Home Healthcare
Children's
PARENT HANDBOOK
4156 South 52nd St
Omaha, NE 68117
402-734-6741 or 1-800-747-7334 Children’s Home Healthcare’s World 7815 Farnam Drive Omaha, NE 68114 402-926-2322
Privacy Notice Written Acknowledgement
I have received the Children’s Healthcare Services Notice of Privacy Practices Version # 1 (draft # 13).
Documentation of Good Faith Effort
Attempted to distribute the Notice of Privacy Practices to the patient/parent/legal guardian, but the patient/parent/legal guardian declined to acknowledge the receipt of the Notice of Privacy Practices. Patient/Parent/Legal Guardian stated they had already received the Privacy Notice at another Children’s Healthcare Service location. Patient/Parent/Legal Guardian directed to Children’s Hospital Website to view the Notice of Privacy Practices. The Notice of Privacy Practices was mailed to the patient/parent/legal guardian. Other
This form also acknowledges that the Children’s Home Healthcare Parent Handbook, which includes the Privacy Notice Act, was received, reviewed and explained to the parent(s) and/or guardian(s) satisfaction. Thank you again for choosing Children’s Home Healthcare. Child’s Name:
Please Print
Parent or Guardian:
Signature
Witness: Signature Date reviewed: _________________________________________________
Table of Contents
TOPIC Page(s)
Service Lines ........................................................................................................................... 1 Mission and Vision ................................................................................................................... 2 Hours of Operation .................................................................................................................. 2 Supply Order Process.............................................................................................................. 2 Delivery Zone Map .................................................................................................................. 4 Rental Procedure ..................................................................................................................... 5 Billing Information and Credit Policy ........................................................................................ 5 Grievance Policy and Home Health Hotline ............................................................................. 5 Advance Directives ............................................................................................................... 5-7 Notice of Privacy Practices……………………………………………………………………..…7-12 Patient Rights ................................................................................................................... 12-14 Home Health Hotline Phone Number………………………………………………………………13 Pain Assessment and Management ................................................................................. 14-17 Developmental Milestones................................................................................................ 17-22 Immunization Record ............................................................................................................. 23 Hand washing Practices…………………………………………………………………………24-25 Child Abuse and Neglect .................................................................................................. 26-27 Latex Allergy Awareness .................................................................................................. 28-33 Cardiopulmonary Resuscitation (CPR) ............................................................................. 34-35 Foreign Body Obstruction ...................................................................................................... 36 Basic First Aid................................................................................................................... 36-38 Sudden Infant Death Syndrome ............................................................................................ 38 Injury Prevention Safety Tips ............................................................................................ 38-41 Safety Tips for Infants and Toddlers ................................................................................. 41-43 Never Shake a Baby…………………………………………………………………………………43 Home Safety Checklist ..................................................................................................... 44-48 Disaster Preparation Checklist ......................................................................................... 49-52 Fire Safety ............................................................................................................................. 52 Storm Safety .......................................................................................................................... 53 Important Phone Numbers..................................................................................................... 55 Community Resources………………………………………………………………………..…56-59
Welcome to Children’s Home Healthcare
Thank you for trusting Children’s Home Healthcare (CHHC) to care for your child. It is a responsibility that we take very seriously. Children’s Home Healthcare is part of the family of care services available from Children’s Healthcare Services in Omaha. Like our affiliated entity, Children’s Hospital, Children’s Home Healthcare is dedicated to the highest standard of quality care possible for children and their families. We are the only home health agency in the Omaha area offering equipment, supplies and services exclusively for children. Children’s Home Healthcare provides 6 lines of services: Home Infusion, Respiratory Care, Home Health Nursing, Private Duty Nursing & Children’s World, Home Medical Equipment & Supplies and Rehabilitation Equipment. HOME INFUSION: Our pharmacists will be able to meet all of your child’s intravenous (IV) needs with Total Parental Nutrition (TPN), IV antibiotics and other medications administered intravenously and IV hydration. RESPIRATORY CARE: Our respiratory therapists will manage your child’s respiratory needs such as oxygen, apnea monitor, nebulizer, tracheostomy and ventilator needs. HOME HEALTH NURSING: Nurses will provide visits in your home for needs such as monitoring your child’s condition, teaching regarding your child’s care, laboratory work collections, central line management, IV needs, enteral needs and phototherapy needs. PRIVATE DUTY SERVICES: Private Duty Service’s offers nursing care for your child. The nurse may provide these hours in the child’s home, attend school with the child or provide care for the child at our center, Children’s Home Healthcare’s World. Nursing hours are often authorized for children with various medical needs such as ventilator dependent, tracheostomy, gastrostomy button and infusion needs along with various other medical needs and diagnosis. Depending on insurance coverage and child’s medical needs, nursing care may be authorized for a specific amount of hours per week for parents to work outside the home, pursue an education, sleep and have some ―respite time‖. Children’s Home Healthcare’s World is a childcare setting-serving children with medical needs. It is located at 7815 Farnam Drive. For more information please call 926-2322. EQUIPMENT AND SUPPLIES: Our warehouse staff will be able to assist with your child’s equipment and supply needs, including such items as urinary supplies, ostomy supplies, respiratory supplies, enteral supplies, specialized rehabilitation equipment and various other medical supplies your child may need. REHABILITATION EQUIPMENT: We provide: Rental Manual Wheelchairs Seating & Mobility Needs Gait Trainers Standers Home Medical Equipment Complex Manual Wheelchairs Bath Chairs Lifts
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ABOUT THIS BOOKLET This booklet was written for two purposes. One purpose is to give you a ready resource for general health care information. In this booklet, you will find sections on basic first aid, home safety for children and a list of important numbers, as well as other administrative information about Children’s Home Healthcare. Another goal of this booklet is to meet the requirements of the Nebraska Home Health Care Association to provide you with your patient rights. This section is written in very specific language to meet that requirement. As you read this booklet, please feel free to call Children’s Home Healthcare at (402) 734-6741 or 1-800-7477334 or CHHC's World and Private Duty Services at (402) 926-2322 with any questions. Mission Statement Children’s Home Healthcare is a family-centered, regional provider of high quality pediatric home care services. Vision Statement Children’s Home Healthcare is recognized as the regional leader in the provision of pediatric home care services. We participate in building the best system of coordinated home healthcare for children by working cooperatively with Children’s Healthcare Services and other providers in the region. Values Excellence in service to children and their families Respect for human dignity Cooperative work relationships (internal and external) Positive attitudes and behaviors Honesty and integrity Wise use of resources
General Information Hours of Operation
Children’s Home Healthcare’s office hours are Monday through Friday, 8 a.m. to 5 p.m. On-call service is provided for your emergency needs 24 hours a day, seven days a week. Our 24-hour telephone number is (402) 734-6741, or if you live outside the Omaha area, 1-800-747-7334. Children’s Home Healthcare Children’s World & Private Duty Services is open 24 hours, 7 days a week. Our 24hour telephone number is (402) 926-2322.
Supply Order Process
CHHC offers a free service of delivery supplies in the Omaha Metropolitan and surrounding area providing that you are home to receive supplies and sign delivery receipt ticket. Please refer to the map of the delivery zones, which are based on zip codes. The delivery day for each zone is also noted on this map. Please take a moment to review this map to confirm your specific delivery date/day. The following information will help to expedite your supply orders: All orders for delivery must be phoned to Children’s Home Healthcare (CHHC) two (2) working days prior to your scheduled delivery date/day. All orders for mail or UPS shipment must be phoned in to CHHC five (5) working days in advance, in order for the supplies to be delivered in a timely manner. Orders that will be picked up from our office must be phoned into CHHC one (1) day prior to pick-up. Federal Regulations and CHHC policy stipulate that all orders for medical supplies or equipment require a proof of delivery. Proof of delivery for a supplier delivering directly is a signed delivery ticket by the person responsible for payment of the delivery or their agent. Proof of delivery for items shipped by a delivery service (UPS) requires the tracking slip and the delivery ticket as proof of delivery. CHHC has implemented the following procedures to ensure that signatures are obtained on a delivery receipts: a. If CHHC is to deliver an order, CHHC will confirm a delivery time when the order is placed. CHHC will deliver the order to your home or work place at the confirmed delivery time and obtain a signature at that time. b. If the order is shipped, CHHC will place the tracking number on the package and on the delivery ticket. This along with the delivery service-tracking log is considered proof of delivery for a delivery service
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order. A signature on the delivery ticket is not required if the ticket has the tracking number on it and a tracking log is kept. The recipient of a shipped service order must check the delivery, if an errors is noted please call CHHC immediately so that it can be corrected prior to confirmation the next day. A person delivered to directly must also check the delivery, but can inform the driver to change the delivery ticket prior to signing it.
If CHHC arrives at your home or work place at the scheduled time and there is no one available to receive the order, CHHC will not be able to leave the order. You will be required to contact CHHC to arrange another time to pick up your order at our CHHC office. If you have any questions regarding this process, please call us at 7346741 or 1-800-747-7334. Supply orders are to be placed with the Patient Services Department between the hours of 8-5pm, Monday through Friday. Pharmacy orders are to be placed directly with the Pharmacy Department during the same hours. The following information will help to expedite your supply orders: Orders that will be picked up from our office must be phoned in at least one (1) day prior to pickup. All orders for delivery must be phoned to Children’s Home Healthcare (CHHC) at least two (2) working days in advance, prior to your scheduled delivery date/day. All orders for mail or UPS shipment must be phoned in at least five (5) working days in advance, in order for the supplies to be delivered in a timely manner. Federal Regulations and our policies stipulate that all orders for medical supplies or equipment require a signed delivery receipt. To ensure that signatures are obtained on delivery receipts: a. If CHHC is to deliver your order, we will confirm a delivery time when your order is placed. We will deliver your order to your home or work place at the confirmed delivery time when you placed the order. b. If the order is shipped, we will enclose a self addressed stamped envelope with your delivery. We ask that you sign and date the white copy of the delivery ticket and return it in the envelope provided. c. If we do not receive the signed copy of the order form returned to us in a timely manner, you will be billed directly for the items that you received and will be unable to receive any future shipments until the signed delivery ticket is received by CHHC. If we deliver your order to your home or work place at the scheduled time and there is no one available to receive your order, you will be required to contact us to arrange a time to pick up your order at our office. We can not leave supplies if no one is available to sign that you received supplies. CHHC employees are not allowed to sign for deliveries. If you have outstanding unsigned delivery receipts from having supplies mailed to your home, you will not be able to receive additional supplies until past delivery receipts have been signed and received by CHHC.
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Delivery Zone Map
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Rental Procedure
All patients referred to Children’s Home Healthcare are required to sign an invoice and rental agreement. The rental agreement defines the way the equipment should be used, your responsibility for equipment operation and maintenance, and the billing process, equipment return policy and Children’s Home Healthcare’s responsibilities. If you sign this agreement you are identifying that you accept responsibility for the equipment.
Billing Process
If you have medical insurance, Children’s Home Healthcare can file your insurance claims for each month’s charges once we obtain an assignment of benefits from you. You will receive a monthly statement for any amount that the insurance does not pay. This amount is to be paid each month. We accept cash, checks, Visa or MasterCard. If you have any questions about billing, please call (402) 734-6741 and ask to speak to a Patient Account Representative. If you child’s insurance is Medicaid, routine monthly statements are not mailed to the family.
Insurance
Even though patients have medical insurance and benefits, the insurance contract is between the insured responsible party and insurance company; therefore, the prompt payment of our fees remains the personal responsibility of the insured responsible party. It is your responsibility to report any change in insurance coverage immediately to Children’s Home Healthcare. If you are unable to pay your account in full on receipt of your statement, we ask that you contact the billing department to make payment arrangements. Accounts are considered delinquent 60 days following date of service. If you need health reports sent to your insurance companies or to attorneys for litigation purposes, claims, etc., CHHC requires payment in advance for reports.
Credit Policy
In accordance with federal and state laws and to assure the integrity and quality of our products and services, we are unable to accept returned products for credit.
Grievance Policy
If at any time during the course of our service you have any problems or concerns with the manner in which your care has been provided, please call any Coordinator or the Executive Director at (402) 734-6741. The ―Medicare Home Health Hotline‖ also is available. The toll-free number is 1-800-245-5832. Joint Commission (JCAHO) is also available for any safety or quality concerns; you may reach JCAHO by calling 800-994-6610.
Advance Directives
Children’s Home Healthcare will comply with the Patient Self-Determination Act and Nebraska law governing competent adult individuals’ rights to make decisions concerning their medical care. This policy does not apply to clients who are under the age of 19, since parents or guardians are responsible for any decisions regarding the health care of minor children. Information about Advance Directives for adult patients is available on request. Advance Directive Information – a written instruction, such as a living will or a durable power of attorney for healthcare, recognized under applicable state law and relating to the provision of healthcare when an adult individual is incapacitated. Adult Individual – (a) a Nebraska resident who is 19 years of age or older or married (if younger than 19 years of age); (b) an individual 18 years of age or older who is a resident of Iowa, South Dakota, Kansas, Missouri or any other state in which the age of majority is 18; or (c) a person younger than 18 years of age who has entered the military and has completed basic training. Competent – a person who has the capacity to make informed and voluntary decisions about medical care and who is able to demonstrate understanding of the nature and extent of the disease process and the possible consequences of alternative treatment and withholding treatment. Living Will – a written document, executed by a competent adult individual authorizing in advance the withholding or withdrawal of artificial life support measures when an adult individual is incapacitated or unable to make their wishes known. 5
QUESTIONS AND ANSWERS 1. What Is An Advance Directive? An Advance Directive is a written statement, which reliably shows that you have made a particular health care decision or have appointed another person to make that decision on your behalf. The two most common forms of Advance Directives are: A ―Living Will‖ and A ―Durable Power of Attorney for Health Care‖
An Advance Directive allows you to state your choices for health care or to name someone to make those choices for you if you become unable to make decisions about your medical treatment. In short, an Advance Directive can enable you to make decisions about your future medical treatment. You can say ―Yes‖ to treatment you want or say ―No‖ to treatment you do not want. 2. What Is A Living Will? A Living Will generally states the kind of medical care you want, or do not want, if you become unable to make your own decisions. It is called a ―Living Will‖ because it takes effect while you are still living. The Nebraska Legislature has not adopted any particular laws or form of Living Will; however, Living Wills are not prohibited in Nebraska. A Living Will should clearly state your choice with regard to health care. 3. What Is A Durable Power Of Attorney For Health Care? A ―Durable Power of Attorney for Health Care‖ is a legal paper naming another person, such as a husband, wife, daughter, son or close friend, as your ―agent‖ or ―representative‖ to make medical decisions for you if you should become unable to make them for yourself. Your agent or representative is guided by your instructions, and you can provide instructions about any treatment you do or don’t want. In general, a power of attorney can give to the agent or representative the same powers an individual may have or could enforce on his/her own behalf. Nebraska has laws on Durable Powers of Attorney, which allow an agent to make medical decisions for the person given the power of attorney. 4. Must A Health Care Provider Follow An Advance Directive? Each health care provider will have policies concerning Advance Directives. The health care provider you choose must inform you in writing of its written policy regarding Advance Directives. Therefore, you should review and discuss with the provider, and others, the provider’s policy on following your Advance Directive. The federal law regarding Advance Directives requires only health care providers, unless they object on the basis of conscience, to follow state laws or court decisions that recognize Advance Directives. 5. When Do Advance Directives Take Effect? It is the policy of Children’s Home Healthcare to comply with the Patient Self-Determination Act and the Nebraska law governing competent adult individuals’ rights to make decisions concerning their medical care. This policy does not apply to our clients who are under the age of 19. Parents or guardians are responsible for any decisions regarding the health care of minor children. Information about Advance Directives for adult patients is available on request. 6. Do I Have To Write An Advance Directive? No. It is entirely up to you whether you want to prepare an advance directive. Questions may arise about the kind of medical treatment that you do and do not want to receive. An Advance Directive may help solve those questions. 7. Can I Change My Mind After I Write An Advance Directive? Yes. To change or cancel an Advance Directive, simply destroy the original or take some other action to notify those who might rely on your Advance Directive that you are changing it or no longer want to have it effective. If you have given the Advance Directive to the doctor, notify your doctor if you change your mind. If you have given it to another health care provider, such as a hospital, nursing or home health agency, or a relative, notify them that you have changed your mind. If you have written a new document, you should give a copy of the new document to your doctor, other health care providers and anyone else who may be involved in your care. 8. Do I Have To Have A Written Document To Express My Wishes To My Doctor? No. If you are able to communicate your wishes to your doctor, they will carry more weight than an Advance Directive. But if you state your wishes in a written document, your doctor will know what you want if you are not able to make decisions and communicate them on your own behalf.
