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Drooling, playing, sharing… a nurse’s recomendations for church preschool ministries

June 17, 2010

I am going to start a series of posts about health, nursing, and church preschool ministries. For those of you who serve in the preschool area, be it volunteer, baby holder, teacher, or preschool minister…. GOD BLESS YOU! There is an art to that service, and a lot of sharing, putting things in one’s mouth, snacks, diapers, hand washing, separation anxiety, hitting, biting, … you get the idea. Preschool workers must have the patience of Job!

After doing an extensive internet and literature search on “church health”, “preschool ministry health”, and “preschool ministers and health” (and several other variations of health and children)…. I found very little. This led me to believe that there is little information out there on the important subject of keeping kids healthy within the preschool area. Further, many churches may be feeling the economic pinch, have small congregations that cannot afford a preschool minister, or may even believe that rearing children is ‘women’s work’ thus any woman will do to run the ministry as long as she is God-fearing (no discrimination intended guys… you all make some of the BEST preschool workers).

While a love for kids, service, and the Lord may be imperative for preschool ministry, the birth to school aged years are a particularly important time for not only growth and development but health.

I will write later about the church’s service to families of preschoolers with health needs, but for now I just want to begin with some food for thought in building a good, safe, healthy preschool ministry. (AND when I say healthy I am not talking about spiritual health…. I mean good grief, Googling health and ministry together get’s a lot of gobbeldy goop about spiritual health.)

Things to consider when building a healthy preschool/nursery ministry:

  • Setting rules about when kids are not allowed. Although this seems like an authoritarian way to begin, it’s really a way to help keep all the kids you serve and their families healthy. Many states’ daycare guidelines have good ideas of where to start on this subject, so check out your state daycare recommendations. I would begin with stating something like; any kid with rash, vomiting, diarrhea, or a fever over 100 degrees Fahrenheit within the last 24 hours should not be brought to the nursery or preschool area.  Then, make this regulation known to parents in a loving but clear way. An introduction packet the first time the bring their child, or posting this on the door of the nursery/toddler room. Remember, be gentle but clear. Something like, “We love your children and want to keep them healthy. The best way to do that is for all of us to work together. We promise to help keep the room clean, enforce hand washing, etc…. and ask that you help us by the following….” Then put in the part about not bringing your child when they are ill.
  • Educate your preschool staff about common childhood communicable diseases, not so they can diagnose, but so they can recognize and keep themselves healthy. Many common childhood illnesses are viral and cannot be cured with antibiotics. The most serious childhood illnesses commonly have vaccine prevention. However, many parents are choosing not to immunize their children. These parents are the middle to upper class Americans, and while I am not condoning or condemning this choice and neither should the preschool staff, it does create greater risk within the preschool area. Immunization is not a 100% guarantee that a disease will not be caught/transmitted (however it really increases the chances of not catching a disease) and thus those who may get and carry a disease can pass it on to an immunized person. Also, some immunizations only provide immunity for several years. Many adults are no longer immune against pertussis, diphtheria, measles, mumps, etc. With recent outbreaks of mumps, pertussis, and measles within the U.S., recognition and education of everyone about communicable disease is important. (I will write a future post with the signs and symptoms of the most communicable and common childhood illnesses.)

With the recent recommendations for pertussis and diphtheria immunization with tetanus boosters (In medical jargon this is called a TDaP), you may want to consider asking your preschool staff to ensure they have their booster. For example, one un-immunized healthy kid may come into the preschool area and interact with a staff member who had bronchitis several weeks ago, but now has a cough hanging on (common with pertussis/whooping cough). That worker, who will shed pertussis virus for several weeks post acute infection now has exposed that un-immunized child.

