Public comments for: Amendment of Child Care Programs and Family Shelter-Based Drop-off Child Supervision Programs (Article 47 of the NYC Health Code)

Comments

Comment:
As a parent and a director of a preschool I am opposed to the mandate requiring children to brush their teeth in school. Feeding, clothing and teaching your child good hygiene are some of the most basic responsibilities a parent has. Instead of taking away the responsibility that a parent has to their child we should instead work to empower them to make these changes in their daily lives. It does not matter if a child brushes their teeth in school if they are going to bed at night with their teeth not brushed. In addition, preschool teachers are being asked to do and be everything to the students in their classrooms. The daily schedules are already hectic and packed with a variety of activities, some of which already target teaching good hygiene.
Agency: DOHMH
Comment:
Children who are at risk or have allergies are prescribed epipens. The parents leave one at the child care center for their child. Staff is trained in using it as part of CPR. We ask the parent to replace the epipen when it expires. If centers are required to have unspecified epipens on site: How do they obtain them? Is the center responsible for the ongoing cost (they expire every 18 months). How will they be disposed of when they expire? Epipens have to be disposed of properly in an environmentally sound way. Will this be an unfunded mandate giving centers another ongoing cost, along with the responsibility of acquiring epipens and disposing them? I oppose it. Re - required tooth brushing. It would seem that the best course of action would be outreach and education for parents on the part of the DOH. The requirement for tooth brushing at a center demands a deployment of staff and time that is considerable.
Agency: DOHMH
Comment:
I would like to share my concerns pertaining to two proposed changes to Article 47. First, I am deeply concerned about the inclusion of 47.77(i). This passage is ambiguous at best and allows for the DOHMH to impose fines as they see fit without providing a clear list of the specific fines incurred for individual violations. In short, there is no way of knowing if fines are being arbitrarily decided and whether these fines are being equally imposed on all programs. These fines place a financial burden on childcare centers, which are already limited in budget, and will have a direct impact on the center’s ability to provide the highest level of care and education. Furthermore, there is no longer an allowance to correct a violation and therefore places a strain on the relationships between center directors and the DOHMH staff. These relationships have always been viewed as a partnership with a common goal – the good of the children. This will not continue to be the case when we feel we are being treated unjustly and being treated like restaurants hoping for patrons passing by to choose us based on the letter grade in our window. Shouldn’t mistakes be an opportunity to reflect and learn? We agree that there should be consequences, but fines are an unfair punishment and will surely create a divide between the schools and the DOHMH. Second, I have serious reservations about the addition of 47.27 (g) pertaining to daily tooth brushing. I understand the rationale behind the addition of this regulation, but for those who have to actually implement this policy there are several concerns: • It places an unfair burden on classroom teachers. • It is time consuming. What will the children lose programmatically to allow for this? • The responsibility of managing the logs and properly sanitizing the toothbrushes. • The responsibility of knowing which children are allowed to use fluoride toothpaste, which have non-fluoride toothpaste, and which children’s parents have opted out of this. • The actual assisting of young children with the process of brushing their teeth. What will this look like during the separation stage in which the children are only beginning to trust the adults in their classroom and transition to the routines of school? To what degree must we insist on them participating in this routine? • The burden of the supplies required on a daily basis. • The additional exposure to germs, both for the children and the teachers. Lastly, I would like to point out that many preschool children are only at school for three to four hours per day. At the very least, allowances should be made for half day programs to elect not to include tooth brushing in their daily routines. Thank you for your consideration regarding these objections to the adoption of 47.77 (i) and 47.27 (g).
Agency: DOHMH
Comment:
I am against the amendment requiring tooth-brushing. This practice will seriously impact child care centers by taking valuable time away from other educational activities, decreasing program quality. This will also increase the risk of spreading disease. This will often mean having one teacher take one child out of the classroom to brush their teeth, leaving the other adult in the class out of ratio, thus creating an unsafe environment for the children. Please re-consider this amendment.
Agency: DOHMH
Comment:
The toothbrushing idea is misguided. I actually tried this a few years ago, I thought it would be a lovely habit to inculcate. But I gave it up for a number of reasons - one of which being that the toothbrushes don't dry properly inside the containers (you can't leave them open) and I felt they were becoming hotbeds of germs, defeating the whole purpose. But besides the practicality of this, which you can infer from the other emails is not feasible, the idea of MANDATING toothbrushing seems physically intrusive to the child and could lead to invasive behavior on the part of a pressured teacher who has to fill out the forms and just shoves the toothbrush into the child's mouth. Also on a moral level, I feel this is a violation of parental rights - we don't cut children's nails or brush their hair, those are tasks a parent should undertake as they are the primary physical caretakers of the child and we are just there to support them in their work. I feel this mandated practice would lead to serious violations and breaches of privacy for the child. Rinse and spit is a good fun way to remove food particles from the mouth, and good training for when they visit the dentist. Why not do that instead? It's less wasteful, invasive, and time consuming. All you need is a paper cup and a sink and it takes 20 seconds.