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9. What Choices Should I Include In My Advance Directive? If you choose to write an Advance Directive, the content of the Advance directive is entirely your own choice. If you have questions, you may talk with family members; close personal advisors, your doctor or others who could help you understand your choices. Your Advance Directive should be personal to you and should reflect your own choices. 10. If You Have An Advance Directive In One State, Will It Be Followed In A Different State? The laws are unclear about honoring an Advance Directive in one state if it was written in a different state. However, because an Advance Directive tells your wishes regarding medical care, it may be honored wherever you are, if it is made known. If, however, you spend a great deal of time in more than one state, you may wish to consider having your Advance Directive meet the laws of both states as much as possible. 11. What Should I Do With My Advance Directive If I Choose To Have One? Make sure that someone, such as a family member, knows that you have an Advance Directive and knows where it is located. You might also consider the following: If you have a durable Power of Attorney, give a copy of the original to your ―agent‖ or ―representative.‖ Ask your doctor to make your Advance Directive part of your permanent medical record. Keep a second copy of your Advance Directive in a safe place where it can be found easily, if it is needed. Keep a small card in your purse or wallet, which states that you have an Advance Directive, where it is located and who your ―agent‖ or ―representative‖ is, if you have named one.
NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOUR CHILD MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. If you have any questions, would like more information, or you do not understand this Notice of Privacy Practices (―Notice‖) or our privacy practices, please contact the Privacy Officer at (402) 955-4116. WHO WILL FOLLOW THIS NOTICE This Notice describes the privacy practices of Children’s Healthcare Services including those of: Any health care professional that can enter information into your child’s medical record. All areas of Children’s Hospital including Children’s Urgent Care Centers. Any volunteer we allow to help your child while he/she is provided care. All Children’s Physicians offices. All Children’s Home Healthcare services. All physicians or allied health professionals that treat your child or enter information into your child’s medical record while your child is a patient at Children’s Hospital. The above may share medical information with each other for treatment, payment or hospital operations as described in this notice.
OUR PLEDGE REGARDING MEDICAL INFORMATION We understand that information about your child and your child’s health is personal and we will try to protect that information. We create a record of the care and services your child receives. This record helps us to provide quality care and meets legal requirements. This Notice covers all records of your child’s care, whether created by Children’s Hospital, Children’s Home Healthcare, Children’s Physician’s office or Children’s Urgent Care Center. The privacy practices described in this Notice may be different than those of other doctor’s treating your child. This Notice will tell you about the ways in which we may use and disclose medical information about your child. It also describes your rights and our responsibilities regarding the use and disclosure of your child’s medical information. We are required by law to: make sure that medical information about your child is kept private; give you this Notice of our legal duties and privacy practices; and follow the terms of the privacy notice that is currently in effect. 7
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOUR CHILD Below are some examples of how we may use and disclose medical information. However, not every use and disclosure is listed. For Treatment. We may provide medical information about your child to doctors, nurses, technicians, residents, medical students, or other personnel who take care of your child. For example, a doctor treating your child for a broken leg may need to know if your child has diabetes since diabetes may slow healing. In addition, the doctor may also need to tell a dietician that your child has diabetes so we can arrange for the right meals. We may share medical information about your child with people and companies outside Children’s Healthcare Services involved in your child’s ongoing medical care. For Payment. We may use medical information about your child so that the treatment and services your child receives can be billed and payment may be collected from you, an insurance company or a third party. For example, we may need to give your child’s insurance company information about your child’s surgery so the insurance company will pay us for the surgery. We may tell your health plan about a treatment your child is going to receive to obtain approval or to determine whether your health plan will cover the treatment. We also may provide medical information about your child to companies outside Children’s Healthcare Services who need this information to bill for services they provided. For Health Care Operations. We may use medical information about your child for health care operations that help us to provide quality care. For example, we may use medical information to review our treatment, services and the performance of our staff. We may also combine medical information about patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments work. We may provide information to doctors, nurses, technicians, medical students and other personnel for review and learning purposes. We may provide medical information about your child to companies outside of Children’s Healthcare Services for health care operations as long as both companies have treated your child. We may also combine medical information we have with medical information from other hospitals to compare how we are doing and see where we can make improvements in care and services. We will remove information that identifies your child from this set of medical information so that others may use it to study health care and health care delivery without being able to identify your child. Business Associates. We may provide medical information to other persons or organizations, known as business associates, who provide services for us under contract. We require our business associates to protect the medical information we provide to them. Appointment Reminders. We may use and provide medical information to contact you as a reminder that your child has an appointment with us. If you do not want to be contacted for appointment reminders you must contact the Children’s Hospital’s Community Relations Department in writing. Treatment Alternatives. We may use and provide medical information to tell you about possible treatment options or other items of interest. If you do not want to be contacted for these reasons, you must contact the Children’s Hospital’s Community Relations Department in writing. Health-Related Benefits and Services. We may use and provide medical information to tell you about health-related benefits or services of interest. If you do not want to be contacted for these reasons, you must contact the Children’s Hospital’s Community Relations Department in writing. Fundraising Activities. We may provide medical information about your child to our hospital-related foundation so the foundation may contact you in raising money for the hospital. We will only release information, such as your and your child’s name, address and phone number and the dates your child received treatment or services. If you do not want to be contacted for fundraising efforts, you must contact the Children’s Hospital’s Foundation in writing. Hospital Directory. We may include limited information such as your child’s name and location in the hospital directory while your child is a patient, unless you notify us that you object. The directory information may also be given to people who contact the hospital and ask for your child by name. This is so your child’s family, friends and clergy may visit your child in the hospital. Individuals Involved in Your Child’s Care or Payment for Your Child’s Care. We may provide medical information about your child to a friend, family member or any other person you say is involved in your child’s medical care or in the payment for your child’s care. We will only provide this information if you tell us to or if
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we think that normally it is in your child’s best interest to allow a person to act on your child’s behalf. For example, you may identify a friend or family member to pick up medical supplies for your child. We will only provide the medical information needed to allow the person to complete that task. In addition, we may provide medical information about your child to someone helping in a disaster relief effort so that your family can be notified about your child’s condition, status and location. Research. We may use medical information about your child for research purposes. For example, a research project may involve comparing the health of all patients who received one medicine to those who took another for the same condition. All research projects are subject to a specific approval process. This process reviews a proposed research project and its use of medical information, comparing the research needs with patients’ need for privacy of their medical information. We may provide medical information about your child to people preparing for a research project. For example, to help them look for patients with specific medical needs, so long as the medical information they receive does not leave the hospital. Normally, we will ask you to agree if the researcher will have access to your child’s name, address or other information that shows the identity of your child. As Required By Law. We will provide medical information about your child when required to do so by federal, state or local law. To Avert a Serious Threat to Health or Safety. We may use and provide medical information about your child when needed to prevent a serious threat to your child’s health and safety or the health and safety of other people. The information will only be provided to someone able to help prevent the threat. Organ and Tissue Donation. If your child is an organ donor, we may provide medical information to organizations that handle organs for organ, eye or tissue transplantation or to an organ donation bank. Workers’ Compensation. We may provide medical information about your child for workers’ compensation or similar programs that provide benefits for work-related injuries or illness. Public Health Activities. We may provide medical information about your child for public health activities. These activities generally include the following: To prevent or control disease, injury or disability; To report births or deaths; To report reactions to medications or problems with products; To notify people of recalls of products they may be using; To notify a person who may have been exposed to a disease or may be at risk for getting or spreading a disease or condition; To notify the government if we suspect a patient has been the victim of abuse, neglect or domestic violence. We will make this disclosure if you agree or when required or authorized by law. Health Oversight Activities. We may provide medical information to a health oversight agency for activities allowed by law. Oversight activities that allow the government to monitor the health care system, government programs and compliance with civil rights laws include audits, investigation and inspections. Lawsuits and Disputes. We may provide medical information about your child in response to a court or administrative order. We may also provide medical information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in a dispute, but only if we have tried to tell you about the request or to obtain an order protecting the information requested. Law Enforcement. We may provide medical information if asked to do so by a law enforcement official, examples being: Response to a court order, subpoena, warrant, summons or similar process; Identify or locate a suspect, fugitive, material witness, or missing person; Inquiries as to the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; Inquiries as to a death we believe may be the result of criminal conduct; Inquiries as to criminal conduct at the hospital; and To report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime. 9
Coroners, Medical Examiners and Funeral Directors. We may provide medical information to a coroner or medical examiner. For example, to identify a person who has died or to determine the cause of death. We may also provide medical information about patients to funeral directors that need to carry out their duties. National Security and Intelligence Activities. We may provide medical information about your child to federal officials for intelligence, counterintelligence, and other national security activities. Protective Services for the President and Others. We may provide medical information about your child to federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or to conduct special investigations. Inmates. We may provide medical information about your child to a correctional institution or law enforcement official if your child is an inmate of a correctional institution or under the custody of law enforcement official. This release would be necessary (1) for the institution to provide your child with health care; (2) to protect your child’s health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
OTHER USES OF MEDICAL INFORMATION Other uses of medical information not covered by this Notice or the laws that apply to us will be made only if you agree in writing. If you give us the right to use medical information about your child, you may change your mind, in writing, at any time. If you change your mind, we will no longer use the medical information for the reasons covered by your written request. You understand that we cannot take back any information that we have already released with your written agreement and that we are required to retain records of the care we provide. YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOUR CHILD You have the following rights regarding medical information we have about your child: Right to Look at and Copy. You have the right to look at and copy medical information that may be used to make decisions about your child’s care. Usually, this includes medical and billing records. This does not include psychotherapy records. You must send your request to look at and copy medical information that may be used to make decisions about your child in writing to the Health Information Department. If you ask for a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies needed to meet your request. We may deny your request to look at and copy medical information. If we do not let you look at your medical information, you may request that the denial be reviewed. A licensed health care professional chosen by the hospital will review your request and the denial. The person conducting the review will not be the person who denied your request. We will follow the outcome of the review. Right to Change. If you feel that medical information we have about your child is not correct, you may ask us to change the information. You have the right to ask for a change as long as the information is kept by Children’s Health Care Services. Your request for a change must be in writing and sent to the Health Information Department. In addition, you must provide a reason that supports your request for a change. We may deny your request for a change if it is not in writing or does not include a reason to support the request. In addition, we may deny your request to change information, if the information is: Not created by us, unless the person or company that created the information is no longer available to make the amendment; Not part of the medical information kept by or for Children’s Healthcare Services; Not part of the information you would be allowed to look at and copy under the law; or Correct and complete. Right to an Accounting of Disclosures. You have the right to ask for an accounting of disclosures, which is a list of medical information given out about your child. To ask for an accounting of disclosures, you must send a request in writing to the Health Information Department. Your request must state a time period that may not be longer than six
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years and may not include dates before April 14, 2003. Your request should say in what form you want the list (for example, on paper, electronically). The first list of disclosures you ask for within a 12-month period will be free. We may charge for the costs of providing additional lists. We will notify you of the cost and you may choose to remove or change your request before any costs are incurred. Right to Request Restrictions. You have the right that we limit the medical information we use or disclose about your child for treatment, payment or health care operations. You also have the right to ask for a limit on the medical information we provide about your child to someone who is involved in your child’s care or the payment for care, like a family member or friend. We do not have to agree with your request. If we do agree to a limitation you ask for, we will follow your request unless the information is needed to provide emergency treatment. You must request a limitation in writing to the Health Information Department. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) who you want the limits to apply too. Right to Ask for Private Communications. You have the right to ask that we communicate with you about your child’s medical matters in a certain way or at a certain place. To ask for private communications, you must make your request in writing to the Health Information Department. We will not ask you the reason for your request and we will agree with all reasonable requests. Your request must say how or where you wish to be contacted. Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you may ask for a paper copy. You may get a copy of this Notice at our website, www.chsomaha.org. To obtain a paper copy of this Notice, contact the Privacy Officer.
CHANGES TO THIS NOTICE
We keep the right to or may be required by law to change our privacy practices, which may result in changes to this notice. We further keep the right to make the most current privacy practices notice effective for medical information we already have about your child as well as any information we receive in the future. We will post a copy of the current Notice in each Children’s Healthcare Services location and on our website. The Notice will include the version number and effective date. In addition, each time your child comes to the hospital or is otherwise treated by Children’s Healthcare Services, we will offer you a copy of the current Notice in effect.
COMPLAINTS
If you think your child’s privacy rights have been violated, you may complain to the Children’s Privacy Officer or the Secretary of the Department of Health and Human Services. You will not be penalized or otherwise retaliated against for filing a complaint.
CONTACTS
Children’s Privacy Officer 8200 Dodge Street Omaha, NE 68114 (402) 955-4116 Children’s Hospital Health Information Department 8200 Dodge Street Omaha, NE 68114 (402) 955-3800 Children’s Hospital Community Relations Department 8200 Dodge Street Omaha, NE 68114 (402) 955-6950 Children’s Hospital Foundation 8401 West Dodge Suite # 160 Omaha, NE 68114 (402) 955-6851
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Giving and Receiving of Gifts
Employees are not permitted to solicit or accept personal tips, gifts or donations. ―Thank you‖ gifts of a nominal value, such as a box of candy or flowers may be accepted but not solicited. Persons who insist on making a cash gift should be referred to the Children’s Hospital Foundation.
Patient Rights and Responsibilities
The patient has the right to be informed of his or her rights and responsibilities. Children’s Home Healthcare must protect and promote the exercise of these rights. Patients have the right to choose care providers and the right to communicate with those providers.
Patient Responsibilities
All patients are responsible to properly care for leased medical equipment, to notify Children’s Home Healthcare when rental equipment is no longer needed, to return equipment in the same condition as when received, and to pay upon demand for any damage done to the equipment while they have it. All patients shall allow Children’s Home Healthcare the right to inspect equipment upon reasonable notice to the user. All patients shall promptly notify Children’s Home Healthcare of any malfunction or abnormality in the equipment, change of residence while using equipment, and any hospitalizations. All patients shall remain under physician’s care while receiving home care services, and notify agency upon changing physician. All patients shall cooperate with agency, physician and staff by complying with agreed upon therapy. All patients shall provide the agency with accurate health history. All patients shall keep the agency updated with current insurance information as well as inform Children’s Home Healthcare of any changes in insurance, employment, phone numbers or address. All patients shall accept responsibility for refusal of care. All patients shall participate in care by asking questions and expressing concerns. All patients are financially responsible for all charges incurred whether or not paid by insurance. All patients are responsible to report any unexpected changes in the patient’s condition to their physician. All patients shall notify Children’s Home Healthcare if they will not be home for a previously scheduled visit.
Patient Rights: 1. Notice Of Rights
Children’s Home Healthcare must provide the patient with a written notice of the patient’s rights in advance of furnishing care to the patient or during the initial evaluation visit before the initiation of treatment. Patients shall be admitted for service only if the agency has the ability to provide safe, professional care at the level of intensity needed. Patients shall have the right to reasonable continuity of care. Patients denied service for any reason shall have the right to receive a verbal and written explanation regarding denial and information regarding community resources upon request.
2. Confidentiality Of Medical Records
The patient has the right to confidentiality of the clinical records maintained by Children’s Home Healthcare. Children’s Home Healthcare must advise the patient of the agency’s policies and procedures regarding disclosure of clinical records. Patients shall have the right to review all health records pertaining to them unless medically contraindicated in the clinical record by the physician.
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3. Exercising Of Right And Respect Of Property And Person
The patient has the right to obtain care or services without discrimination in regards to race, color, handicap, sex, age or national origin. The patient has the right to be fully informed of all his or her rights and responsibilities by the home care supplier, in terms that the patient and his or her family can readily understand. Patients will receive advice only if the agency has the ability to provide safe and professional care at the level of intensity needed. The patient has the right to exercise his or her rights as a patient of Children’s Home Healthcare. The patient’s family or guardian may exercise the patient’s rights when the patient has been legally judged to be incompetent. The patient has the right to have his or her property treated with respect. The patient has the right to voice grievances regarding treatment or care that is (or fails to be) furnished, or regarding the lack of respect for property by anyone who is furnishing services on behalf of Children’s Home Healthcare and must not be subjected to discrimination or reprisal for doing so. Children’s Home Healthcare must investigate complaints made by a patient or the patient’s family or guardian regarding treatment or care that is (or fails to be) furnished, or regarding the lack of respect for the patient’s property by Children’s Home Healthcare, and must document both the existence of the complaint and the resolution of the complaint. Patients have the right to refuse home health care within the confines of the law and to be informed of the possible health consequences of such action. Patients shall have the right to be free from verbal, physical and psychological abuse and to be treated with dignity.
Patients shall have the right to participate in consideration of ethical issues related to their care.
4. Home Health Hotline
The patient has the right to be advised of the availability of the toll-free ―Medicare Home Health Hotline‖ in the state 1-800-245-5832. This Home Health Hotline was established by the state as a means which the public can access to verbalize complaints or ask questions about local providers. When CHHC accepts the patient for treatment or care they must advise the patient in writing of the telephone number, the hours of operation and the purpose of the Home Health Hotline.
5. Patient Liability For Payment
The patient has the right to be advised, before care is initiated, of the extent to which payment for services may be expected from Medicare or other sources, and the extent to which payment may be required from the patient. Before the care is initiated, Children’s Home Healthcare must inform the patient, orally and in writing, of: The extent to which payment may be expected from Medicare, Medicaid, or any other Federally funded or aided program known to Children’s Home Healthcare, The charges for services that will not be covered by Medicare; Medicaid or any other federally-funded or aided program; and The charges that the individual may have to pay. The patient has the right to be advised orally and in writing of any changes in the charges of services provided when they occur. Children’s Home Healthcare must advise the patient of these changes orally and in writing as soon as possible, but no later than 30 calendar days from the date Children’s Home Healthcare becomes aware of a change.
