood field have to help promote a healthier and safer environment for children and their families

References

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Bales, D., Coleman, M., & Wallinga, C. (2004). Teaching basic health and safety in the early childhood classroom. Unpublished training curriculum, University of Georgia, Athens.

Birtch, L. L., & Fisher, J. O. (2000). Mothers' child-feeding practices influence daughters' eating and weight. American Journal of Clinical Nutrition, 71(4), 1054-1061.

Bredekamp, S., & Copple, C. (1997). Developmentally appropriate practice in early childhood programs (Rev. ed.). Washington, DC: National Association for the Education of Young Children.

Bronfenbrenner, U. (1979). The ecology of human development. Cambridge, MA: Harvard University Press.

Burt, C. W., & Fingerhut, L.A. (1998). Injury visits to hospital emergency departments: United States, 19921995. Vital and Health Statistics, 13(131) (DHHS Pub. No. PHS 98-1792). Washington, DC: U.S. Government Printing Office.

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Children's Defense Fund. (2001). 2001 yearbook: The state of America's children. Washington, DC: Author.

Cole, R. E., Crandall, R., & Kourofsky, C. E. (2004). We can teach young children fire safety. Young Children, 59(2), 14-18.

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Grossman, D. C. (2000). The history of injury control and the epidemiology of child and adolescent injuries. The Future of Children: Unintentional Injuries in Childhood, 10(1), 23-52.

Huettig, C. I., Sanborn, C. F., DiMarco, N., Popejoy, A., & Rich, S. (2004). The O generation: Our youngest children are at risk for obesity. Young Children, 59(2), 50-55.

Issel, L. M. (2004). Health program planning and evaluation: A practical, systematic approach for community health. Sudbury, MA: Jones & Bartlett.

Jurs, J., Mangili, L., & Jurs, S. (1990). Preschool children's attitudes toward health risk behaviors. Psychological Reports, 66(3), 754.

Kendrick, A. S., Kaufmann, R., & Messenger, K. P. (1995). Healthy young children: A manual for programs (Rev. ed.). Washington, DC: National Association for the Education of Young Children.

Krebs, N. F., Baker, R. D., Greer, F. R., Heyman, M. B., Jaksic, T., & Lifshitz, F. (2003). Prevention of pediatric overweight and obesity. Pediatrics, 112(2), 424-430.

Litovitz, T. L., Smilkstein, M., Felberg, L., Kleinschwartz, W., Berline, R., & Morgan, J. L. (1997). 1996 annual report of the American Association of Poison Control Centers toxic exposure surveillance system. American Journal of Emergency Medicine, 15(5), 447-500.

Mobley, C. E. (1996). Assessment of health knowledge in preschoolers. Children's Health Care, 25(1), 11-18.

National Center for Health Statistics. (2003). Health, United States, 2003. Hyattsville, MD: U.S. Department of Health and Human Services.

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National Children's Study. (2004). What is the national children's study? Retrieved August 28, 2004, from www. nationalchildrensstudy.gov

National Safe Kids Campaign. (2003, May). Report to the nation: Trends in unintentional childhood injury mortality, 1987-2003. Washington, DC: Author.

National Safe Kids Campaign. (2004a). Safe kids highlights. Retrieved August 23, 2004, from www.safekids.org/ National Safe Kids Campaign. (2004b). Children at risk fact sheet. Retrieved August 21, 2004, from www.safekids. org/tier3_printable.cfm?content_item_id=1031&folder_ id=540

Newacheck, P. W., Hughes, D. C., Hung, Y. Y., Wong, S., & Stoddard, J. J. (2000). The unmet health needs of America's children. Pediatrics, 105(4), 989-997.

Pollack, M. D. (1994). School health instruction: The elementary and middle school years (3rd ed., pp. 3-24). St. Louis, MO: Mosby.

Sulkes, S. B. (1998). Developmental and behavioral pediatrics. In R. E. Behrman & R. M. Kliegman (Eds.), Nelson essentials of pediatrics (3rd ed., pp. 1-55). Philadelphia: W. B. Saunders.

Taras, H. L., Frankowski, B. L., McGrath, J. W., Meats, C. J., Murray, R. D., & Young, T. L. (2004). Policy statement: Soft drinks in schools. Pediatrics, 113(1), 152-154.

U.S. Department of Health and Human Services. (2000a, November). Healthy people 2010: Understanding and improving health (2nd ed.). Washington, DC: U.S. Government Printing Office.

U.S. Department of Health and Human Services. (2000b, November). Healthy people 2010: Understanding and improving health (Vol. 2, 2nd ed.). Washington, DC: U.S. Government Printing Office.