  • Keep a first aid kit easily accessible but out of the reach of children. A first aid kit is a must. In it should be the following: Bandaids, gloves, some antibacterial soap to clean wounds with (NOT HAND GELL), larger bandage pads to soak up blood if needed, some bandage tape, incident report sheets, a frozen sponge in a zip-lock bag (kept in the freezer) and liquid benadryl (diphenhydramine) with a standard dosage chart. Gloves are obvious, use them when cleaning and treating any open wound. Bandaids are obvious and work to make many ouchies feel better. Antibacterial hand soap (in a pump, so it carries less germs) is a must to clean a wound. Use it with water and let air dry (never blow on a cut, it introduces bacteria). I do not recommend antibacterial ointment for cuts, parents can do that at home and many kids now have allergies to antibiotics due to frequent exposure. Larger wound pads to soak up blood or to dress bigger cuts and tape to make it stick. Slightly damp, frozen sponges make excellent ice packs and can be reused over and over… simply put a new zip-lock around it between each use.  Should an allergic reaction or hives occur in someone in the preschool benadryl is the medication of choice. You would never dose without the parent/guardian there to do it themselves, but it is great to have handy and anyone can swallow the liquid form.  Finally, incident reports should be little sheets of paper that the adult in the room can fill out and give to parents when any ouchy, even if minor, has occurred. This keeps parents in the loop and helps them feel a part of the team. No one wants to hear from their child in the car on the way home from church, “Little Tommy hit me in the head with a block today and made me cry”.
  • Hand washing, hand washing, hand washing…. Both kids and adults, put up signs, pictures, etc…. Enough said.
  • Conform to recommended teacher to child-ratios for nurseries and preschools set by your state and let parents know you do this. There is nothing more frightening for a parent than to turn their children over to strangers for 2 hours of time, but it is even more frightening if the room is packed with kids and there is only one adult trying to hold it all together. Further, there is nothing scarier or more frustrating for nursery staff than to be the only adult in a room of 20 preschoolers (Even 2 adults in such a room is too few). Not only will this drive parents and volunteers out of your church faster than you can say ‘boo’, but it is extremely dangerous. What if one child is climbing on the sink while another is biting? What if you have two fighting in the corner while this is going on? There need to be eyes on the kids at all times. In fact, I would say that going to an even smaller student to teacher ratio than what your state recommends is highly advised. (FYI, counting people who check kids in and out or run other areas of the preschool and nursery do not count in staffing for rooms.)
  • Consider allergies. All kids, whether long-time attenders or newbies need allergy and other important information. Consider keeping file cards on each child or stickers on the ones with allergies to alert anyone that comes into contact with them (this works well if you are changing teachers/volunteers frequently). Keep this information accessible to all volunteers in the area, but also confidential if the parent wishes. HAVING SAID THIS…. do not let allergies keep you from being creative (the next area). While peanut allergies are common and you may not want to serve any snacks that even have a hint of nuts (this would include any processed chocolate)… You also DO NOT want to serve the same thing all the time and bore the kids out of their mind. Pretzels every week, YUCK! Likewise, if the allergy the child has is severe and requires epinephrine treatment immediately upon exposure, then the parents MUST ensure that the epinephrine injector set is sent with the child every week and that someone in the preschool area is trained to use it. Since we cannot control everything in every environment, or everything that goes into a kid’s mouth, someone other than the parents, because often parents may be difficult to track down, must know be trained in using epinephrine auto-injectors. The child’s life may depend on it. Also, encourage these parents to pack their kids a snack, so the kids do not miss out and yet the parents will feel safe about what the kids are getting.
  • Keep it creative. This is a child development issue, but also one that if not followed can create bored kids… and bored kids may find mischief. Make rooms safe (like no tall book shelves, folding chairs, small toys that can be swallowed, if there is a sink make sure the hot water does not get over 120 degrees, etc…), but inviting, ensure there are plenty of toys to share, do more than a coloring page every week, have structure but creativity. Kids like to explore, feel, touch, taste (as they learn)… so do not expect them to sit still and color or listen to a story without pictures. Further, allow your staff to be creative and expand within the curriculum and let them prepare ahead of time.
  • Consider special needs kids. Often parents who have children with special needs do not send their children to a preschool area because they are fearful for many reasons. Consider a specialized program for these kids where you put them with a secure one-on-one adult buddy every week who helps them, builds trust, knows their needs, and can help them into a class with other kids their age. Or consider a specialized class for a certain population you may serve. Consider translators when needed and use congregational nurses, occupational/physical therapists, and child development experts to help you design or implement such programs (these people are often looking for ways to use their educational gifts within a congregation).

These tips are certainly not the entirety of safety and health in the preschool area, but it does provide some ideas for thinking about the importance of this population in a church congregation. Often churches have adult ministers, youth ministers, music ministers, etc… but leave the nursery and preschool as an area that can take care of itself. Careful planning, communication, and education will help make parents feel better and help keep kids safe.

More later on other similar topics….

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