6. Right To Be Informed And To Participate In Planning Care And Treatment
The patient has the right to be informed, in advance, about the care to be furnished, and of any changes in the care to be furnished. 13
Children’s Home Healthcare must advise the patient, in advance of the disciplines that will furnish care, and the frequency of visits proposed to be furnished. Children’s Home Healthcare must advise the patient in advance of any change in the plan of care before the change is made.
The patient has the right to participate in the planning of the care. Children’s Home Healthcare must advise the patient in advance of the right to participate in planning the care or treatment and in planning changes in the care or treatment.
7. Pain Assessments And Management
The patient has the right to appropriate pain management. Patients with pain will receive comprehensive assessment of pain, as warranted by their condition and scope of services provided. Patients, caregivers and families are educated about pain and managing pain as part of their treatment as appropriate.
Commonly Asked Questions Regarding Pain Assessment And Management Of Children
Does my child experience pain? It is important to properly assess if your child is having pain, and if so, provide the necessary intervention to alleviate the pain. Many children can tell us when they are uncomfortable or hurting, but often due to age, illness or fears, the child will not voluntarily tell us about their pain. Children of all ages feel pain, including premature babies. Pain that is controlled promotes healing and faster recovery. If not controlled, pain can make the child afraid. It is important to remember that a child’s perception of pain is very real. We don’t want to guess if they are in pain, we want them to tell/show us from their own perspective, if applicable.
How much pain does your child have?
You can tell how much pain children are having by how much they say it hurts, by a change in appearance or behavior, or by how their body reacts. We have several pain tools available to help your child describe his/her level of pain. When asking your child about pain, avoid the word ―pain.‖ Use the word ―hurt‖ instead and have them describe what they might feel using words like pressure, heat, prickly, cold and aching. These words help the child understand more clearly what he/she might feel. The health care team will be using different pain tools that help them know how much pain your child is having. We continually look at your child’s level of comfort to make sure it is well managed. What do I say to my child about pain? Always remember to be honest with your child. Don’t say ―This won’t hurt a bit‖ unless it really won’t. Children remember when people tell them things that are not true, then they are less likely to believe adults the next time they tell them what to expect. The child must understand that their pain will be taken seriously. They must know that their parents and health care team will do their best to help the pain. What can I do as a parent or loved one for the child’s pain?
The best pain treatment is a combination of medication and non-medication. Parents are important because they are experts on their child’s behavior, how the child responds to pain, and what works best to relieve the pain. If you think your child is uncomfortable, please don’t hesitate to speak up.
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What will help my child’s pain? Age Group Infants Birth To 12 months Preparing for Procedure Should be calmed before, during and after procedures. Ideas to Help the Hurt Pacifier, swaddling with arms/legs close to body, touching, soothing music, tapes (especially muffled heartbeat sounds and environmental sounds), one calm consistent voice, rocking, stroking, cuddling, massaging, provided boundaries, decreasing light/noise. Blowing bubbles, pop-up books, key chains, simple picture books, simple search books, variety of balls, pinwheels, sound books, security items, gentle touch and stroking, heat, cold and vibration, one calm consistent voice. I spy books, magic wands, slow release ball, medical play, hand puppets, stuffed animals, key chains, bubbles, pinwheels, music, movie/TV, heat and cold, one calm consistent voice. Blowing bubbles, pinwheels, bubble necklaces, hand-held games, brainteaser toys, Walkman with music, relation, deep and steady breathing, movie/TV, guided imagery, heat and cold, one calm consistent voice.
Need simple explanations and descriptions of what will happen within minutes before starting a procedure. With adult supervision, allow child to touch and play with some simple equipment (stethoscope) to see it is not threatening. Preschool Need simple explanations and direct 3 years commands. Give simple choices they can make. to Describe what will happen minutes before 5 years starting. Allow child to play with equipment. Role-play. School Age Need a little more time for asking questions. 5 years Benefits from seeing, touching and playing with and up medical objects before the procedure to help reduce fear of the procedure. Let them know it is okay to show emotion during procedure. Non-Medical Methods:
Toddlers 1 year to 3 years
There are times when the best treatment for pain may be having a parent or loved one with them. The health care team will always provide comfort measures for your child, as needed. Remember that each child is unique, and each will react differently when faced with discomfort. Below are guidelines to help predict how your child will react and what approach might benefit your child the most. Ideas to help your child may vary depending on the age of your child and personal preference Medications: After surgery and/or injuries and other conditions that evoke pain, children are prescribed pain-reducing medications. It is very important when you are at home with your child to give the pain medication as prescribed. Studies have shown that typically parents under medicate their children for pain. We know that kids heal faster when their pain is properly controlled. Giving your child pain medication will not only make the child happier, it also makes them heal quicker! Pain medications come in different forms and can be given at different intervals. Be sure to consult with your child’s physician or pharmacist if you are concerned that your child’s pain is not being properly controlled or if your child’s current pain medication needs revisions (Won’t swallow pill, needs liquid).
PAIN SCALES Pain Tool #1:
When to Use: Cry No cry Moaning, whimpering, sobbing Crying, Screaming Torso/Extremities Neutral, relaxed Shifting, squirming, restless Tense, rigid, shaking, arched, tremors, kicking Verbal No complaints, no whining No talking, refuses to talk, complains of being tired or wanting ―mommy‖ Complains of pain, i.e. ―owie‖ 0 1 2 0 1 2 0 1 2 Smiling, positive Blank affect, neutral Frown, grimace, furrow brow, clench, negative Touch Allows exam, no guarding of painful site. Hesitant for exam, guards painful site Refuses exam, turns or rolls away. Score Minimum Score: Maximum Score: Maximum Score Nonverbal Patient: 0 10 9 15
Infant Toddler Pain Assessment Tool
Infant to 3 years, or when child is unable to communicate. Facial 0 1 2 0 1 2
How to Use Pain Tool: Observe your child’s behavior in each of the five categories and select the behavior that is similar to your child. Add the number in each category to get the total score. What To Do With Pain Score: If 0: 1–6 4–6 7–10 Continue to watch your child. Try non-medicine methods and continue pain medication as instructed by the physician Consider increasing medication strength, dose or frequency as ordered by the physician. Call your child’s physician.
Pain Tool # 2
When to Use: Score Range: 1 2
Numbers
8 years and up. Child must be able to count to 10 and knows when one number is greater than another
3
4
5
6
7
8
9
10
How To Use Pain Tool: Ask your child to pick the number that describes his/her hurt from 0–10. Zero is no hurt and 10 is the worst hurt that they can imagine. What To Do With The Pain Score: 0: 1–6 4–6 7–10 Continue to watch your child. Try non-medicine methods and continue pain medication as ordered by the physician Consider increasing medication strength, dose or frequency as ordered by the physician. Call your child’s physician.
Pain Tool #3:
When to Use:
Faces
3–8 years, as appropriate
How to Use Pain Tool: Explain to child that each face is for a person who feels ―happy‖ because there is no hurt or feels ―sad‖ because there is a lot of hurt. Show the FACES to your child and ask him which face looks like how he feels ―deep down inside,‖ not the face they show to the world. What To Do With The Pain Score: 0: 2–8: 6–8: 8–10: Continue to watch child. Try non-medicine methods and continue pain medications as ordered by the physician. Consider increasing medication strength, dose or frequency as instructed. Call your child’s physician.
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Pain Tool #4: Color Adaptive
When to Use: Nonverbal child but is able to communicate (such as eye movement).
0 No Hurt
4 A Little Hurt
8 A Lot of Hurt
How to Use Pain Tool: Color the first face green, the second face yellow and the last face red. Explain to your child that each face is for a person who feels happy because there is no hurt or feels sad because there is a little or a lot of hurt. Ask your child to choose the face that best describes how their hurt feels by looking or blinking at the face that best describes how the hurt feels. What To Do With The Pain Score: No hurt = Continue to watch Little hurt = Try non-medicine methods and continue pain medication as directed. A lot of hurt = Call your child’s physician.
Developmental Milestones for Children Birth to 16 years old
The following guidelines of normal childhood development from birth to sixteen years old. Remember that each child learns and grows at a different pace. The following guidelines are an aid, not a test.
Physical Development Fine Motor Development Language Development Mental Development Social Development
Average weekly weight gain is 5 to 6 ounces until 6 months Average monthly height growth is 1 inch until 6 months Head sags when not supported Raises head slightly when lying on stomach
One Month
Briefly regards objects Hands form a fist/are tightly closed Occasionally brings hands to mouth Wraps fingers around object when placed in palm of hand
Cries when uncomfortable Makes low throaty noises Responds to voice
Is egocentric Can distinguish tastes Expects feedings at certain intervals Briefly watches objects
Makes eye contact when alert Quiets when picked up Regards faces and reacts to stimulation Reacts to sounds
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Physical Development
Fine Motor Development
Language Development
Mental Development
Social Development
Switches from reflex to voluntary body control Sits when supported with minimum head bobbing Turns head toward bright colors Moves eyes in same direction Makes fists with both hands Raises head when prone 45°
Briefly grasps objects Visually follows moving objects Hands open most of the time Actively holds a toy Hands come together at eye level – center of vision Pulls at blankets or clothing Visually follows objects 180 degrees Bears weight on forearms while on tummy Brings object to mouth Pulls blanket off face Plays with hands at center of their vision or in front of their face Holds onto objects for up to 30 seconds Both hands on bottle or breast Knows what it is reaching for Looks or goes after dropped objects Transfers objects from hand to hand Reaches for an object with one arm
Three Months
Makes vowel-like sounds Responds with vocalization to mother’s smile and voice Listens to voices Cries less Makes cooing sounds
Is attentive for up to 15 minutes at one time Follows object from side to side of body Repeats actions for their own sake Recognizes bottle or breast
Begins to understand that hands and feet are extensions of self Stop crying when parents approach Responds with total body to face he recognizes
Six Months
Average weekly weight gain is 3 to 5 ounces for the next 6 months Chews and bites Reaches for objects and picks up Holds a rattle briefly Rolls from stomach to back, rolls side to side
Vowels begin to be interspersed with more consonants Babbles and becomes active during exciting sounds Vocalizes pleasures and displeasure
Picks up blocks briefly and directly Inspects objects at length Senses the relationship between hands and objects they manipulate
Shows fear of strangers and excitement to familiar people Laughs when head covered with a towel Laughs out loud Holds out arms when wants to be picked up Smiles Self conforts
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Physical Development
Fine Motor Development
Language Development
Mental Development
Social Development
Nine Months
Crawls with one hand full Crawls up stairs Builds a tower of two blocks Gets down from standing Clasps hands or bangs objects together
Bangs toys on surface Hands to feet/feet to mouth Holds two objects, one in each hand Bangs, drops, shakes toys Uses both hands to play with toys Bangs two objects together Grasps small objects using thumb against side of index finger Plays pat-a-cake/claps hands Pokes with index finger Lets go of objects in an awkward way Reaches for objects that are close With demonstration will release cube into cup Places cube on cube, tries to stack objects Uses finger and thumb to pick up objects that are small Holds crayon in a way that allows them to color
Uses words meaningfully Responds to 1 or 2 words other than name Imitates coughs, tongue clicking and hissing
Fears heights, aware of vertical space Beginning of intelligence, assigns symbols to events Begins to show a quality of persistence
Recognizes mother and self in mirror Perceives mother as a separate person; father as a separate person probably
12 Months
Crawls on hands and knees Birth weight is tripled Walks with help Drinks from cup and eats from spoon with help Sits without support
Says 2 to 8 words Imitates sounds of animals Controls intonations, patterns of those similar to parents
Stacks two blocks Searches for a hidden object, even if he hasn’t seen it hidden, but only remembers where it was last seen Understands no and bye-bye
Distinguishes self from others Fears strange people and places Waves byebye, plays patty cake and peek-aboo
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Physical Development
Fine Motor Development
Language Development
Mental Development
Social Development
Soft spot on top of head closes Abdomen protrudes Imitates housework Needs 10 to 12 hours of sleep each night Walks without help
13 to 18 Months
Turns more than one page at a time Builds tower of two cubes Removes lid from shoe box to retrieve toy Holds foot out to put on shoe Holds two cubes in one hand Scribbles on paper Removes both socks and shoes Builds tower of three or four cubes Places two shapes in a puzzle Puts several blocks into a cup/container
Says 4 to 6 words at 15 months, 10 or more at 18 months Points to desired object Vocalizes voice up and down
Understands relationship between object and use Beginning concept of “up” and “down” Recognizes familiar pictures
Feeds self with hands Enjoys being the center of attention Prefers certain people to others Begins to adjust to baby sitter Likes to look at pictures
Physical Development
Fine Motor Development
Language Development
Mental Development
Social Development
24 Months
Average yearly weight gain is 4 to 6 pounds Gait is steadier and more like adult
Birth weight is quadrupled Primary teeth complete Can build tower of 8 blocks Copies circle from model Throws ball about 4-5 ft.
Strings three beads Snips paper in one place with scissors Unzips zipper Draws a straight line Separates pop beads in one place Turns pages one at a time Places three shapes in a puzzle Removes screw on cap from a bottle Places rings on stand in any order Imitates making a train with cubes Draws a straight horizontal line Removes shirt, pants and shorts with help for fasteners Able to turn a door knob
Forms short sentences with vocabulary of about 300 words Uses pronouns Verbalizes need for food, drink and toilet
2 ½ Years
Gives first and last names Enjoys rhymes and singing
Refers to self by name Invents new ways to play with a toy Begins mental problem-solving and play Has insight and forethought Builds tower of 4 –8 blocks Is egocentric Symbolic and fantasy play Begins to understand the concept of time Uses symbols increasingly
Dawdles Is negative Wants to make friends but doesn’t know how Likes to imitate parents
Separates easily from parents Notices sex difference Independent in toileting except for wiping
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Physical Development
Fine Motor Development
Language Development
Mental Development
Social Development
Average yearly weight gain is 4 to 6 pounds Begins to use scissors Balances on one foot for 5 seconds Runs easily Rides a tricycle Uses a toilet Balances on one foot 4-8 seconds Jumps from step Cuts straight with scissors Copies a circle
Draws circle, end point within one-half inch of beginning Imitates making a bridge with cubes Demonstrates hand washing Cut paper from one side to the opposite side with scissors Unbuttons large buttons Winds up toy by turning knob Cuts entire length of traced line within onehalf inch of the line Pulls on shorts Draws a cross with intersecting lines Begins to show a hand preference Strings 4 to 5 beads Copies the word “stop” Draws a person with at least 8 body parts Copies a diamond Imitates building steps with blocks
Vocabulary of about 900 words Talks in sentences of about nine words Asks many questions Repeats common rhymes Says sounds a, m, b, p, n, l, w Asks question – “What, Where, Who?” Speaks clearly and is understood by nonfamily members Gives reasonable answers to basic questions Says sounds of d, g, f, k, y
3 Years
Repeats three numbers Still engages in fantasy play Builds a tower of 9-10 cubes
Less negative More friendly Begins to understand taking turns and sharing Begins to learn meaning of simple rules Shows many emotions Parallel play with other children
Dresses and undresses with little help Gives first and last name Counts to 5 Builds a tower of 10 blocks
4 Years
5 Years
Physical Development Skips using alternate feet Catches large ball Bathes self Walks backwards toe to heel
Fine Motor Development Folds paper in half with edges within 1/8” of each other Cuts square within 1/8” of lines
Language Development Speaks clearly in sentences up to 5-6 words
Mental Development Dresses alone Counts up to 10 object Copies familiar shapes (square, circle, triangle) Put objects behind, in front of, under, back, etc.
