Asthma – Friendly Child Care

A Checklist for Parents and Providers

Asthma is the most common chronic childhood disease. Children with asthma have sensitive airways. They are bothered by many things that start (or “trigger”) their symptoms and make their asthma worse. The most common asthma triggers are allergies to dust mites, cockroaches, animal dander, mold, and pollens, and exposure to irritating smoke, smells, are very cold air. Children's asthma can also be triggered by excessive exercise or an upper respiratory infection. The airways of people who have asthma are “chronically" (almost always) inflamed or irritated, especially if they are exposed to their triggers every day. This makes it hard for them to breathe.

Asthma can be controlled by being aware of its warning signs and symptoms, using medicines properly to treat and prevent asthma episodes, and avoiding the things that trigger asthma problems. Each child's asthma is different, so it is important to know the asthma triggers and treatment plan of each individual.

Use this checklist to learn how to make your child care setting a safe and healthy environment for children with asthma and allergies.

Avoiding or Controlling Allergens

Dust mites

	Needs Improvement	O.K.
Surfaces are wiped with a damp cloth daily. (No aerosol "dusting" sprays are used.)
Floors are cleaned with a damp mop daily.
Small area rugs are used, rather than wall-to-wall carpeting. Woven rugs that can be washed in hot water are best. (Water temperature of at least 130^. F/54^. C kills dust mites.)
If wall-to-wall carpeting can't be avoided, children are prevented from putting their faces, nap mats, blankets or fabric toys directly on the floor.
Children's bed linens, personal blankets and toys, are washed weekly in hot water.
Fabric items (stuffed toys or "dress up" clothes) are washed weekly in hot water, to kill dust mites.
Furniture surfaces are wiped with a damp cloth.
Soft mattresses and upholstered furniture are avoided.
Beds and pillows that children sleep or rest on our encased in special allergy-proof covers.
Curtains, drapes, fabric wall hanging and other "dust catchers" are not hung in child care areas.
If light curtains are used they are washed regularly in the hot water.
If window shades are used, they are wiped often with the damp cloth.
Books, magazines and toys are stored in enclosed bookcases, closed boxes, or plastic bags.
Supplies and materials are stored in closed cabinets; piles of paper and other clutter are avoided.

Animal substances: (both pets and pests shed dander, droppings and other proteins which cause

allergic responses and trigger asthma symptoms)

	Needs Improvement	O.K.
Furry or feathered pets are not allowed anywhere on the premises (cats, dogs, gerbils, hamsters, birds, etc.).
Cockroaches and mice infestation are aggressively controlled, using preventive practices and least toxic extermination methods (see "Cleaning and Maintenance").
Feather-stuffed furnishings, pillows or toys are not used.

Mold and mildew:

	Needs Improvement	O.K.
Exhaust fans are used in bathrooms, kitchens and basement areas to help remove humidity.
Wet carpeting and padding are removed if not dry within 24 hours to prevent mold growth.
Mats that are placed on carpeted floors (especially in basement areas) are vinyl-covered, and wiped regularly with diluted chlorine bleach and water (1/4 cup bleach in 1 gallon water).
Mildew growth in bathroom and other damp areas (such as refrigerator drip pans) is prevented by regular wiping with diluted chlorine bleach and water.
Indoor houseplants and foam pillows, which can develop mold growth, are not used.

Outdoor pollen and mold spores:

	Needs Improvement	O.K.
If ventilation is adequate, windows are kept closed during periods of high pollen count
Air conditioners with clean filters are used during warm seasons, if possible.
Outdoor yard and play areas are kept clean of fallen leaves, compost piles, and cut grass.

Latex: (products made with natural rubber)

	Needs Improvement	O.K.
Avoid latex gloves. If gloves are used, only non-powdered, non-latex gloves.
Avoid latex balloons, pacifiers, koosh balls and other latex products (if child or staff member has latex sensitivity).

Avoiding or Controlling Irritants

Tobacco Smoke: (triggers asthma symptoms; causes children to have more respiratory and

ear infections, and to need more asthma medication)

	Needs Improvement	O.K.
Smoking is not allowed anywhere on the premises. This rule is strictly enforced.
Staff and parents are encouraged to participate in smoking cessation programs, and given referrals and assistance.