Diane Bales is Associate Professor, Charlotte Wallinga is Associate Professor, and Mick Coleman is Professor, Department of Child and Family Development, University of Georgia, Athens.

Table 1

Definitions of Key Terms Associated
With Dental Care: Terrific Teeth

Models and pictures of teeth were used to help children understand
the following concepts and terms.

* Why do we have teeth? "We have teeth to help us eat. Our teeth cut
and grind food into little pieces so that we can swallow it."

* Crown. "The crown is the top part of your tooth that you can see
when you open your mouth." (After washing their hands, children are
invited to touch the crowns of their teeth.)

* Roots. "The roots are the parts of your tooth that you cannot see
because they are in your gums."

* Gums. "Your gums are pink and are in the top and bottom of your
mouth. Gums hold your teeth in place. You need to keep your gums
clean and healthy so they can hold your teeth in place." (After
washing their hands, children are invited to touch their gums.)

* Enamel. "The enamel is the white smooth coating on the outside of
your teeth that protects them and helps keep the germs out. We keep
the enamel clean when we brush our teeth." (After washing their
hands, children are invited to rub the enamel of their teeth.)

* Cavities. "If our teeth are not cleaned, a substance called plaque
can cause holes in our teeth. These holes are called cavities."

* Plaque. "When we eat, food leaves behind an invisible coating on
our teeth called plaque. We can't see it, but this plaque hides
between our teeth. We need to clean the plaque off our teeth
each day. This is why we brush our teeth after we eat."

* Tongue. "Your tongue is inside your mouth (everyone sticks out
their tongues). We use our tongue to help us taste food and to talk.
It is important that we keep our tongue clean because germs can
get on our tongue and give us bad breath."

* Dentist. "A dentist is someone who helps us keep our teeth healthy.
The dentist checks our teeth to make sure they are healthy. The
dentist also fills cavities in our teeth."

Table 2

Examples of Activities Used To Teach
Health and Safety in Learning Centers

Large Group

* Personal experiences. Ask children to describe their experiences
with different health and safety situations. Use these descriptions
as a way to launch discussions of how we can remain healthy
and safe.

* Control. Provide children with a sense of control over their fears
of visiting a doctor by introducing and discussing basic medical
equipment, such as stethoscopes, blood pressure cuffs, and bandages.
Allow children to gain a sense of control over these pieces of
equipment by setting up a doctor's office in the dramatic play
center.

* Guessing game. Place items associated with healthy bodies (e.g.,
plastic food models) and safety (e.g., smoke alarm, sunscreen lotion)
inside a tub and ask children to close their eyes as they retrieve an
item. Also include items that are not healthful (e.g., candy bars) or
safe for children (e.g., matches). Ask the children to discuss
whether each item retrieved from the tub is healthful or safe.
Clarify why the items are healthful or unhealthful, safe or unsafe.

Art

* Medical art. In addition to offering markers and crayons, provide
children with medical supplies, such as bandages, cotton swabs, and
tongue depressors, which can be incorporated into their artwork. As
the children make their art, facilitate discussions of why and how
the medical supplies are used.

* Healthful collages. Invite the children to cut out pictures from
old magazines to make collages of healthy bodies, healthful behavior,
or healthful food.

* Use color to explain concepts. Help children to "see" plaque by
painting colored water or a thin film of corn syrup over laminated
pictures of teeth. Invite children to brush off the "plaque,"
using toothbrushes.

* Food preparation. Facilitate children's appreciation of color and
the visual appeal of healthful snacks. Invite children to name the
different colors in a fruit salad or a vegetable soup. Ask children
to observe the change in texture of fruits after they have been mixed
in a blender to make fruit smoothies.

Music and Movement

* Practice songs. Make up simple songs that children can sing while
they brush their hair, take a bath, clean their room, or brush their
teeth.

* Healthful movement. Invite children to move to music, pointing out
how such movements are fun and provide a form of exercise.

Math and Science

* Health and safety problem-solving skills. Plan and facilitate
children's involvement with materials, field trips, and center
activities that engage their problem-solving skills. For example,
help children learn to correctly identify different parts of their
body represented in X-rays; identify which part(s) of the food
pyramid that simple (e.g., apple) and complex (e.g., cake; pizza)
foods belong to; read a thermometer to determine if a bowl of water
is hot or cold; and identify potential safety threats, like steam
coming from a boiling pot. Take field trips to help children learn to
identify and take appropriate action when seeing traffic signs, exit
signs, poison prevention signs, etc.