Social Development Plays with boys and girls Likes playing with adults or older children
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Physical Development
Fine Motor Development
Language Development
Mental Development
Social Development
Climbs, skips, hops and gallops Learning to ride bikes
Connects dots with straight line Touches each finger to thumb rapidly Colors within lines without crossing lines more than two times Imitates building a pyramid of cubes Copies the word “stop” Copies a diamond Increasingly skillful with hands Likes to build things Fond of puzzles, board games and cards Is learning to write in cursive
6 Years
Uses all types of sentence structure Prints letters Draws a person with at least 8 body parts Imitates building steps with blocks
Able to define object’s use (a spoon is something to eat with) Describes objects seen in pictures Recognizes shapes, numbers Makes decisions easily Curious about the function and use of objects Concrete operational stage (age of relational thinking & concrete concepts)
Likes to have a best friend Developing a sense of right and wrong Likes small group play Knows right from left
7 to 12 Years
Dexterity increases Skates, rides bike Agility and coordination improves Motor skills improve Girls have sudden growth spurts
Thinks in concrete terms Able to read and write
Body changes associated with puberty Increases in height/weight May become more clumsy
Learning to type Able to write stories Able to draw a person with appropriate body parts
13 to 16 Years
Able to understand advanced levels of communication May respond with monosyllable answers High level of comprehension and vocabulary
Concerned about body image and function Begins to develop abstract thinking and logic Enjoys developing intellectual powers
Privacy is important Hero worship begins Wants to be involved in clubs May reject Santa Claus & Easter Bunny Concern for privacy Tends to be self-conscious Beginning interest in opposite sex Peer groups more important than family Mood swings Period of conflict with parents Adopt extreme in mannerisms clothing and music, etc
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IMMUNIZATION RECORD
Vaccine DTaP1 DTaP 2 DTaP 3 DTaP 4 DTaP 5 Hib 1 – Hep B1 (Comvax) Hib 2 – Hep B2 (Comvax) Hib 3 – Hep B3 (Comvax) IPV 1/OPV 1 £ IPV 1/OPV 2 £ IPV 1/OPV 3 £ IPV 1/OPV 4 £ MMR 1 MMR 2 Rotavirus Date Hep B 1 Hep B 2 Hep B 3 Hib 1 Hib 2 Hib 3 Hib 4 PCV7 1 (Prevnar) § PCV7 2 (Prevnar) § PCV7 3 ( Prevnar) § PCV7 4 (Prevnar) § Td 1 Td 2 Varicella 1 Varicella 2 Vaccine Date
£ OPV is no longer recommended for routine immunizations § Heptavalent pneumococcal conjugated vaccine Vaccines1 are listed under routinely recommended ages. ** Stars indicate range of recommended ages for immunization. Any dose not given at the recommended age should be given as a ―catch-up‖ immunization at any subsequent visit when indicated and feasible. .Age Vaccine Diphtheria, Tetanus Pertussis Hib & Hep B (Comvax) Birth 1 mo 2 months DTaP Comvax ***Hep B Hepatitis B H. influenzae type b Polio Measles, Mumps, Rubella Rotavirus IPV 1/OPV (Prevnar) Varicella (Varivax) RV6 Prevnar Rv6 Prevnar Rv6 Prevnar Varvax Prevnar Var8 Hib IPV ***Hep B Hib IPV Hib ***Hep B ***Hib ***Polio5 ***MMR Polio MMR7 Hep B 4 months DTaP Comvax 6 months DTaP Comvax 12 months 15 months 18 months 4-6 yrs DTaP 11-12 yrs ***Td 14-16 yrs
***DTaP3
This is merely an immunization guideline schedule suggested from the American Academy of Pediatrics, Advisory Committee on Immunization Practices and American Academy of Family Practice. However, your child’s physician may use a slightly different timetable on administering immunizations, so please refer to your physician for the exact time schedule for your child. Remember that it is important to immunize your child to give them the best protection from many childhood diseases .
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HANDWASHING
Hand washing is the single most effective step in preventing the spread of germs and infection. Germs which cause infection often travel from person to person simply through touching. Anyone who has seen a family member come down with a cold or flu will tell you it is easy for infections to spread from one person to another. Washing hands with soap and water helps scrub away disease causing germs before they enter the body or are spread to another person.
Let’s learn about hand washing:
To protect yourself and others, be sure to: Wash your hands often -- remember, clean hands are a key to preventing spread of infection. Wash your hands after removing gloves. EVERY TIME YOU REMOVE GLOVES WASH YOUR HANDS! Wash your hands after touching items which are dirty and may have germs on them. Wash your hands after using the rest room, blowing your nose, or covering a sneeze. Wash your hands before you eat, drink, prepare or handle food. Wash your hands if you get any blood or other body fluids on your skin. Wash your hands after handling soiled or contaminated items such as dressings, clothing, linen, tissues, etc. An antibacterial soap is recommended. Ten to 15 seconds is minimum acceptable hand washing time. Some authorities recommend up to 30 seconds if MRO (Multiply Resistant Organisms) are known to be present.
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CHILD ABUSE AND NEGLECT
The problem of child abuse and neglect constitutes one of the most severe challenges facing childcare providers today. Statistics reveal that at least one million children in the United States are severely abused annually. Thousands of these children die as a result of injuries sustained. In addition to this, it is estimated that millions more suffer less severe forms of abuse and neglect. All childcare providers are in a primary position to identify and protect those who may be victims of abuse and neglect. NEBRASKA LAW: All states have enacted laws that define what constitutes child abuse and neglect and indicate the responsibility to report suspected instances of abuse and neglect to the appropriate child protection agency. Nebraska statutes define ―abuse‖ and ―neglect‖ as follows: Abuse or neglect shall mean knowingly, intentionally or negligently causing or permitting a minor child or an incompetent or disabled person to be: (a) placed in a situation that endangers his or her life or physical or mental health; (b) cruelly confined or cruelly punished; (c) deprived of necessary food, clothing, shelter, or care; (d) left unattended in a motor vehicle, if such minor child is six years of age or younger; (e) sexually abused; or (f) sexually exploited by allowing, encouraging or forcing such person to solicit for or engage in prostitution, debauchery, public indecency, or obscene or pornographic photography, films or depictions. This same state law mandates that when any physician, medical institution, nurse, school employee, social worker or any other person has reasonable cause to believe that a child or an incompetent or disabled person has been subjected to abuse or neglect, or observes such person being subjected to conditions or circumstances which reasonably would result in abuse or neglect, he or she shall report such incident or cause a report to be made to the proper law enforcement agency or to the Department of Social Services. Such report may be made orally by telephone with the caller giving his or her name and address and shall be followed by a written report, and to the extent available shall contain the address and the age of the abused or neglected person, the addresses of the person or persons having custody of the abused or neglected person, the nature and extent of the abuse and neglect, or the conditions and circumstances which would reasonably result in such abuse or neglect, any evidence or previous abuse or neglect including the nature and extent, and any other information which in the opinion of the person may be helpful in establishing the cause of such abuse and neglect and the identity of the perpetrator or perpetrators. This same state law goes on to quite clearly state that any person who willfully fails to make any report required by the above section shall be guilty of a Class III misdemeanor (maximum penalty 3 months in jail and/or a fine of $500). In addition, it is important to note that any person participating in an investigation, in the making of a report, or participating in a judicial proceeding resulting from a report shall be immune from any liability, civil or criminal, that might otherwise be incurred or imposed except for maliciously false statement. All communications that normally would be considered privileged (e.g. physician/patient, husband/wife), will have such privilege waived if the sharing of such information is considered important as evidence regarding abuse and neglect. If there is suspicion of physical abuse, sexual abuse or if the child is in immediate danger, law enforcement will immediately be contacted. In Omaha, call 444-5636, to report concerns. In all cases of suspected child abuse/neglect the appropriate child protective services agency will be contacted. In Omaha, call 595-3331, or after hours call the hotline at 1-800-652-1999. Type of CA/N
Physical Neglect
Physical Indicators
Consistent hunger, poor hygiene, inappropriate dress Consistent lack of supervision especially in dangerous activities or long periods.
Behavioral Indicators
Begging, stealing food Extended stays at center (early arrival and late departure) Constantly falling asleep Alcohol or drug abuse Delinquency (e.g. thefts)
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Type of CA/N
Physical Abuse
Physical Indicators
Unexplained Bruises & Welts on face, lips, mouth on torso, back, buttocks, thighs in various stages of healing clustered, forming regular patterns reflecting shape of article used to inflict (electric cord, belt buckle) on several different surface areas regular appearance after absence, weekend or vacation Unexplained Burns: cigar, cigarette burns, especially on soles, palms, back or buttocks immersion burns (sock-like, glovelike, doughnut shaped on buttocks or genitalia) Patterned like electric burner, iron, etc. Rope burns on arms, legs, neck or torso Unexplained Fractures: femur fracture younger than 2 yrs. rib fractures in infant & children to skull, nose, facial structure in various stages of healing multiple or spiral fractures do not correlate with child’s gross motor ability Unexplained Lacerations or Abrasions to mouth, lips, gums, eyes to external genitalia Central Nervous System S/S relating to head injury from violent shaking
Behavioral Indicators
Wary of Adult contacts Apprehensive when other children cry Behavioral Extremes: aggressiveness or withdrawal Frightened of parents Afraid to go home Reports injury by parents
Sexual Abuse
Difficulty in walking or sitting Torn, stained or bloody underclothing Pain or itching in genital area Bruises or bleeding in external genitalia, vaginal or anal areas Venereal disease, especially in pre-teens Pregnancy
Unwilling to change clothes Withdrawal, fantasy or infantile behavior Bizarre, sophisticated or unusual sexual behavior or knowledge Poor peer relationships Delinquent or run away Reports sexual assault Behavior Extremes: Complaint, passive or aggressive, demanding Overly adaptive behavior: Inappropriately adult Inappropriately infant Development lags (physical, mental, emotional)
Emotional Maltreatment
Habit Disorders (sucking, biting, rocking, etc.) Conduct Disorders (antisocial, destructive, etc.) Neurotic traits (sleep disorders, speech disorders, inhibition of play) Psychoneurotic reactions (hysteria, obsession, compulsion, phobias, hypochondria)
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LATEX ALLERGY AWARENESS
Recently an increase in latex allergies has been seen. Among the more common affected groups are children with spinal bifida and urologic abnormalities. Research shows that the common trait these two groups share is the increase in repeated exposure to latex such as during catheterization and bowel programs. This information is to help make you aware of the symptoms and the treatments available to help avoid complications due to exposure. What symptoms would I see if my child were experiencing a latex allergy? Facial symptoms include skin rash, red swollen skin, tearing eyes, sneezing, coughing, swollen eyes, itching, hives and/or welts. General body symptoms include wheezing, difficulty breathing, chest pains or tightness, general feeling of uneasiness, generalized rashes or hives. What should I do if I think my child is having an allergic reaction? The first and most important action is to remove the source of allergy. Suspect latex allergy if your child has the above mentioned symptoms during exposure to latex such as dental visits when the dentist is using rubber dental dams, blowing up rubber or latex balloons, during catheterization or bowel training programs where red rubber catheters or latex finger cots are being used. If your child is experiencing any symptoms of wheezing, coughing, chest pain or generalized feeling of uneasiness, he/she may need medical attention immediately. Call your physician, poison control center, or emergency room to determine immediate needs. Are there ways my child can be tested for latex allergy? Yes, latex testing is available when your child has had a questionable reaction through a pediatric allergist. He or she may provide you with an emergency medication called epinephrine (Epi-pen) that can be used at home in the event of a serious reaction. Ask your doctor or nurse for more information. This information is important for you as a caregiver, parent or child with a potential allergy problem. It is intended to inform you of this allergy and to be prepared. Latex allergy can develop at any time even if negative allergy tests have been seen in the past. Reaction can worsen with repeated exposure and in some cases be life threatening. It is best to discuss this with your doctor if you feel your child is experiencing a slight allergy to help prevent further problems with reactions. Latex products and some alternatives Source: Latex Allergy Information Service, Torrington, CT
Frequently contain latex Airway, masks and straps Ambu bag Anesthesia, bags & ventilator circuits Band-Aids
Bed protector (washable rubber) Bite block Blood pressure cuff Bulb syringes Buretrols (have latex diaphragm) Casts–Delta-Lite comfortable (J&J) Catheters, leg bags, drainage systems Catheters, rectal pressure Catheters, condom Catheters, indwelling Catheters, urodynamics Catheters, straight, Coude Chux (washable underpads) Colostomy pouch Dental dams Drains (rubber)
Latex-free alternatives Hudson, Vital Signs airways and mask Silicone–PMR 2 (Puritan-Bennett), SPUR (ambu), Vital Blue, Respironics, Laerdal, Armstrong Neoprene bag (Anesthesia Associates, Ohmeda adult), well-washed systems Active Strips (3M latex in packaging), Snipp Band (Quantasia), Readi-Bandages, sterile dressing with plastic tape Disposable underpads Use over clothing Webril or Stockinette, Cleen Cuff (Vital signs), Dinamap, Critikon PVC (Davol) B. Braun Burettes Scotchcast soft cast, Delta-Lite S, Fiberglass, Fabric (J&J) Velcro, nylon straps (Mentor, Daie) Life Tech, Cook Silicone (Mentor, Coloplast, Rochester) Silicone (Kendall, Argyle, Bard, Rochester, Vitaid) Bard, Rusch, Cook, Life Tech Mentor, Coloplast, RobNel (Sherwood), Bard Disposable underpads
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Frequently contain latex Dressings–Moleskin (J&J), Action Wrap, Colban (3M), BDF Elastoplast
Elastic wrap–ACE wraps, Esmarch, Zimmer, Elastikon Dyna-Flos (J&J) Electrode pads, grounding Endotracheal tubes Enema, ready to use (Fleet-latex valve) Fluid-circulating warming blankets G-tubes, buttons Gastroscopy tubes Balloons Balls–Koosh, tennis, rubber, basketball Bath Mat Bathroom throw rugs (non-skid latex backing) Bowling balls (usually house balls are 100% rubber) Bungee cords Camera eye piece, binoculars eye piece Carpet backing, gym floors Chewing gum Cleaning/kitchen gloves Condoms, diaphragms
Latex-free alternatives Veingard, Duoderm (Squib), Reston foam, Comfeel (Coloplast), Xcrofoam (Sherwood) PicCare (Hollister), Bioclusive, Montgomery strap (J&J), Webril (Kendall) Note: Steri-strips,. Tegaderm, Tegiasorb (3M) have latex in packaging. Adban Adhesive compression Bandage (Avcor), cover skin with cotton barrier Baxter, Conmed, Vermont Med, Valleylab, Dantec EMG Mallinckrodt, Sheridan, Portex, Polamedco, Shiley, Berman Glycerin, Baby Lax (Fleet), Theravac, Bowel Management Tube (MIC) Cover and keep away from patient skin Silicone (MIC, Bard, Stomate) Mylar balloons PVC (Hedstrom Sports Ball) Gerry baby products Pound Pales 100% cotton reversible throw rugs Check with manufacturer
Provide barrier–cloth or mat, wooden floors Vinyl, cotton liners Polyurethane (Avanti), female condom (Reality), Polymer male condoms soon on market (Condomania 800/926-6366) Cotton balls Cover with cloth or tape Wire springs Tranquility, First Quality, Huggies diapers, some Attends Cover with cloth (Decent Exposures 800/5244949) FarberCastell Art erasers Silicone (Gerber, Evenflo, MAM, some Ross, Mead Johnson) Kimberly-Clark products
Contraceptive sponge Cosmetic applicator sponges (Buff Puffs) Crutches–auxiliary, hand pads Dental braces with rubber bands Disposable diapers, rubber pants Elastic on underwear, leg and waist of clothing Erasers Feeding nipples Feminine sanitary pads Finger cot Fish tanks and decorations in tank (seals for tanks are often latex) Foam rubber lining of braces Helmets, bike Infant tooth brush massager Insulation material Kitchen cleaning gloves Lottery tickets (instant winner scratch-off is latex) Pacifiers Plants, tarps, hose, tires, electric cords Racquet handles–ping-pong, golf clubs, bats, tools, ski poles Rain coats, rubber boots Rubber bands
Cover with felt cloth Soft bristle brush or cloth Magla Home Helpers (800/247-5281) Plastic, silicone and vinyl made by INFA, Gerber, MAM, Binky, Kip Vinyl, leather Neoprene-coated nylon String, spring clips, Plasti Band (800/247-5547) 29
Frequently contain latex Sailing equipment Silk flowers (latex-covered stem) Socks Swimming goggles, caps, bathing suits Toys, rubber duckies, teething toys Gloves–sterile, clean and surgical
Latex-free alternatives
Buster Brown cotton socks without elastic (Vermont Country Store: 802/362-2400) Plastic, cloth, vinyl Vinyl, neoprene, polymers gloves—(B-D) Neolon, Sensicare, Tru-touch (SmartPractive), Tactyl 1, 2 (Ansell), Dermaprene (J&J), Allergard, Nitrex, Triflex (Baxter), Elastryn (Hermal) Cover Y-sites and do not use. Use stopcock to inject meds. Flush IV tubing before use. Abbott nitroglycerin tubing; Walrus, Gemini (LMED) systems, Braun Burettes, Braun, Clave, Abbott needle-less systems Do not puncture ports to add meds. (B, Braun Burettes) Jobst has a non-latex material Eli-Lilly, Fujisawa; if not certain, remove latex stopper Replace elastic bands with twill tape
IV med pumps (do not use: cassettes have rubber) IV access—injection ports, Y-sites, PRN adapters, and needle-less systems
IV bags, buretrols, PRN adapters Jobst Spandex products Medication vial stoppers NG tube OR masks, hats, shoe covers Orthopedic appliances Oxford tubes Oxygen masks, cannulas Penrose drain Pulse oximeters Protective sheets Respirators-TB (3m 970) Rubber reflex hammer Rubber head straps (OR) Spacer (for MDI inhalers) Stethoscope tubing Suction catheters Surgical gowns, boots, drapes Syringes, disposable, auto-injectable
Remove elastic bands; check valve content Jackson Pratt, silicone tubing, Zimmer Hemovac Certain oxisensor (Nellcor), cover digit with Tegaderm Advantage (MSA), Hepa-tech (Uvex) Cover with baggie ACE spacer (Center Laboratories: 800/223-6837) PVC (Armstrong), cover Stockinette, or ScopeCoat (800/373-0747) PVC (Mallinckrodt, Yankauer, Davol, Superior, Lacdral) Prepare medication in syringe right before use, or in a glass syringe. Baxa, Abboject, Abbott PCA, Epi-Pen (Center Labs) B-D 1cc TB syringe Microfoam, Micropore, Durapore, Transpore (3M), Dermaclear, Dermicel, Waterproof, (J&J, Scanpore (Hermal) Cover with cloth, exercise putty (Roylan) Grafco, Children’s Med Ventures. VelcroPedic; or place over clothing or Stockinette, or cover with cloth Plastic tubing Tygon LR-40 (Norton), elastic thread, sheets (JPS Elastomerics)
Tape—adhesive, porous, pink
Teeth protectors Theraband, therastrips, theratubes Tourniquet
Tubing
Tympanonometers—rubber Ureteral stints Ventilator hose, balloons, bellow Waterproof mattress covers on beds, OR tables, Cover with sheets and avoid any contact with and stretchers patient skin Home Environment Art supplies—paint makers, paints, glue, erasers Elmer’s (school glue, glue-all, Glu colors,
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Frequently contain latex
Latex-free alternatives Carpenter’s Wood Glue, Sno-Drift Paste), Crayola products (except for rubber stamps and erasers), Liquitex paints Jurassic Park figures (Kenner), 1993 Barbie Disney dolls (Mattel), many toys by Fisher Price, Little Tykes, Playschool, and Discover
Toys—Stretch Armstrong, old Barbie dolls, bowling balls Truncheons Water toys, scuba gear, snorkels, wet suite Weather stripping Wheelchair cushions, tires Zippered storage bags
Jay, ROHO, cushions, cover seat, use gloves Waxed paper, plain plastic bags, Ziploc (Dow) Miscellaneous
Diazosensitized photocopy paper Driveway sealant Glue—envelope, plastic removers Gaskets Floor covering, carpet backing The Stopper (non-skid rug pad: 800/245-2217 Milking machines Mouse pad for computer Plasters, check labels Rubber button pads—phone, calculator, computer keyboard covers, TV remote controls Thermopoast polymers—plexiglass cosmetics Clothing Crepe sole shoes Stretch textiles Rubber raincoats, protective wear Swim suits FYI: other items that contain latex: Paint & markers Koosh balls Tennis Balls Barbie dolls Rubber dolls Rubber ducky Rubber bands Rubber balloons Racquet handles Beach toys Scuba gear Bungee cords
Foods
It is thought that people allergic to kiwi, bananas, chestnuts, avocados, papaya, fig, passion fruit, nectarines, plums, cherries, melons, tomatoes, and celery are more prone to a latex allergy, so conversely, people allergic to latex should avoid those foods. There are other foods rumored to be from the same plant group, and that is being investigated. Food handled by latex gloves can also be a problem. Check with restaurants and stores before eating.
