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Adopted Rules: Closed to Comments

Adopted Rules Content: 
 
 

Statement of Basis and Purpose

          The Department of Health and Mental Hygiene (the “Department”) enforces Article 47 of the Health Code, which regulates certain child care services provided to children under six years of age.  

          The Board of Health is amending Article 47 of the Health Code as follows to also regulate the provision of child supervision services in family homeless shelters in order to enhance the health, safety, and supervision of children receiving services in such facilities.

Adopted Changes

             Tier II homeless shelters for families are required by 18 NYCRR 900.10(c)(5) to provide access to child care services to enable the resident parent or caretaker relative of a child to seek employment and/or permanent housing or to attend school or training. For Tier II homeless shelters that choose to provide such child care services on site, the Department will regulate the programs to provide for the health, safety, and supervision of the children receiving the services. Unlike those child care programs currently regulated by the Department, these on-site programs are not designed to provide for the early education or full-time, long-term care of children; accordingly, the amendments limit the amount of time that any child may attend such a program. The amendments also establish health and safety standards for family shelter-based drop-off child supervision programs similar to those for the child care programs currently regulated by the Department. In response to comments received, the Department has revised the amendments to extend the amount of time that a child may attend such programs, and has added additional responsibilities to the role of the child care liaisons working in such programs. The Department has also added training requirements for child care liaisons.

Statutory Authority

          The authority for these amendments is found in Sections 556, 558, and 1043 of the New York City Charter (the “Charter”). Section 556 of the Charter provides the Department with jurisdiction to protect and promote the health of all persons in the City of New York. Section 1043 grants the Department rule-making authority. Sections 558(b) and (c) of the Charter empower the Board to amend the Health Code and to include all matters to which the Department’s authority extends.

 

 

Effective Date: 
Fri, 10/20/2017

Proposed Rules: Closed to Comments (View Public Comments Received:7)

Agency:
Comment By: 
Tuesday, July 25, 2017
Proposed Rules Content: 

Statement of Basis and Purpose

The Department’s Bureau of Child Care enforces Article 47 of the Health Code, which regulates non-residential-based child care centers for children under six years old. The Department is proposing that the Board amend Article 47 of the Health Code as follows to also regulate the provision of child supervision services in family homeless shelters in order to enhance the health, safety, and supervision of children receiving care in such facilities.

Proposed Changes

Tier II homeless shelters for families are required by 18 NYCRR 900.10(c)(5) to provide access to child care services to enable the resident parent or caretaker relative of a child to seek employment and/or permanent housing or to attend school or training. For Tier II homeless shelters that choose to provide such child care services on site, the Department proposes to regulate the programs to provide for the health, safety, and supervision of the children receiving the services. Unlike those child care programs that are currently regulated by the Department, these on-site programs are not designed to provide for the early education or full-time, long-term care of children; accordingly, the proposal limits the number of hours per week that any child may attend such a program. The proposed rule change would also establish health and safety standards for family shelter-based drop-off child supervision programs similar to those for the child care programs currently regulated by the Department.

Statutory Authority

The authority for these proposed amendments is found in Sections 556, 558, and 1043 of the New York City Charter (the “Charter”). Section 556 of the Charter provides the Department with jurisdiction to protect and promote the health of all persons in the City of New York. Section 1043 grants the Department rule-making authority. Sections 558(b) and (c) of the Charter empower the Board to amend the Health Code and to include all matters to which the Department’s authority extends.

Statement pursuant to Charter §1043

This proposal was not included in the Department’s Regulatory Agenda for Fiscal Year 2017 because the need for the proposal was not known at the time the Regulatory Agenda was promulgated.

Subject: 

Proposed resolution to amend Article 47 (Child Care Services) of the New York City Health Code regarding care for children in shelter.

Location: 
New York City Department of Health and Mental Hygiene, Gotham Center
42-09 28th Street, 3rd Floor, Room 3-32
Queens, NY 11101
Contact: 

Svetlana Burdeynik at (347) 396-6078 or resolutioncomments@health.nyc.gov

Download Copy of Proposed Rule (.pdf): 

Adopted Rules: Closed to Comments

Adopted Rules Content: 
 
 

Statement of Basis and Purpose

 

The Department of Health and Mental Hygiene (the “Department”) enforces Article 47 of the Health Code, which regulates non-residential-based child care centers for children under six years of age.   

The Board of Health is amending Article 47 of the Health Code as follows to enhance the health, safety and supervision of children in Department regulated child care services.

Educational directors

            Department experience has shown that the consistent presence of an educational director is an important factor in providing quality safe child care. The educational director is charged with developing a child care service’s curriculum, implementing teacher training and ensuring that all staff are aware of and compliant with the child care service’s written safety plan and the requirements of the Health Code. When there is no educational director present, or there is constant turnover in the educational director position, child care quality is diminished.

The Department attempts to routinely inspect all the 2,000+ child care services annually. When it finds on inspection that there is no educational director present, it is often told that the person holding the position is “temporarily absent,” a statement which the Department cannot always corroborate.  The Health Code requires that a fully qualified State-certified group teacher be designated as an acting educational director when the educational director is temporarily absent.  The Department has no way of knowing, however, how long the educational director’s absence has been or will last.  To address these concerns, Health Code §§ 47.13, 47.15 and 47.17 have been amended to require that child care service permittees notify the Department when educational directors are terminated or resign.  Notification means that Department staff can timely follow up with the child care service to determine if the educational director has been replaced, and whether there is an appropriate certified teacher supervising other teachers and assuming the duties required of the educational director.  When there is a temporary absence of an educational director, the Health Code will require the permittee to notify teaching staff in writing that there will be a temporary substitute educational director, and make such communication available for Department inspection.