* Experiments. Ask the children, "What happens to the sunscreen
lotion that you put on after you have played in the water?" Test
different types of sunglasses to determine if some are better than
others for finding hidden objects placed in the partial and full
sun.

* Graphing health and safety. Use bar graphs to measure how many
children prefer different types of healthful foods, practice
different safety practices at home and in the classroom, or prefer
the taste of one brand of toothpaste over another.

* Matching games. Invite children to sort toy models of different
emergency vehicles (e.g., police car, fire engine, paramedic vehicle,
ambulance) according to their purpose. Can children correctly
identify which model vehicles should be "driven" to different types
of emergencies?

* Traffic signs. Set up a "safety town" on the playground. Place
"traffic signs" with different shapes and colors along the "streets."
Invite children to identify or count the different colors and shapes.
Discuss the meaning of the signs as you and the children walk or ride
along the "streets."

Outside Play

* Obstacle courses. Keep children moving in new ways by designing
obstacle courses.

* Emergency runs. Set up city blocks through which "ambulances"
(wagons) and "fire trucks" (tricycles) must maneuver to reach an
accident.

* Practice outdoor safety skills. Use the safety town mentioned above
to encourage the children to follow safety skills, such as riding
tricycles only on the sidewalk. Guide children's problem-solving
skills by discussing what to do when their ball rolls into the
"highway." Practice what to do when crossing a "street." What should
they do when they arrive at a "railroad crossing" or "traffic
light"?

* Safety hunt. Hide pictures of safe and unsafe activities. Ask
children to retrieve only pictures of safe activities, and then only
unsafe activities. Can they tell the difference?

* Walks and field trips. Take walks to a local market to select
fruits and vegetables for a cooking activity. Walk to a local park.
Take a field trip to pick apples, carrots, or other fruits and
vegetables. Use the fruits and vegetables to make a healthful snack.

Dramatic Play

* Role playing. Set up the dramatic play center to resemble a
doctor's or dentist's office, a grocery story, a "healthful" and an
"unhealthful" bedroom, a bathroom for practicing dental hygiene
skills, or a kitchen for practicing kitchen safety skills.

* Fruit stand. Set up a fruit stand in the dramatic play center or
outside. Children can use the stand to select their morning or
afternoon snack. Or, they can select a snack to take home with
them.

Sensory Play

* Sensory explorations. Provide children with opportunities to touch
and smell the materials and equipment used by medical professionals.
Provide children with different healthful foods to smell and taste.

* Practice sessions. Incorporate safety lessons into children's
sensory play with water, as well as with potentially poisonous or
unhealthful materials, such as finger paint, modeling clay, and sand.

Literature and Writing

* Health and safety reading. Work with a local librarian to stock the
reading center with age-appropriate books related to healthy bodies,
emergencies, safety practices, dental care, and stories about going
to the doctor and dentist.

* Dictating health and safety stories. Take children's dictation about
what they have learned from their reading of health and safety books.

* Note cards. Help children write thank-you cards to health and safety
community workers who visit the classroom. Invite children to write
get-well cards to their peers who are sick.

Table 3

Family Involvement Activities for
Supporting Health and Safety Activities

The following family involvement strategies, developed by the authors,
were incorporated into the health and safety curriculum to provide
families with a range of opportunities for reinforcing their
children's health and safety education at home.

* Tip sheets. Family tip sheets were used to inform parents of
potential home health and safety threats, as well as to guide them in
teaching their children about health and safety practices.

* Parent-child interactive bulletin boards. Guides to developing
interactive bulletin boards were used to provide children with an
opportunity to help "teach" their parents during visits to the
classroom. Such experiences can help build children's self-esteem
and encourage them to share their educational experiences with
others. Interactive bulletin boards also can help demonstrate
the teacher's interest in making families a part of the educational
process.

* Family night workshop guides. Family night workshop guides
encouraged teachers to form collaborative relationships with
community health and safety professionals. Such collaboration can
help teachers introduce topics and information that they personally
may not have the background to address. For example, a dental
hygienist can be asked to speak to parents about helping their
children prepare for a visit to the dentist. A nurse can provide
families with information about caring for children with different
types of illnesses. Firefighters can conduct workshops for families
on identifying potential home fire hazards and developing fire
escape plans.

* Activity calendars. Activity calendars were developed to provide
families with health and safety home activities for each day of the
month. Parents were encouraged to post the calendars on their
refrigerator doors as a reminder of the different ways they can
incorporate health and safety lessons into their children's home
routines.

* Family backpacks. Health and safety family backpack plans were
developed that included simple instructions for carrying out health
and safety activities at home. The materials needed to carry out
the activities also were included in the backpacks as a means of
helping parents to facilitate the activities.