Latex Item
Latex Common Item Alternatives Non-Latex Item
Vinyl or plastic gloves Plastic, durapore, silk Plastic mentor or Silicone Silk tape and a cotton ball String Place over clothing and not directly on skin Avoid contact with latex toys Mylar balloons Silicone nipples and pacifiers Cross out errors Soft bristle brush or cloth Cover with cloth 31
Latex gloves Tapes-cloth and adhesive Red rubber catheters Band-Aids Rubber bands Tourniquets Certain toys such as Barbie dolls, rubber or Koosh balls, tempra paint and teething rings Rubber or latex balloons Nipples and pacifiers Erasers Infant NUK toothbrush Wheelchair cushions (Roho)
Latex Item
Wheelchair tires
Latex Common Item Alternatives Non-Latex Item
Propel with leather gloves
These are just a few items commonly noted to contain latex. If you question whether an item contains latex it is best to check with the supplier or check the package content list The following products contain latex, but can be modified for use. How to modify Latex products Dinamap Blood pressure tubing Stethoscope Suction canister tubing Crutch pads Wheelchair (seat & rubber wheels) Foam rubber lining on splints, braces Completely cover tubing with cotton gauze Cover with gauze & avoid patient contact Cover with gauze & avoid patient contact Completely cover with gauze or stockinette Cover seat with blanket. Use gloves to push chair Use cloth, felt lining LATEX-FREE ALTERNATIVE BD Thermometer covers Trays contain latex gloves and are considered contaminated with latex proteins. Piece together supplies needed to perform procedure (assure sterility) All Cook & Arrow Catheters L-Cath and Gesco PIC Lines Insyte Needles ACE Wrap (Brown) Coban & Elastic Wraps BP Cuffs & Tubing Adhesive cloth & paper tape, Pink ―Hy-tape‖ White cotton ACE Wrap Kling, Cotton Gauze Dinamap Cuffs (tubing does contain latex, modify as described below) Transpore, Dermaclear, Silk
LATEX PRODUCTS
Thermometer Covers All ready-made trays including: Hyperal trays, Medline trach Clean & Clear set, Female Cath Kit, Bard Urethral Cath Tray, Bard Foley Tray, IV Start kits. Intravenous Catheters
The following products contain Latex, but can be modified for use. LATEX PRODUCTS Pleuravac Chest tube drainage system Tourniquet (Penrose tubing) Dinamap Blood pressure tubing Stethoscope Suction canister tubing Crutch pads Wheelchair (seat & rubber wheels) HOW TO MODIFY Completely cover tubing with cotton gauze Apply over clothing, or wrap arm with gauze/cotton batting Completely cover tubing with cotton gauze Cover with gauze & avoid Patient contact Cover with gauze & avoid Patient contact Completely cover with gauze or stockinette Cover seat with blanket. Use gloves to push chair
Foam rubber lining on splints, braces Use cloth, felt lining FYI: other items that contain latex. Paint & markers Koosh balls Tennis Balls Barbie dolls Rubber dolls Rubber ducky Rubber bands Rubber balloons Racquet handles Beach toys Scuba gear Bungee cords
Bouncing balls Teething toys Water toys Kitchen gloves
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Latex Products List This list is provided as a reference to facilitate choosing products that are Latex-Free For patients who are determined to be at risk for Latex Sensitivity. LATEX PRODUCTS Pacifiers: Minimam & Nuk Nipples: all standard nipples Latex Exam gloves Urinary catheters; Foley, Robnel, Mallinckrodt ET tubes Trachs Suction catheters Rubber Nasopharyngeal tubes Chux Blue pads 5FR Feeding tube Preemie Feeding Setup Nasogastric Tubes Enteral Feeding Setup Gastrostomy Buttons Transparent Dressings Adhesive Band-Aids LATEX-FREE ALTERNATIVE Gerber Silicone Pacifiers Gerber Silicone Nipples BD Sensicare Powder Free Gloves Silicone/silastic Catheters from Bard & Foley (size 6fr20fr) Mentor Self-Cath (all sizes) All Portex & Mallinckrodt ET tubes All Shiley trachs Medline (all sizes) Argyle (all sizes) Linen bed pads Bard/Davol #3640 Preemie Infant Feeding Set Argyle All Biosearch tubes; Peditube, Entriflex, Dobbhoff. (Weighted & unweighted sizes 6, 8, 12) Kangaroo Feeding bag (500ml) Mic-Key & Bard Buttons (all related equip.) Tegaderm & Bioclusive Curad Plastic Strips #7028
Foam Mattress Covers Allergy Identification Bracelets Ear/Bulb syringe
Eggcrate Mattress Mark-Clark; Excelloband – identification bracelet Davol
LATEX/LATEX FREE PRODUCTS LIST
NOTE: If at all uncertain about the latex content of a product, it is recommended to contact the manufacturer directly. PRODUCTS WITH LATEX Theraband Beach Toys Jobst Spandex products Electrode pads Racquet PRODUCTS WITH LATEX Oral – pharyngeal airways Breathing circuits Reservoir breathing bags ETT ALTERNATIVES (LATEX-FREE) Avoid contact Avoid contact Jobst non-latex material Baxter pads, Dantee EMG pads Vinyl handles ALTERNATIVES (LATEX-FREE) Oral airways – plastic Plastic circuits Latex free res. Bag Mallinckrodt
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Basic Cardiopulmonary Resuscitation (CPR): For Infants (Birth to 1 year) -if alone it is VERY important to do CPR for 1 minute before calling 911
EVALUATE THE INFANT’S RESPONSIVENESS: Assess for responsiveness-gently stimulate foot, arm, call out name, etc. to see if the patient or infant responds. Do Not Shake! If no response: shout for HELP or if available have some one call for an ambulance (911). If you are alone, you will need to begin CPR for approximately 1 minute before phoning for help.
IF THE INFANT IS NOT RESPONSIVE: Move infant carefully; supporting the head and neck. Be careful to avoid bending or twisting if there has been a possible injury to the neck or spine. Position the infant on his or her back on a firm flat surface such as floor, dresser, table, counter top, etc.
OPEN THE INFANT’S AIRWAY: If there is not a suspected neck or spinal injury, gently tilt the head back with one hand on the forehead while lifting the chin gently up and out with the fingers of the other hand. The infant’s nose should be aimed at the ceiling. Do not push the infant’s head back too far, as this can block the airway. If there is a suspected neck or spinal injury, open the airway with a jaw-thrust movement. Place 2 or 3 fingers under each side of the lower jaw at an angle and lift up and out. If you suspect a foreign body is blocking the airway, look into the throat to see if a foreign object or a piece of food is visible. Only if you suspect something should you try to remove it. Look, listen and feel to see if the infant is breathing by placing your cheek over the infant’s mouth and nose to see if you feel air on your cheek, look at the infant’s chest to see if it is rising and listen to see if you hear the infant breathing. If the infant is not breathing and does not appear to be choking; give 2 slow rescue breaths. Place your mouth over the infant’s nose and mouth, making a tight seal. If you are unable to cover and seal both the infant’s nose and mouth, you can cover and seal the mouth and pinch the nose closed. Give 2 slow rescue breaths, (about 1 to 1 ½ seconds per breath), pausing to inhale between breaths. Blow in enough air so you can see the infant’s chest rise slightly. Allow the infant’s chest to fall between breaths. If the chest does not rise and fall, reposition the infant’s head and try again. If you still do not see the chest rise and fall after several attempts, look for and carefully remove any object you can see blocking the airway.
CHECK FOR BREATHING:
CHECK FOR SIGNS OF CIRCULATION: Assess for circulation, which includes normal breathing, coughing, and movement by infant in response to the rescue breathing or by checking for a pulse for approximately 5-10 seconds. On an infant you check for a brachial pulse, which is on the inside of the upper arm, between the elbow and shoulder. If signs of circulation, but no breathing, then you will provide rescue breathing at a rate of 1 breath every 3 seconds (20 breaths per minute). If no signs of circulation; begin chest compressions. On an infant you will use your first and middle fingers on the baby’s sternum, with fingers below the nipple line press down approximately 1/3 to 1/2 the depth of the chest. You will do 5 compressions and 1 breath. To get proper rate: count ―1-2-3-4-5-Breath 1‖ ―1-2-3-4-5-Breath 2‖, ―1-2-3-4-5-Breath 3‖ ―1-2-3-4-5-Breath 4‖, ―1-2-3-4-5-Breath 5‖. Do this for 20 cycles or 1 minute and if still no response, call emergency help or 911. If still no response, continue CPR until emergency help arrives and check for response every few minutes.
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AFTER 20 CYCLES (APPROXIAMATELY 1 MINUTE OF CPR): If you are alone, stop and quickly call for emergency medical help (911) then continue CPR. Check for signs of circulation and breathing every few minutes, if they remain absent, continue with CPR, beginning with chest compressions and check again for signs of circulation and breathing every few minutes.
CHILD CPR (2-8 years) You will do the same steps as with the infants except you will use the heal of your
hand instead of your fingers Assess for responsiveness-gently stimulate foot, arm, call out name, etc. Do Not Shake! If no response: shout for help and begin CPR. Open the airway. Move the child to a hard surface, place on back and open airway with head tilt chin lift (if no suspected head, neck or back injuries). Look, listen and feel for breathing by placing your cheek over the child’s mouth and nose and looking at the child’s chest. If no breathing: give 2 slow rescue breaths by pinching closed the child’s nose and covering the mouth with your mouth. Observe for the rise of the chest with each breath Assess for circulation by checking for a pulse. On a child, you check for a carotid pulse, which is on the side of the neck. If no signs of circulation: begin chest compressions using the heel of one hand on the child’s sternum. Do 5 compressions and 1 breath. Count ―1-2-3-4-5-Breath 1‖ ―1-2-3-4-5-Breath 2‖, ―1-2-3-4-5-Breath 3‖ ―1-2-3-4-5-Breath 4‖, ―1-2-3-4-5-Breath 5‖. Do this for 20 cycles or 1 minute and if still no response, call for emergency help or 911. When you call for emergency help; clearly state name, address and phone number and child’s condition. After you have called them, resume CPR and check for pulse every few minutes. If still no response, continue with CPR until emergency help arrives or child responds.
Adult (8 years to Adult) CPR: After checking for unresponsiveness, you should call 911 before beginning
CPR, because in this age and older, the sooner you can activate the emergency medical system the greater the chance of survival. Assess for responsiveness-gently stimulate foot, arm, call out name, etc. Do Not Shake! If no response: CALL 911, prior to beginning the steps to CPR, if alone. Open the airway. Move them to a hard surface, place on back and open airway with head tilt chin lift (if no suspected head, neck or back injuries). Look, listen and feel for breathing by placing your cheek over the their mouth and nose and looking at the person’s chest. If no breathing: give 2 slow rescue breaths by pinching closed the nose and covering the mouth with your mouth. Observe for the rise of the chest with each breath. Assess for circulation by checking for a pulse. You check for a carotid pulse, which is on the side of the neck. If no signs of circulation: begin chest compressions by placing one hand on top of the other hand and interlocking fingers together. Do 15 compressions and 2 breaths. The goal is to get 100 compressions in a minute. You will need to strive to hit 15 compressions in 6 seconds, so you will be doing the compressions very fast. Every couple minutes check for pulse. If no pulse, continue CPR until ambulance arrives and takes over.
When calling 911:
Clearly state name, address and phone number and child’s condition. After you have called them, then resume CPR and check for pulse every few minutes, if the victim does not respond continue to do CPR until you are relieved.
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Foreign-Body Airway Obstruction-Choking
Sudden Onset of respiratory distress associated with weak or silent coughing, inability to speak, and stridor or increased respiratory difficulty.
Infants:
Hold the infant face down, by supporting the body on your forearm and the head and jaw with your hand deliver 5 back blows between the shoulder blades with the heel of your free hand. If object not expelled, then turn infant over supporting back on forearm and head in hand and do 5 chest thrusts by placing 2 or 3 fingers over the sternum in the same position used for chest compressions and do 5 chest thrusts in an upward motion. Check mouth to see if you can see the object, if so attempt to remove it. If you cannot see object continue to alternate 5 back blows and 5 chest compressions until object is expelled or infant becomes unresponsive. If infant becomes unresponsive, place on hard surface and continue to perform 5 back blows, 5 chest thrusts, then tongue-jaw lift, finger sweep (if object is visible) attempt rescue breathing and if unable continue sequences until obstruction is expelled and infant resumes breathing or until chest rises with rescue breath.
Children or Adults:
For Universal sign of choking (holding hand to neck) and when person is unable to speak do the Heimlich Maneuver. Make a fist with one hand and place on the abdomen slightly above the navel and below the sternum. Grasp the fist with your other hand and deliver quick upward thrusts into the abdomen several times and watch to see if object is expelled. Continue to do this until object is expelled or victim goes unresponsive. If unresponsive, ease to floor, shout for help, perform a tongue-jaw lift and look in the back of the mouth, if you see an object perform a finger sweep to remove it, but if do not see object do not do finger sweep. Open airway and give a rescue breath, if unable to make chest rise, reposition head and attempt to give another rescue breath. If you still cannot deliver breaths, perform abdominal thrusts by straddling the victim’s thigh. Keep repeating sequence until obstruction removed or chest rises with rescue breath.
Basic First Aid Minor Burns
Immerse the burn in cool water. Cover it lightly with a clean cloth. Do not apply butter, ointments or other home remedies.
Falls
Don’t move the victim if you suspect neck or spine injury, unless absolutely necessary. Stop bleeding and treat for shock, if necessary.
Electric Shock
Do not touch the victim—shut off the power by unplugging the appliance or turning off the power. Restore breathing, if necessary, and treat for shock.
Poisoning
For inhaled poison, move the person into fresh air. Avoid breathing fumes. Open doors and windows wide. For poison on the skin, flood skin with water for 10 minutes. Gently wash with soap, water and rinse. For poison in the eye, flood eye with lukewarm water poured from a large glass two to three inches from the eye. Repeat for 15 minutes. Do not force the eye open.
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For swallowed poison, do not give anything by mouth until calling The Poison Center national toll free number 1-800-222-1222 or your physician.