Agency: DOHMH
Comment:
I am the Chief Administrative Officer for The International Preschools which has an enrollment of 338 and was founded in 1963. Our school greatly appreciates its collaborative relationship with the Department of Health in keeping children safe in a developmentally appropriate educational environment. I do have serious concerns about the proposed changes 47.77(6)(i) Closing and Enforcement. This section does not incorporate any language about corrective actions or remediation timelines but rather seems to solely focus on fine enforcement. I would ask that this language be carefully reviewed to support the collaborative relationship that our school (and many other schools) have with the DoH representatives.
Agency: DOHMH
Comment:
We are particularly concerned with the toothbrushing and EpiPen mandates, as the burdens that respectively relate to hygiene and financial burden are significant. The sweeping powers for the Department of Health to tack fines onto each issued violation is additionally unsettling. Each of these measures seems likely to detract - in a variety of ways - from the ultimate goals of high-quality childcare: safety, education, and joy.
Agency: DOHMH
Comment:
Tooth Brushing: While dental health is important that is a parent's responsibility. I think it is unfair to want to levy violations on programs who do not want to do this. Head start programs are given the resources and funding to ensure tooth brushing during school. Will DOHMH give programs the resources and funding? Who will purchase toothbrushes? Who will train staff? Who will track and supervise this? Epi-Pens: My center has a food and allergy training yearly. We ensure that children (and teachers) who have allergies have an epi-pen on site that is prescribed by the doctor. We train teachers on how to use an epi-pen. However, these training's are not cheap. Once again my question is WHO will pay for this? There are centers where they are struggling to keep afloat and you will require them to HAVE TO purchase EXPENSIVE epi-pens? If anyone in the building has an allergy the parent/staff member should be responsible to bring in their own epi-pen. The school should have a separate allergy plan for that child/staff member filled out by a doctor. The center should have an internal allergy plan that includes call 911. Remember training's cost $$$, epi-pens cost $$$, tooth brushes cost $$$.....DOHMH has great regulations they want to enforce and give violations for when you don't comply but how can programs survive if there is no $$$??? Who will pay for these violations??? This is unfair and DOHMH needs to think about the programs also when creating these regulations. If the regulations came with training and technical assistance and funding I bet more programs would be in compliance and would have no problem following these mandates. If you want programs to operate under the Head Start model please give us the Head Start funding and training!!!
Agency: DOHMH
Comment:
I am commenting on the proposed regulation that would require schools and daycare centers to assist children in tooth brushing. This process seems an opportunity for cross contamination of bacteria and viruses. How would teachers who are assisting children with toothpaste and brushes keep from cross contamination? Would they need to change gloves or wash hands between each child? How to would sinks be kept sanitized between children as they rinse their mouths after brushing. I am also concerned about storing brushes. Even with toothbrush covers, some fluid leaks out after a brush is rinsed. If stored on a toothbrush rack - again this leaves opportunity for cross contamination. Will parents be able to opt out of this requirement? Many children have difficulty with brushing - will teachers be required to brush their teeth for/with them... I believe that is invasive and not something I would ever advise a teacher to do. Finally, most children in NYC do not spend more than 8-10 hours in school or daycare centers. If children brush before school, when returning home and then before bed, the suggested tooth brushing schedule can be met at home. This seems to me to be a family support issue - not an educational issue. I am sure teachers would be happy to support a unit of study on healthy teeth to encourage brushing at home, but to add this to the school day in a way that seems unhygienic and invasive is irresponsible.
Agency: DOHMH
Comment:
The burden of maintaining and purchasing an epic pen places the responsibility on the School rather than the family. We indirectly become the funders for a prescription medication which has an expiration date and squarely place us "playing" the role of pharmacy instead of instruction and guidance. What next? Are we going to be asked to keep a series of drugs at our disposal to advert future illnesses? Since when does the role of the childcare facility change to become the pharmacy for all? Where does individualize planning and attention come in? This is a partnership with the parent. A moment where programs who find themselves with a child that is in need of an epic pen work with the families and provide the necessary support and guidance. We all know that failure to use a car seat, results in a series of fatalities. Are we going to have to purchase a car seat for every parent because that is what the statistic shows? Instead, the proposal should consider ways that families can be furthered strengthen and cost mitigated to enable the access of an epic pen at a reasonable cost. On the matter of a toothbrush, we all need to think through the time the child spends at the program. Not all proposals need to become a mandate. Some need the time to be assimilated into our society.
Agency: DOHMH

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