Chemical Fumes, Fragrances, And Other Strong Odors:

	Needs Improvement	O.K.
Arts and crafts materials with fragrances or fumes are avoided (e.g., markers, paints, adhesives). If they are used, extra ventilation is provided.
Staff does not wear perfume or other scented personal products. (Use "fragrance-free" products.)
Personal care products (such as hair spray, nail polish, powders) are not used around the children.
Air fragrance sprays, incense, and "air fresheners "are not used. (Open the windows and/or use exhaust fans instead.)
New purchases (such as pressed-wood furnishings or plastic laminated products) are checked for formaldehyde fumes, and aired out before installation.
Cleaning supplies and home repair products with strong smells are not used when children are present; indoor spaces are carefully ventilated during and after their use.
Office equipment that emits fumes (e.g., photocopiers) are in vented areas away from children.

Other Irritants:

	Needs Improvement	O.K.
Fireplaces and wood or coal stoves are not used.

Policies and Practices

Asthma Management And Care:

	Needs Improvement	O.K.
All staff are trained to watch for symptoms of asthma, warning signs that asthma is flaring up, and how to recognize emergency situations. New staff receive this training when hired.
Every child with asthma has a written plan on file, listing allergies and asthma triggers, medication schedule, and emergency instructions.
Staff is trained to administer medication, and in the use and care of nebulizers, inhalers, spacer and peak flow meters.
Parents and providers communicate regularly about child's asthma status.
Outdoor time is adjusted for cold-sensitive children, and alternative indoor activities are offered (After an asthma episode or viral infection, they are also more sensitive.)
Staff and children should wash hands frequently; toys and surfaces are wiped often, to prevent the spread of viral infections that can trigger asthma.

General Physical Site/Space:

	Needs Improvement	O.K.
Ventilation provides good air flow in all rooms and halls in every season. There is no stale or musty smell. Outdoor intake and inside supply vents are checked for blockages.
Heating or cooling system filters are properly installed, and changed often; other service guidelines and routine maintenance procedures are followed.
Heating or cooling ducts are professionally cleaned once a year.
Outdoor fumes (such as from car exhaust, idling vans or buses, or nearby businesses) are prevented from entering the building through open windows or doors.
The building is checked periodically for leaks and areas of standing water.
Plumbing leaks are fixed promptly.
Humidity level is monitored, using a humidity gauge, if possible. Humidifiers are not used; dehumidifiers are used if necessary. (Dust mites and mold thrive on humidity.)
Wet boots and clothing are removed and stored where they don't track wetness into activity space.
Doormats are placed outside all entrances, to reduce tracking in of allergens.

Cleaning and Maintenance:

	Needs Improvement	O.K.
If rugs or carpets must be used, they are vacuumed frequently (every day or two).
High efficiency vacuum cleaner (ideally with a "HEPA" filter) is used. (Others blow tiny particles back into the air.)
Dusting is done often, with a damp cloth, to avoid stirring up the dust.
Vacuuming and other cleaning is done when children are not present.
Integrated pest management techniques are used, to limit amount of pesticide needed (e.g., Seal all cracks in walls, floors and ceilings; eliminate clutter; keep food in air tight containers).
Pesticides are applied properly, with adequate ventilation, when children are not present.
Garbage is kept in tightly covered containers, and removed promptly to outdoor enclosed trash area that is not accessible to children.
Painting, repairs or construction work is done when children are not present. Indoor spaces are protected from construction dust, debris, strong odors and fumes.
Shampooing of rugs and upholstery is done with low emission, fragrance-free products. They are dried thoroughly to prevent growth of mold and dust mites.

Ideas for improvement: _______________________________________________________________

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FAMILY DAY-CARE: Special Concerns

When children are cared for in "family day-care" settings, they are exposed to things that are part of daily life in that household, some of which may be harmful for children with asthma. Parents and providers need to have honest discussions about these issues, which may involve sensitive matters. For example:

Members of the provider’s family may smoke cigarettes in the home, or use strong smelling perfumes or lotions;
the family may have pets, or acquire new pets, to which the asthmatic child is allergic;
the home may have a wood stove, fireplace or space heater that produces particles or fumes that irritate sensitive airways;
home furnishings are likely to include upholstered chairs and sofas that contain dust mite allergen;
hobbies or home repairs may produce fumes strong odors.

The habits and activities of a child care provider’s family may need to be adjusted, in order to provide a healthy environment for all children who spend time in the household. Parents of children with asthma need to find out whether asthma triggers are present. In some circumstances, they may need to make other child care arrangements. Child care centers housed in public or private buildings may also have limits on their ability to improve their indoor air quality and remove all asthma triggers.

This checklist was developed by the Asthma & Allergy Foundation of America/New England Chapter, with the support of a grant from the U.S. Environmental Protection Agency, Region. I.

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