Head Injuries:
If child has any periods of unconsciousness, seek medical advice immediately! If you suspect head, neck or spine injury do not move child until emergency help arrives. If child did not pass out and seems okay, be sure to observe closely over next 24-48 hours. Notify physician if you notice any of the following symptoms: nausea or vomiting, dizziness, confusion, restlessness, changes in personality, slurred speech, headaches, irritability, inability to move arms or legs equally, blurred vision or unequal pupils or other unusual symptoms your child might display.
Sprains/Strains
R-Rest. I-Apply ice for at least 30 minutes to reduce swelling. C-Compress the injury or wrap to support injury. E- Elevate the sprained area immediately.
Fractures/Broken Bones
Pain, tenderness or the inability to use an injured part are symptoms of fractured or broken bones. Any fracture or suspected fracture requires immediate medical attention. Remember, unless it is very obvious the bone is broken the only way to be sure is to have a x-ray taken. If you suspect a fracture, immobilize the injured area and the joints both above and below the area. Apply ice packs immediately to prevent swelling, do not try to push bone back in place if protruding and do not give the child anything to eat or drink in case they might need surgery. If there is any possibility of head, neck or spinal injury keep the child from moving and notify ambulance.
Shock
Treat the causes of shock—stopped breathing, blood loss, etc. Keep victim lying down. Place unconscious victim on the side to allow drainage of fluids. Cover only enough to maintain body heat. Seek medical help immediately.
Bleeding
Cover the wound with a clean cloth and apply firm, direct pressure. Elevate the wounded limb above the heart if there is no fracture. After bleeding stopped wash affected area then cover with bandage. If skin area has large gapping area that does not close, seek medical attention.
Heat Wave and Cold Weather A. In Hot Weather
Drink plenty of water. Don’t drink alcohol. It will just further dehydrate you. Wear cool, light-colored clothes, even if you don’t feel hot. Use air conditioning where possible.
B. Signs Of Heat Exhaustion
Cold, clammy skin. Heavy sweating Nausea Weakness
In case of heat exhaustion: rest; drink water; sponge off with a cool, wet cloth; lie down; and continue to rest.
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C. Signs Of Heat Stroke
Hot, dry skin Fast, strong pulse Body temperature of 104º or higher Heat stroke is a serious illness that can result in death, dial 911 or your local emergency medical center.
D. In Cold Weather
Dress warmly even if you don’t feel cold. Keep your home well heated. Drinking alcohol will make you lose body heat faster.
E. Watch For A Drop In Body Temperature: Signs of below-normal body temperature:
Confusion or sleepiness Slurred speech Stiffness in arms or legs Severe shivering
Any of the above signs mean you need to seek medical help immediately. Body temperature below 96º F is dangerous. Loss of body temperature can cause death.
F. Re-Warm The Body
1. Wrap in blankets. 2. Lie close to another person so their body heat can help warm you. Avoid rubbing the skin. 3. Do not drink caffeine or alcohol. SOME MEDICATIONS CAN KEEP YOUR BODY FROM ADJUSTING TO NORMAL HEAT OR COLD.
PREVENTION OF SUDDEN INFANT DEATH SYNDROME (SIDS)
SIDS is the sudden death of an infant that can not be explained even after an autopsy. SIDS typically occurs in infants 1 month to 1 year old, with the highest number of deaths occurring from age 2 to 4 months. Many factors associated with an increased risk for SIDS include: a prone sleeping position (on the stomach), winter months, low family income, male gender, being a sibling of a SIDS victim, a mother who smokes or is addicted to drugs, a history of life threatening events and low birth weight. For more information contact ConSIDerations at 888-8CJSIDS, or 888-825-7437. TO REDUCE THE RISK OF SIDS: Place healthy infants supine (on their back) to sleep and not on their stomach. Face up to wake up. Prop and position infants placed on their side to prevent them from rolling. Do not place infants to sleep on soft materials such as a fluffy comforter, lamb’s wool blanket, waterbed, or other soft surfaces. Do not allow infants to sleep with stuffed animals that might trap exhaled air near face. Place baby in a crib meeting Consumer Product Safety Commission crib safety standards; do not place pillows, quilts, bumpers, toys or anything in the crib. If a light blanket is needed, securely tuck all sides along the bottom half of the crib, below baby’s arms. Make sure baby’s feet are at the bottom of the crib. Supervise tummy time during play as it is important to baby’s healthy development. Do not let your baby get too hot. Dress your baby in as much or as little clothing as you would wear. Do not wrap your baby in lots of blankets or clothes. If your baby is sweating, has damp hair or a heat rash, he or she may be too hot. A baby that has a fever or is not able to rest may also be hot.
Injury Prevention Safety Tips
In the United States injuries are the leading cause of death for children. The most common causes of fatal injuries in children that can be prevented are motor vehicle passenger injuries, pedestrian injuries, bicycle injuries, drowning, submersions, burns, smoke inhalation, poisoning, falls, choking, strangulation, suffocation, and firearm injuries. Prevention of these injuries would greatly reduce childhood injuries, disabilities and deaths. Therefore we have included some information about injury prevention.
Car Safety: Injuries sustained while riding in a car are the # 1 preventable cause of death in young children.
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As of July 13, 2000, it is illegal for children 15 and under to be unrestrained in a motor vehicle, according to the Nebraska law. Everyone in the car must ―buckle up‖ with age-appropriate restraints. The BACK seat is the BEST seat for children under the age of 15 years old. A child who is properly restrained in the back seat of a car is less likely to sustain injuries in a crash as they are away from the dashboard, front-seat air bags and windshields. Never hold a child on your lap in a moving car. Front-seat air bags have saved many lives when people are correctly ―buckled up‖, but they have also fatally injured several children who were in the front seat, as their heads are very close to the dashboard. For more information about children and air bags, call the National Highway Traffic Safety Administration Auto Safety Hotline (1-800-424-9393 or 1-888-327-4236) or visit their website (www.nhtsa.dot.gov). For an infants weighing less than 20 pounds and less than 1 year old: Use rear-facing safety seats or infant carriers designed for car seats in the BACK seat of the car. Never place an infant in the front seat of a car and especially a car with a passenger-side air bag.
For children weighing more than 20 pounds and 1 to 5 years old: Use a child safety seat secured in the BACK seat of the car. Children under the age of 5 and weighing less than 40 pounds must be in a car seat. The safest place for a car seat is in the middle of the rear seat.
For children 5 through 15 years old: Children ages 5 to 15 must be in an appropriate booster seat or seat belt. The National Highway Traffic Safety Administration recommends that children remain in a high back, belt positioning booster seat until approximately 70 pounds. Or the seat belt fits properly across the collarbone and upper thighs. Children under 12 years old should not be allowed to ride in the front seat.
For children greater than 12 years old: Use lap and shoulder belts that are positioned correctly. If in the front seat make sure to move the front seat as far away from the dashboard as possible. Make sure the shoulder belt crosses the body from the shoulder, across the breastbone, down to the hip. Make sure the shoulder belt does not cross the neck or face and that the lap belt fits snugly across the hips.
Other helpful hints about car safety: Car seats manufactured before January 1, 1981, do not meet current federal safety standards and may not adequately protect a child in a crash situation. Beware of the ―hand-me-down‖ or buying used car seats with missing straps or safety instructions. If the seat has a tether, be sure to use it properly, without it, the safety strap isn’t sufficient. ALWAYS use the safety straps. The curved, padded shield isn’t enough by itself. When securing a safety seat in the car, make sure to tighten the belt so that the seat does not move more than ½ inch (1 cm) in any direction. Push the seat forward, backward, and side to side to make sure it is secure.
Bicycle and Pedestrian Safety:
Teach young children to cross streets at intersections, to always stop at curbs and to stop, look both ways and listen for cars before crossing any street. Children between 5 and 9 years old are most often injured when they dart in the street in front of traffic while playing or crossing the street. Infants and toddlers are most often killed by cars when backing out of driveways or parking lots. The most serious bicycle injuries result from head injuries, which can cause death or permanent brain damage. About 85% of head injuries could be prevented if children were wearing approved helmets that fit snugly and are on properly. 39
Burns and Smoke Inhalation:
Burns occur when a child comes in contact with a heating source such as a wood stove, portable heater, a curling iron, stove, etc. Keep children out of the kitchen except when eating. Most scalds occur when a hot liquid is spilled on the child. Make sure that when putting a child in the bathtub that you check the water prior to putting your child in it. Water temperature greater than 120 degrees can scald the skin in less than 5 minutes. Smoke detectors are one of the most effective ways to prevent death from fire and smoke inhalation. Make sure smoke detectors are on every floor, near play areas, and the bedrooms, and that the batteries are checked several times a year.
Choking, Suffocation and Strangulation:
Choking and suffocation are among the most common causes of preventable death in children less than a year old. Choking occurs when food, toys, or other objects block the trachea (windpipe). Suffocation occurs when the nose, mouth, or windpipe is blocked. Strangulation is caused by a constriction around the neck. The most common objects that cause choking in infants and children are foods such as hot dogs, grapes, nuts, popcorn, hard candy, raw vegetables, fish with bones, and peanut butter. Plastic balloons, toys or small parts of toys that are small enough to be placed in child’s mouth is another big cause of suffocation or choking. Store all thin plastic wrapping materials—dry cleaning bags, produce sacks, trash bags, plastic food-wrap—away from children. They are a common cause of suffocation. Signs that a child is having a hard time breathing include inability to speak, weak cry, decreased responsiveness, blue or pale lips, rapid to shallow breathing. SIDS is another big cause of death in infants under 6 months of age. Place healthy infants to sleep on their back or side. Do not place them on their stomach to sleep.
Falls:
About 200 children die annually from falls, and are the most frequent cause of nonfatal injury in children less than 6 years old. About 20% of all falls occur on steps. Keep stairways as safe as possible. Make sure you have good lighting, secure flooring, and appropriate gates or doors with safety latches. Many falls occur from windows, make sure upper windows can open less than 6 inches or open from the top. You can also place locks or gates over windows. Make sure to keep close supervision on children especially when they are in the bathtub, on counter tops, or changing tables. Some children are more prone to falls. The children that may be at a higher risk for falling include children that have seizures, cerebral palsy or any gait impairment (which includes normally developing toddlers), wheelchair dependent children and children on medications that may have the side effect causing dizziness or drowsiness. Strategies to implement for prevention of falls includes; one on one supervision of the child while ambulating, standing, transferring from bed to chair, adequate lighting at night. The use of bed rails and having two individuals assist with all transfers from bed to wheelchair or wheelchair to bed is another safety measure that could be implemented.
Poisoning:
Food poisoning can make children extremely ill. Make sure that you do not serve foods that are in cans or containers that are bent, bulging, leaking, dented or rusted as they may be contaminated. Always check expiration dates on packages and do not use if expired. Do not serve foods with mayonnaise or poultry that have been unfridgerated more than 1 to 2 hours or foods that smell spoiled, have mold or other abnormal discoloration. Do not keep leftovers in refrigerator greater than 24 hours. Remember to be safe, when in doubt, throw it out. Lead poisoning is a dangerous condition caused by children eating chipped and peeled old paint. Although it has been years since lead has commonly been used in paint (the lead limitation law went into effect in 1978), it’s a good idea to completely strip paint off all old furniture and toys and re-paint with lead-free paint.
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NEVER hesitate to call The Poison Center National Toll Line at 1-800-222-1222, and ask for prevention tips, or get advice about a suspected poisoning. It’s better to be safe than sorry! The staff can provide you with immediate first aid instructions and treatment recommendations. Make sure to have their number listed by the phone. The best place to obtain information about poisons is your local poison control center. Make sure to always store medications, household cleaning products or other potentially harmful substances so that children can not get in to them. Make sure to have Syrup of Ipecac on hand, in case needed.
Store all chemicals up and away, properly sealed and labeled in a locked storage space. Common poisons that might be found in your home include: o o o o o o o Cleaning products, bleaches, and detergents Cosmetics Hair coloring products House Plants Insect and rodent poison Gasoline, kerosene, & other petroleum products Pesticides, weed killers, and fertilizers o o o o o o o Perfumes, after shave Lye and acids Glues Alcohol and liquor Oven and Drain cleaners Paint and paint thinners Foods such as vanilla extract
Drowning:
Drowning is a major cause of death and disability in children. It can occur indoors or outdoors. The bathtub is the most common site for drowning of infants up to 1 year old. Remember, young children can drown in a few inches of water as their head is top heavy and if they fall into a bucket, toilet, or container their legs may be too light and arms too weak to lift their head out of the water. Drowning in backyard swimming pools is a leading cause of death and permanent brain damage for children 1 to 4 years old. Young children are often capable of getting into a swimming pool, but not able to get out. Make sure that your pool is completely fenced in, with at least 5 feet fence around the pool. Always supervise children when they are in or playing around water. Make sure that children wear life vests when playing in rivers, lakes, and beaches.
Safety Tips for Infants and Toddlers in the Home
Changing Tables: NEVER turn your back while baby is on the table or any other high surface. Always strap your baby in place. Have wipes, diapers, and other supplies within easy reach so you are not tempted to leave baby even for a second, as that’s when falls occur.
Diaper Pails: Cribs 41 Keep the diaper pails tightly closed and out of the reach of young children. There have been many instances in which children fell headfirst into diaper pails and drowned. Keep deodorizer discs out of the reach of children eager for new taste sensations.
Wind-up Swings: Mount on strong posts with wide stance to prevent tipping. Seat should be made of soft, sturdy material and molded to an infant’s shape. Safety straps should hold firmly. Use these at all times.
No more than 2 3/8 inches between slats (about three adult finger widths). Corner posts shouldn’t be taller than 5/8 of an inch, or child’s clothing or necklace could catch on them, causing strangulation. Watch out for decorative cutouts; a child’s head could get caught in the small openings. Mattress should fit snugly (less than two adults finger widths between mattress and crib sides) or baby could roll in there and suffocate. Rail height should be at least 22 inches above mattress when set at lowest position (to prevent falls). Sides, when lowered, should be four inches above top of mattress. Bumper pads should run around the entire crib, secured by at least six straps. Remove this item when baby can stand or a baby will use pads to crawl out. Crib mobile must be out of baby’s reach. Cord should be shorter than 12 inches or there is risk of strangulation. NEVER tie objects with string or elastic around cribs or playpens, or your child could become entangled and choke. If you use a crib gym, make sure it is installed securely so it cannot be pulled down into the crib. Lay your baby to sleep on a firm mattress. Do not let the baby sleep on soft things, like cushions, blankets, pillows, the couch, sheepskins, foam pads or waterbeds. NEVER use the crib as a playpen; never leave toys or small hard objects in the crib. NEVER use pillows in the crib; babies can smother in them. NEVER use thin plastic sheets or garment bags as mattress protectors; they can cause smothering.
Playpens: Playpens should have slats no more than 2 3/8 inches apart (three adult finger widths). Mesh netting must be a close-weave, smaller than the tiny buttons on baby’s clothes. They should have a firm floor (to prevent collapse) covered with well-fitting foam pads. Hinges should lock securely with no sharp edges or protruding bolts.
Portable Cribs: As with the playpen, never use the port-a-crib with a side left down. An infant could easily roll into the loose pocket formed by the mesh and suffocate.
Walkers: Wheelbase should be wider and longer than frame. Materials should be unbreakable plastic, tough fabric seat, heavy-duty stitching, or large rugged straps. Hinges and coil springs should have protective covers. Avoid old walkers with X-frames that act like scissors when closed, or your baby’s finger could be trapped or amputated. Remove throw rugs and place guards at the top of any stairway. Walkers tend to tip when the baby tries to move from a floor to a rug, or over a threshold. Use walker on a smooth floor, never on carpeting or rugs.
High Chairs: High chairs should have a wide base for stability. Safety straps should be attached to chair, not the tray, and always in use. The tray is not effective as a restraining device in place of a strap. Tray should lock securely in place with no rough or sharp places. Position the chair far away from doorways, refrigerator, range, and all electrical outlets and equipment. NEVER leave your child alone in the high chair; that’s when falls are most common.
Hook-on Chairs:
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Avoid placing where the child’s feet can reach the table supports or benches to push off from and dislodge the chair from the table. Chair should clamp to lock the chair securely onto the table.
Stroller/Carriages: Base should be wide enough to prevent tipping, even when baby leans over the side. Wheels should be large in diameter. Brakes should be large in diameter. If the seat reclines, it should not tip backwards when baby lies down. Stroller should have no sharp edges or scissor-like mechanisms. Have firmly attached safety belt, always fastened when in use. Always fold and unfold stroller away from your child. Fingers can be pinched or amputated in the mechanism.
Infant Seats: Toys: Make sure to keep toys of your older children separate from your baby. Enforce rules for toy storage and plan to make sure a crawling baby gets nowhere near potential dangers such as tiny plastic building blocks on which a baby could choke. Pacifier must have a guard or shield to keep it from being drawn entirely into baby’s mouth. The guard or shield must have ventilation holes to make it possible to breathe if the pacifier does get into the mouth. Rattles, squeeze toys, and teethers should be large enough so that they couldn’t be swallowed or lodge in the baby’s throat. Avoid shapes like a telephone receiver, safety pin, clothespin, or barbell. NEVER tie a pacifier or other item around your baby’s neck. Cords and ribbons can become tightly twisted, catch on crib corner posts, or otherwise cause strangulation. Don’t buy heavy toys, toys with small parts that can be pulled off and put into baby’s ears, nose, or mouth, with objects that could break easily, or objects with sharp edges. Infant seat should be very stable, made of sturdy materials with a wide base and supports that are firm and attached securely. Seats should have nonskid surface on bottom (or attach rough-surface adhesive strips). Safety straps should always be fastened when baby is seated. Soft ―backpack‖ style should have sturdy straps, heavy-duty snaps, and safety-lock buckles. Should have good head support and even weight distribution. Leg and armholes should be large enough to prevent chafing, but small enough to keep baby from slipping out.
Baby Carrier:
Toy Chests: Gates: Expandable gates for stairways and to block off certain rooms are a great safety aid. However, children have been strangled when they caught their head or neck in the open ―V‖ shapes atop some models. NEVER buy a gate with a top like a series of ―V’s‖, called accordion-style. Buy a gate with a straight edge. Choose a rigid mesh screen instead of V-shaped or diamond-shaped openings in the gate to avoid entrapment or strangulation. 43 REMOVE free-falling lid. Children have been killed or seriously injured when such a lid dropped on their head or neck. Choose a chest with supports that holds the lid open at any position, or use sliding panels or a lightweight, removable lid. Look for ventilation holes or a gap between the lid and the sides of the chest. Children have suffocated inside faulty toy containers.
Make sure the gate is securely anchored, or a child will push it over and fall down the stairs. If the gate has an expanding pressure bar, install it on the side away from the child.
NEVER, NEVER SHAKE A BABY…
Lives are shattered.
Shaking a baby can cause blindness, permanent brain damage, and even death.
No one likes to listen to a baby cry.
Babies cry when they are hungry, wet, tired or need company. Some babies cry at certain times of the day or night, usually when you want to sleep or eat. Feeding and changing may help, but sometimes the baby still cries. Remember the baby doesn’t hate you or want to ruin your life.
If you’ve had enough: Step back and Count to ten
Make sure the baby is in a safe place like a crib. Go to another room. Stay there a few minutes until you feel calmer. Remember: a little crying will not hurt the baby.
If the baby is still crying and you need help:
Call someone you trust—a relative, friend or neighbor. You may also try these 24-hour hotlines. Health Touch One—331-1111 or 1-800-273-3737 Boystown National Hotline—1-800-448-3000 Your child’s physician is an excellent source of further information on this subject.
HOME SAFETY FOR CHILDREN
Each year more than 16,000 children die in household accidents, and another 20,000 are hurt seriously enough to need medical attention. More children die in home accidents than from all childhood diseases combined. The most common hazards for babies under age 1 are choking, suffocating, fires, burns and falls. Familiar baby items often cause problems. Accidents don’t happen because parents don’t care; however, parents often lack the safety information that may have prevented the accidents or may need help in getting assistance. The following checklist will help ensure safety in your home.
Check List For Home Safety
Fire Safety:
Escape Route:
Do you have an evacuation plan that is rehearsed on a regular basis? Do you have at least 2 unobstructed emergency exits from your home? Do all exits identified have clear pathways that are free of boxes and furniture? Are all bedrooms close to an exit or do you have escape ladders in bedrooms or floors that are high from the ground? Do you have a key accessible to all deadbolt-locked doors?
Smoke Detectors and Fire Extinguishers:
Are there smoke detectors on every level? Do you have smoke detectors on the ceiling outside rooms where children play and sleep? Are the smoke alarm batteries changed on a regular basis, such as spring and fall? Do you have extra batteries for the smoke detectors? Do you have fire extinguishers in easy accessible places such as kitchen and garage? Are fire extinguishers checked on a regular basis? Do you know how to properly use your fire extinguishers?
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General Fire Safety:
Do you have your chimney inspected and cleaned annually? Do you leave space heaters, kerosene heaters or lanterns, wood stoves or fireplaces unattended? Is your wood burning stove inspected yearly and vented properly? Are your space heaters approved and in safe condition? Do you keep your space heaters at least 3 feet from curtains, drapes, papers, furniture, clothes or anything else that might be flammable? Do you leave cooking or grills unattended for extended periods of time? Do you ensure that electric cords are not frayed or overloaded and are out of the reach of children? Do you remember NOT to smoke in bed or when drowsy?
Tornado Safety:
Is an area in the home identified for shelter? Do you practice, as a family, seeking shelter at least annually in the spring? Do you have an operational battery-powered radio and extra batteries for it? Are blankets, flashlights and batteries placed in safe shelter area?
Winter Storm Safety:
Do you winterize your home annually? Have you caulked, insulated and wrapped water pipes, etc. to ensure it is winterized? Do you keep plenty of heating fuel or wood for fireplace or wood burning stove available in winter? Do you have flashlights, candles, matches, or other means for lighting if no electricity is available? Do you have several days of food and water available in case you were stranded in your home?
House Safety:
Electrical Safety:
Are all cords removed from beneath furniture and rugs or carpeting? Have all frayed cords been replaced? Do you have the appropriate sized light bulbs in all lighting fixtures? Do you have electrical outlet plugs in outlets not being used? Do you overload your extension cords? If so, could you remedy this situation? Do you use only the correct fuse sizes in the electrical fuse box?
Bedrooms:
Are light switches or lamps near the bed? Is there a flashlight near the bed? Do you have a telephone at your bedside? Are the fire exits clear? Do you shut off heating pads prior to going to sleep? Do you remove all ashtrays and smoking materials from the bedroom?
Stairs and Hallways:
Are stairs in good repair and free of obstacles? Are the hallways and stairs well lighted to prevent falls? Are there secure handrails that are sturdy? Do you wear shoes while on stairs? Do you use toddler gates at the top and bottom of stairs? 45
Are there deadbolts or latches at the top of the doors to stairs leading to basements or garages to prevent children from entering those areas?
Living Areas:
Are floors free of clutter? Are there decals on glass doors? Have loose rugs, runners and mats been secured with double-sided adhesive, rubber backing or tacked down? Are closet/cupboards arranged so that heavier and frequently used items are on the lower shelves? Is there a sturdy step stool available to reach items in high places? Is there a phone available that does not require a person to stand to use it or a cordless phone available? Do you keep potentially harmful or poisonous plants out of your child’s reach?
Kitchen:
Are all kitchen appliances safe? Is there a fire extinguisher? Are spills cleaned up immediately afterwards? Are cleaners and disinfectants stored properly in cabinets with safety latches or locks? Are knives and other sharp appliances stored out of children’s reach? Are towels, curtains and other flammables away from the stove? Does your child know the meaning of the word ‖hot‖? Do you place hot foods and liquids away from the edge of the table? Do you cook on the back burners when possible or keep the pot handles turned around so that children can not grab them? Do you keep all foods that a child can easily choke on out of their reach? Do you keep high chairs and stools away from the stove? Do you keep snacks away from the stove? Do you avoid using hanging tablecloths that could easily be pulled off the table spilling hot foods?
Bathroom:
Are there grab bars in the shower, tub or toilet area where necessary? Is the hot water temperature set at 120 degrees or below to prevent burns? Do you check bathtub water temperature prior to placing your child in it? Do you bathe your children in not more than 1 to 2 inches of water? Do you stay with your children during their bath? Do you use skid proof mats or stickers in your bathtubs? Do you keep toilet lids closed? Do you keep electrical appliances such as radios, hair dryers, curling irons, space heaters, etc away from water and out of a child’s reach?
Basement/Garage:
Are walkways clear? Are heating and cooling systems checked regularly? Are power tools stored safely? Is there a fire extinguisher that is checked regularly available? Are gasoline, solvents and similar products stored in covered containers away from heat? Do you keep old newspapers or cleaning cloths stockpiled? If so, are they safely away from flammable products?
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Are bright lights available in work areas?
Firearm Safety:
If firearms are stored in the home, do you make sure they are locked, unloaded and inaccessible to children? Do you store your gun and ammunition separately?
Poison Safety:
Do you keep purses containing vitamins, medications, cigarettes, matches, jewelry, etc. out of reach of children? Do you keep all medications and vitamins locked up and in child resistant containers? Do you have safety locks or latches on all cabinets that contain potentially dangerous items and are within a child’s reach? Do you store cleaning products and chemicals out of sight and reach of children and away from food? Do you keep all cleaning products, chemicals and other potentially poisonous substances in their original containers? Do you keep all poisonous or harmful plants out of reach of children? Do you have a supply of Syrup of Ipecac on hand? Do you have Poison Controls phone numbers listed by your phones?
Outdoor Safety:
Are walkways clear of leaves, snow, ice or other debris? Is night lighting adequate? Are handrails available on steps? Is your playground equipment safe, was it assembled and anchored correctly? Is there a cushioned surface such as sand, wood chips, rubber, grass, etc. under playground equipment? Is your yard fenced in? Do you supervise your children when they are playing outside? Have you taught your children how to handle and care for pets? Have you taught your children not to separate fighting animals and stay away from unfamiliar animals? If you have a swimming pool, is it enclosed with at least a 5 feet high fence, self-closing and self-latching gates and protected from use by unsupervised children? Do you make sure that you never leave a child unsupervised when swimming?
Emergency Information
Do you have all emergency numbers listed by all phones? Do you have the national toll free number for the Poison Control center 1-800-222-1222, listed in your emergency numbers in your purse/wallet so that when traveling you can call from anywhere in the United States and it will get you to the nearest Poison Control Center. Do you have an emergency list of phone numbers of your child’s physician, emergency rooms, etc listed by your phone (in back of book there is a phone list that could be used for this)? When you have a babysitter do you leave the names and phone numbers of three adults who could help the baby-sitter in your absence, and the phone number of where you will be? Do you make sure the sitter understand the services of ―911‖ or other emergency numbers in your area?‖ Do you know basic first-aid procedures for bleeding, choking or burns? Do you know cardiopulmonary resuscitation (CPR)?
For more information on Home Safety or for answers to your other health care questions, please contact Children’s Home Healthcare, your physician, local fire departments, the nurses at Health Touch One, (402) 331-1111 or the American Academy of Pediatrics website.
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Natural Disasters, Inclement Weather, Community Disaster
Natural disasters are defined as but not limited to earthquakes, tornadoes and floods. Inclement weather is defined as, but not limited to blizzard, ice storm, severe thunderstorm or hailstorm. A community disaster is defined as, but not limited to power outage, fire, hazardous spill and roadblocks. Children’s Home Healthcare’s emergency preparedness plan is to notify patients in need based on the services provided. If a patent is concerned about delivery of services causing a possible detriment to their health, they should call Children’s Home Healthcare immediately. If unable to contact Children’s Home Healthcare by phone and no contact has been made by Children’s Home Healthcare, the patient should call the local Emergency Medical Service to help transport them to the nearest healthcare facility to receive services without disruptions until homecare services can be resumed. To find out how prepared you are, read the following and check off each category you’ve completed. In each category, think about what other needs you and your family may have.
Disaster Preparation
What you can do to be prepared for storms or disasters?
Stock disaster supplies to last several days to a week for yourself and those who live with you. This includes having nonperishable foods, stored water and an ample supply of prescription and nonprescription medications that you regularly use. See Disaster Representative for Disaster Supply Kit suggestions. As you would in preparation for a disaster of any kind, have some extra cash on hand in case electronic transactions involving ATM cards, credit cards and the like cannot be processed. Plan to keep cash in a safe place, and withdraw money from your bank in small amounts. Similar to preparing for a winter storm, it is suggested that you keep your automobile gas tank above half full. If case the power fails, plan to use alternative cooking devices in accordance with manufacturer’s instructions. Don’t use open flames or charcoal grills indoors. Have extra blankets, coats, hats and gloves to keep warm. Please do not plan to use gas-fueled appliances, like an oven, as an alternative heating source. The same goes for wood-burning or liquidfueled heating devices that are not designed to be used in a residential structure. Camp stoves and heaters should be used only out-of-doors in a well-ventilated area. If you do purchase an alternative heating device, make sure it is approved for use indoors and is listed with the Underwriters Laboratories. Have plenty of flashlights and extra batteries readily on hand. Don’t use candles for emergency lighting. Examine your smoke alarms now. If you have smoke alarms that are hardwired into your home’s electrical system (most newer ones are), check to see if they have battery back-ups. Every fall, replace all batteries in all smoke alarms as a general fire safety precaution. Be prepared to relocate to a shelter for warmth and protection during a prolonged power outrage or if for any other reason, local officials request or require that you leave your home. Listen to a batteryoperated radio or television for information about where shelters will be available. If you plan to use a portable generator, connect what you want to power directly to the generator; do not connect the generator to your home’s electrical system. Also, be sure to keep a generator in a well ventilated area, either outside or in a garage, keeping the garage door open. Don’t put a generator in your basement or anywhere inside your home. Check with the emergency service providers in your community to see if there is more information available about how your community is preparing for any potential problems. Be an advocate and support efforts by your local police, fire and emergency management officials to ensure that their systems will be able to operate at all times. Sign up for a class with the American Red Cross that helps people prevent, prepare for and respond to emergencies. They’re in your neighborhood every day, providing disaster preparedness information and teaching classes in first aid and other lifesaving skills to help keep families like yours safer. Get a Medical Alert Bracelet. It alerts rescue crews to any medical condition that you may have. Keep it on at all times. Post medical instructions on your refrigerator or in easy-to-see spots.
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Disaster Preparation:
Prepare a Disaster Supply kit. It should be in an easy-to-carry container such as duffel bag, camping backpack, suitcase or large covered plastic container. You should have enough supplies to maintain your family for at least 3 days. Store your kit in a convenient place known to all family members. You should also keep a smaller version in the trunk of your car. Be sure to keep items in airtight bag. You should also change your stored water supply and food every 6 months to keep them fresh. Recheck your kit at least once a year and replace clothes, batteries and other supplies at least annually. Disaster Supply Kit Should Include:
Food that won’t spoil or need refrigeration. First aid kit, medical supplies and medications. Clothing and blankets/bedding. Flashlights, battery-operated radio and extra batteries. 1 gallon water per person a day.
Sanitation items such as soap, toilet paper, towelettes, etc. Tools and other emergency supplies. Special items such as diapers, formula, bottles, etc. Important family documents such as birth or marriage certificates, immunization records, insurance policies, etc.
Create a Disaster Plan: Meet with your family and discuss why you need to prepare for a disaster. Explain the dangers of fire, severe weather and earthquakes to children. Plan to share responsibilities and work together as a team. Discuss the types of disasters that are most likely to happen. Explain what to do in each case. Pick two places to meet: a) b) c) Right outside your home in case of a sudden emergency, like a fire. Outside your neighborhood in case you can’t return home. Everyone must know the address and phone number of where to meet. Ask an out-of-state friend to be your ―family contact.‖ After a disaster, it’s often easier to call long distance. Other family members should call this person and tell them where they are. Everyone must know your contact’s phone number. Discuss what to do in an evacuation. Learn how to take care of your pets. (Shelters don’t take in animals.)
Complete This Checklist:
Post emergency telephone numbers by phones (fire, police, ambulance, etc.). Teach children how and when to call 9-1-1 or your local Emergency medical Services number for emergency help. Show each family member how and when to turn off the water, gas and electricity at the main switches. Check if you have adequate insurance coverage. Get training from the fire department for each family member; on how to use the fire extinguisher (ABC type), and show them where it is kept. Install smoke detectors on each level of your home, especially near bedrooms.
Practice and Maintain Your Plan
Quiz your kids every six months on your family’s disaster plan. Conduct fire and emergency evacuation. Replace stored water every six months and stored food every six months. Test and recharge your fire extinguisher(s) according to manufacturer’s instructions. Test your smoke detectors monthly and replace the batteries at least once a year.
Conduct a home hazard hunt.
During a disaster, ordinary objects in your home can cause injury or damage. Anything that can move, fall, break or cause a fire is a home hazard. For example, a hot water heater, oxygen tanks, pictures or bookshelves can fall. Inspect your home at least once a year and fix potential hazards.
Stock emergency supplies and assemble a Disaster Supplies Kit. Take a Red Cross first aid and Cardiopulmonary Resuscitation class. Determine the best escape routes from your home. Find two ways out of each room. Find the safe places in your home for each type of disaster. Contact your local fire department to learn about home fire hazards.
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In Case a Disaster Occurs: If disaster strikes, remain calm; put your plan into action. Check for Injuries—Give first aid and get help for seriously injured people. Listen to your battery-powered radio for news and instructions. Evacuate, if advised to do so. Wear protective clothing and sturdy shoes. Check for damage in your home. Use flashlights. Do not light matches or turn on electrical switches, if you suspect damage or a gas leak. If you have trouble hearing, arrange for someone to keep you informed. Sniff for gas leaks, starting at the water heater. If you smell gas or suspect a leak, turn off the main gas valve, open windows and get everyone outside quickly. Shut off any other damaged utilities. (You will need a professional to turn gas back on). Clean up spilled medicine, bleaches, gasoline and other flammable liquids immediately. Remember to: o o o o Confine or secure your pets. Call your family contact—do not use the telephone again unless it is a life-threatening emergency. Check on your neighbors, especially elderly or disabled persons. Make sure you have an adequate water supply in case service is cut off. Stay away from downed power lines.
If evacuation necessary: o o o o Evacuate immediately and take your disaster supplies kit. Wear protective clothing and sturdy shoes. Lock your home. Listen to your battery-powered radio and follow instructions of local emergency officials. Use travel routes specified by local authorities—don’t use shortcuts because certain areas may be impassable or dangerous. Be sure to take every piece of equipment your child needs for any of his/her cares. Take a list and take all of the prescription medications that your child requires.
o o
If you’re sure you have time: o o Shut off water, gas and electricity before leaving, if instructed to do so. Make arrangements for your pets.
Disaster Supply Checklist Keep enough supplies in your home to meet your needs for at least three days. Assemble a Disaster Supplies Kit with items you may need in an evacuation. Store these supplies in sturdy, easy-to-carry containers such as backpacks, duffel bags or covered trash containers. Water: Store water in plastic containers such as soft drink bottles. Avoid using containers that will decompose or break, such as milk cartons or glass bottles. A normally active person needs to drink at least two quarts of water each day. Hot environments and intense physical activity can double that amount. Children, nursing mothers and ill people will need more. Store one gallon of water per person per day. Keep at least a three-day supply of water per person (two quarts for drinking, two quarts for each person in your household for food preparation/sanitation). Food: Store at least a three-day supply of non-perishable food. Select foods that require no refrigeration, preparation or cooking, and little or no water. If you must heat food, pack a can of heat. Select food items that are compact and lightweight. Include a selection of ready-to-eat canned meats, fruits and vegetables. First Aid Kit: Assemble a first aid kit for your home and one for each car. A first aid kit should include: Sterile adhesive bandages in assorted sizes Assorted sizes of safety pins Cleansing agent/soap Latex gloves (2 pairs) Sunscreen 2-inch sterile gauze pads (4–6) 4-inch sterile gauze pads (4–6) Triangular bandages (3) Non-prescription drugs 2-inch sterile roller bandages (3 rolls) 3-inch sterile roller bandages (3 rolls) Scissors
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Tweezers Needle & thread Moistened towelettes Antiseptic solutions
Thermometer Tongue blades (2) Tube of petroleum jelly or other lubricant
Prescription Drugs ALL prescription drugs for ALL family members
Non-Prescription Drugs Aspirin or non-aspirin pain reliever Anti-diarrhea medication Antacid (for stomach upset) Syrup of Ipecac (use to induce vomiting if advised by The Poison Center Laxative Activated charcoal (use if advised by The Poison Center
Sanitation Toilet paper, towelettes Soap, liquid detergent Feminine supplies Personal hygiene items Plastic garbage bags, ties (for personal sanitation uses) Plastic bucket with tight lid Disinfectant Household chlorine bleach Blankets or sleeping bags Hat and gloves Thermal underwear Sunglasses Aluminum foil Plastic storage containers Signal flare Paper, pencil Needles, thread Medicine dropper Shut-off wrench, to turn off household gas and water Whistle Plastic sheeting Map of the area (for locating shelters)
Clothing and Bedding Include at least one complete change of clothing and footwear per person Sturdy shoes or work boots Rain gear
Tools and Supplies Mess kits Battery-operated radio and extra batteries Flashlight and extra batteries Cash or traveler’s checks, change Non-electric can opener, utility knife Fire extinguisher: small canister ABC type Tube tent Pliers Tape Compass Matches in a waterproof container
Special Items: (Remember family members with special requirements, such as infants and elderly or disabled persons) For Baby Formula Diapers Bottles Powdered milk Baby food Medications/Diaper Creams Blankets and clothes Special toy or rattle Pacifier Special Equipment or items baby has such as apnea monitors, feeding pumps etc.
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For Adults Heart and high blood pressure medication Insulin Prescription drugs Games and books Denture needs Contact lenses and supplies Extra eye glasses
Important Family Documents: Keep these records in a waterproof, portable container: Will, insurance policies, contracts deeds, stocks and bonds Passports, social security cards, immunization records Bank account numbers Credit card account numbers and companies Inventory of valuable household goods, important telephone numbers. Family records (birth, marriage, death certificates) and keep with the Emergency Supplies A listing of all medications that your child takes. A listing of all medications that other family members take.
Evacuation: If you go to a shelter, take the following with you: Utilities Locate the main electric fuse box, water service main and natural gas main. Learn how and when to turn these utilities off. Teach all responsible family members. Keep necessary tools near gas and water shut-off valves. Remember; turn off the utilities only if you suspect the lines are damaged or if you are instructed to do so. If you turn the gas off, you will need a professional to turn it back on. A three-day supply of water (one gallon per person per day) and food that won’t spoil. One change of clothing and footwear per person, and one blanket or sleeping bag per person. A first aid kit that includes your family’s prescription medications. Emergency tools including a battery-powered radio, flashlight and plenty of extra batteries. An extra set of car keys and a credit card, cash or traveler’s checks. Sanitation supplies. Special items for infant, elderly or disabled family members. Take your child’s medical equipment, apnea monitors, feeding pump etc. and all medications.
Note: Let neighbors know that you may need help during an emergency situation or natural disaster. Make sure that you have a network to assist you.
Fire Safety
When There Is A Fire A. Try To Get Out Right Away 1. Feel doors before opening them. If they feel warm of if smoke is seeping in, don’t open! Use the second way out. 2. If you’re caught in smoke, crawl close to the floor. B. Keep Doors Closed If You Can’t Get Out 1. Stuff cloth around doors and cover vents to keep smoke out. 2. Phone the fire department. Let them know where you are in the building. 3. Signal for help. Open windows only if no smoke comes in.
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C. Stop, Drop & Roll If Your Clothes Catch Fire 1. Roll on the floor until the flames go out. 2. If you can’t roll, smother the flames with a blanket or rug. 3. Don’t run. Note: Ask your fire department about fire sprinkler systems. Also ask how to protect against carbon monoxide poisoning.
Storm Safety
A. Thunderstorms
1. Stay inside, away from windows. 2. Stay away from water faucets. 3. Use the phone only in emergencies. 4. If caught outside, get away from tall trees, open fields, metal objects and water. Crouch low to the ground, but don’t lie down.
B. Tornadoes
1. Go to the basement or lowest floor possible. 2. Stay in a hallway or small room in the center of the building. 3. If you live in a mobile home, go to a sturdy building nearby. If not possible, go outside. Lie flat in a ditch or low area.
C. Floods
1. Identify safe routes to higher ground ahead of time. 2. Move to high ground immediately if there is a ―flash flood warning‖ or if you suspect flooding has started.
D. Winter Storms
1. Get help winterizing, caulk your home (insulate, wrap water pipes, etc.) before winter. 2. Don’t let your supply of heating fuel get too low. Ask your supplier about fuel assistance programs. 3. Have extra blankets on hand. 4. Stay indoors during storms. Always follow evacuation instructions Officials may decide you need to leave the area for your safety. Local radio and TV stations will tell you where to go and the best route to take. Ask your Children’s Home Healthcare provider for special tips if you are taking medication(s).
After An Emergency Has Occurred
A. Check For Injuries Don’t move anyone with serious injuries (unless they are in danger of further injury). Obtain and wait for medical or emergency help. B. Beware Of Hidden Damage 1. Use a flashlight to check for damage. Don’t use a candle or other open flame. 2. Inspect electrical wiring and gas, water and sewage lines. If you suspect damage, do not use the lines until a utility company representative has inspected them. If natural gas lines are shut off, have a representative from the gas company turn the line back on. 3. Follow local advisories regarding boiling tap water. 4. Don’t go into buildings that might be damaged. Request help from rescue personnel. C. Use The Phone For Emergencies Keep phone lines clear for people who need emergency help. 53
D. Listen For Official Instructions Officials may tell you to avoid certain roads or highways and may give further instructions or advise you to take other precautions. If there is a need to evacuate, officials will advise when it is safe to return to your home.
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Important Numbers
Children's Home Healthcare (CHHC) 4156 S. 52
nd
St. Omaha, NE 68117…... (52
nd
& F)…
734-6741
Children’s Home Healthcare’s World & Private Duty Services………..………………………….926-2322 7815 Farnam Drive, Omaha 68114 (78th & Farnam) Children’s Hospital…..8200 Dodge St. Omaha, NE 68114……. (82nd & Dodge)………......… 955-5400 Children’s Emergency Dept….8200 Dodge St. Omaha, NE 68114….. (82nd & Dodge)….….. 955-5150 Eagle Run Urgent Care Center…13808 W Maple Rd. Omaha, NE 68144(138th & Maple)… 955-3600
Harvey Oaks Urgent Care Center.14421 DuPont Ct. Omaha, NE 68144 …(N 144th & Center) 955-7200 Your Primary Physician………………………………………………………………………… Specialist ………………………………………………………………………………………….. Specialist………………………………………………………………………………………….. CHILDREN’S HOSPITAL SPECIALTY CLINICS Pediatric Cardiology ................................................................................. 955-4350 Developmental .......................................................................................... 955-4160 Craniofacial ............................................................................................... 955-4168 Diabetes .................................................................................................... 955-3871 Feeding and Growth Management ........................................................... 955-5740 Gastroenterology ...................................................................................... 955-5713 Hematology/Oncology ......................................................................... 955-3949/50 Neurology ................................................................................................. 955-5372 NICU Follow-up ........................................................................................ 955-4178 Rehabilitation Services ............................................................................. 955-3987 Outpatient Diagnostic Services ................................................................ 955-4022 Pediatric Pulmonology .............................................................................. 955-5570 Renal ........................................................................................................ 955-4002 Rhizotomy ................................................................................................. 955-5678 Social Work............................................................................................... 955-5418 Family Support.......................................................................................... 955-3900 Poison Center National Number ......... in Omaha call 955-5555 or 1-800-222-1222 ______-________ ______-________ ______-________
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Community Resources
Agency Name Food Or Food Pantries First Call for Help 211 WIC Douglas & Sarpy Counties WIC – One World Community American Red Cross Heartland Chapter American Red Cross Pantry Bellevue Ministerial Association Food Pantry Benson Baptist Church Food Pantry Care & Share House 5th Ave. Methodist Broadway Church Nebraska Food Bank Network Food Stamps Nebraska Health & Human Services Food Stamp Information NHHSS Immunizations Dental Information Counseling Service Children’s Family Support Bereavement Group Youth Mentoring Programs Education Bellevue Public Schools Early Intervention Services Millard Public Schools Omaha Public Schools Early Development Network OPS Papillion LaVista Schools Ralston Public Schools Westside Schools JP Lord School Nebraska School for the Deaf Head Start LaFern Williams Center Salivation Army of Omaha Child Abuse Child Adult Abuse Hotline Omaha Police Dept. Children’s Advocacy Team Young Victims of Domestic Violence Children Helping Children 56 Type of Services Offered or Location
Information about emergency food pantries Omaha, NE Omaha, NE Omaha, NE Bellevue, NE Omaha, NE Council Bluffs, IA Council Bluffs, IA Omaha, NE Douglas County NE
Phone Number
444-6666 444-1770 734-2028 343-7700 343-7755 293-3138 551-1512 712-323-4889 712-323-7741 331-1213 595-3400 595-3400 444-6163 345-1439 955-3900 391-3900 444-1630
Douglas County Health Dept
For anyone who has lost a loved one. All Our Kids Inc. The Midlands Mentoring Project
School for children with disabilities
Lied Renaissance Center
293-4000 330-2770 895-8200 557-2222 557-2360 898-0400 331-4700 390-2100 554-6771 595-2155 444-5570 444-7700 898-5900 1-800-652-1999 444-5636 955-5414 345-7273 595-3521
Youth Division
Support group for 9-18 yr. old victims
Parent Assistant Line Child Protective Services
of incest Confidential referrals & resources for parents under stress Douglas County Sarpy County After 5 PM
397-9909 595-3330 595-2600 1-800-652-1999 553-6000 444-6666 597-3100
Child Saving Institute First Call for Help Voices for Children Domestic Abuse Domestic Abuse Crisis Line (Family Service) Shelters
Information referral and crisis intervention. Omaha Sarpy County Council Bluffs Shelter for victims of violence Shelter for abuse victims, support groups & training for independent living Shelter for abused women & their children Omaha Sarpy County Council Bluffs Nebraska Statewide Domestic Violence 24-hr crisis intervention for children & parent Domestic Violence Unit Police Custody Status Douglas County Attorney Sarpy County Attorney Pottawattamie County Attorney Douglas County Health Department
1-800-523-3666
Lydia House “Safe Haven” Concealed Shelter The Shelter Crisis Lines
402-588-5700 1-800-523-3666 712-328-0266 345-9342 292-5888 558-5700
402-345-7273 1-800-523-3666 712-328-0266 1-800-876-6238 734-1800 444-7456 444-4597 877-634-8463 444-3545 593-2230 712-328-5649 444-7825
Youth Emergency Services Non-Emergency Omaha Police Victim Assistance Unit Victim Information Notification County Attorney Offices
Housing Information Childhood Lead Poisoning Prevention Program Emergency Housing Lydia House Safe Haven The Shelter Safety Safety Education Safety & Health Council of Greater Omaha
Shelter for victims of violence Shelter for abused victims, support groups and training for independent living Shelter for abused women and their children.
345-9342 292-5888 558-5700 493-9628 592-7233
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Support Groups 556-1880 Alcoholics Anonymous Hotline
Information Services
553-5033 341-8060 392-9072 342-7007 444-6666 330-6164 553-6567 572-3280 572-3560 572-3160 572-3180 572-3190 572-3570 402-466-9655
Alcoholics Anonymous
Alcohol counseling Greater Omaha Community Action
Big Brother Big Sisters Lutheran Family Services of Nebraska United Way of the Midlands First Call for Help Cystic Fibrosis Foundation Epilepsy Association of NE & Western Iowa Leukemia Society of America March of Dimes Muscular Dystrophy Association National Kidney Foundation of NE National Multiple Sclerosis Society Spinal Bifida Association United Cerebral Palsy of NE
Matches single parent’s children ages 7-17 with volunteers.
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Community Resources & Their Websites
Community Resource
Children’s Home Healthcare’s website American Red Cross 1-877-568-3317 Answers4Families 1-800-746-8420 Child Abuse Hotline 1-800-652-1999 Early Childhood Training Center 1-800-89CHILD Early Development Network 1-888-806-6287 My Baby’s Hearing Nebraska’s CHILDFIND 1-888-806-6287
What assistance they provide
Information about the services that Children’s Home Healthcare provides. Provides information about CPR & First Aid classes, swimming and disaster relief. Provides information, opportunities for dialogue education and support to Nebraskan’s with special needs and their families. Report suspected abuse cases to Health & Human Services or local laws enforcement. For library resources and parenting information, questions about quality childcare and other childhood issues. Provides information about services and support for infants and toddlers with disabilities and their families. A website for parents of infants identified through newborn hearing screening as having a hearing problem. Answers to questions about child development and provides information for parents of children from birth to 21 with disabilities about their rights, available resources and responsibility of the local school district in providing services. Provides information about services and support to children birth to 5 with disabilities through their local school district. Provides information about health coverage to uninsured children under 19 yrs and children with minimal insurance. Provides information regarding immunizations for both children and adults. Provides family-focused information & services, case management, specialty medical team evaluations and payment of treatment. Provides information to obtain birth and death certificates. Provides free food and nutrition information and referrals to other services for pregnant women, infants and children under 5. Provided information and resources to families of children with disabilities. Provides information about all aspects of poisoning. An online resource designed to help seniors and caregivers of seniors, disabled and caregivers of disabled, parents and families, and low-income people, locate help and support in Nebraska.
Internet address
www.chsomaha.org Then click on the Children’s Home Healthcare button on the left hand side. www.redcross.org www.answers4families.org
www.hhs.state.ne.us/cha/chaindex.htm www.esu3.org/ectc
www.nde.state.ne.us/edn/
www.babyhearing.org
www.hhs.state.ne.us/ATP/childfind.asp
Office of Early Childhood Special Education 1-402-471-2471 Kids Connection 1-877-632-5437 Immunizations 402-471-2851 Medically Handicapped Children’s Programs 1-800-358-8802 Vital Records 402-471-2871 WIC and Commodity Supplemental Food Program 1-800-942-1171 Nebraska Parent Training & Information Center 1-800-284-8520 Poison Center 1-800-222-1222 NE 211
www.nde.state.ne.us/ECH/ECH.html
www.hhs.state.ne.us/med/kidsconxapp.htm
www.hhs.state.ne.us/imm/immindex.htm www.hhs.state.ne.us/chd/mhcp.htm
www.hhs.state.ne.us/ced/nevrinfo.htm www.hhs.state.ne.us/nut/wicindex.htm
www.pti-nebraska.org
www.nebraskamed.com/poison_center/ www.ne211.org
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