Teacher and trainer qualification verification

      All teaching staff in Article 47 programs are required to hold certain educational credentials and certifications, and many teaching staff in current child care programs present foreign and domestic education institution credentials and teacher certifications that require Department staff to spend a great deal of time checking and verifying such credentials and certifications. Equally important are the qualifications of trainers.  Health Code §§47.13, 47.15, 47.17 and 47.37 have been amended to require child care permittees to submit teachers’ and trainers’ documentation and certifications for review to an agency designated by the Department. The agent would review teaching staff certifications, diplomas, educational transcripts and trainers’ credentials to determine that education and training are in compliance with the Health Code.  

Teacher immunizations

      A new Recommended Adult Immunization Schedule was approved by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices and published in February 2016.  The Department’s requirements for child care staff and volunteer immunizations in Health Code §47.33(c) have been amended to be consistent with these recommendations. The major change is that having a history of measles and mumps will not be allowed to substitute for the vaccines for measles and mumps – the vaccines must still be administered even if a health care provider indicates that an individual has a history of these diseases. Vaccinations are not needed if there is laboratory proof of immunity.  Vaccinations are also not needed for people born on or before December 31, 1956, regardless of their vaccination history, as such old vaccination histories are unreliable and most people were already exposed to these diseases.

Permit suspensions and revocations

            These amendments also clarify circumstances that may result in suspension and revocation of child care service permits, provide child care services with more concrete information about the Department’s expectations and describe how the Department evaluates performance.

The Department evaluates a child care service’s performance by comparing it to that of other child care services. Child care services found performing below standards may voluntarily enroll in a Department program to improve performance.  As part of this program, Department staff help permittees identify and address administrative and other factors that compromise child safety.  Department staff also work with the permittee to create a corrective action plan to remedy these factors. This voluntary improvement process is being made mandatory, amending §§47.21 and 47.77 and failure to make changes required by the corrective action plan would result in a child care service being required to defend its permit at a hearing at the Office of Administrative Trials and Hearings (OATH).

Health Code §47.77 has been amended to provide that, in addition to actions authorized by other provisions of the Health Code, the Commissioner may revoke a child care service permit in certain circumstances, including but not limited to:

  • having a history of prior or current child care permit,

license or registration suspensions,

  • revocations or suspensions (whether by the Commissioner or other government agencies) or
  • failing to implement required corrective action plans.

Section 47.77 has been amended to add that when a child care service permit is revoked by the Commissioner, any application for a new permit by any of the service’s individual or corporate managers or directors will not be accepted for at least five years following the date of revocation. In response to a comment, new subdivision (j) has been amended to authorize the Commissioner to exercise discretion in determining the circumstances in which to invoke this sanction.  

            These measures will enable the Department to take expedited action against unsafe facilities and clarify the bases for taking regulatory actions.  

Fraud prevention

Individuals who work or volunteer in or are in control of any child care service must be fingerprinted in accordance with Health Code §47.19.  Fingerprints are forwarded by the City Department of Investigation (DOI) to the New York State Division of Criminal Justice Services (DCJS). DCJS then reports on the individual’s criminal history to DOI, and DOI informs the permittee of the individual’s relevant criminal background.  In recent years, there have been a number of incidents where permittees claimed as staff members people who did not work in a child care service. Several permittees fraudulently submitted credentials of qualified persons or created false documents and certifications to show the Department that they have a full complement of cleared and/or qualified staff. One permittee allowed an otherwise unidentified individual to assume the identity and credentials of another person and passed her off as a qualified group teacher for many years.  In these cases, the fraud eventually results in revocation of the permits, in accordance with Health Code §5.13.  Requiring permittees to include identification numbers assigned to fingerprints (the New York State Identification or “NYSID” number) by DCJS when applications for permits and staff qualifications are submitted for approval will enable the Department to  more readily verify individuals’ identities.  Accordingly, Health Code § 47.09 (a) has been amended to require permittees to provide NYSID numbers for persons with ownership and other interests in child care services, and any other persons whose credentials the Department is being asked to approve.  

Early Intervention and CPSE services for disabled children

            Health Code §47.19 requires that all staff, volunteers, contractors and others in child care services obtain clearances every two years from the State Central Register of Child Abuse and Maltreatment (SCR), be fingerprinted and have employment references checked unless “such person is working under the direct supervision and within the line of sight of a screened employee of the child care service.”  The Department has been asked to exempt from these requirements persons conducting assessments of or providing services to individual children who are disabled or at risk for disability under the Department’s Early Intervention (EI) program (children under three years of age) or the City Department of Education’s committee on preschool special education (CPSE) (ages three through five). Since these individuals are already cleared, it is unnecessary that child care service permittees also clear them, and this provision is being amended accordingly. 

Lead in water

            Health Code §47.43(a), requiring child care service permittees to test water for lead, has been amended to specify that such testing must be done every five years and to require that test results be sent to the Department.  Any elevated test results that are submitted must be accompanied by a plan for remediation and until remediation is completed alternate sources of potable water provided. The original proposal was changed to extend the amount of time child care service permittees have to conduct drinking water lead testing from 30 days to 60 days after filing the required notice, to accommodate the amount of time needed for such testing.

Fire alarms and sprinklers

            Health Code §47.59 (c), which requires that all child care services attended by 30 or more children have fire alarms, has been amended to require all newly permitted child care facilities and those undergoing extensive renovation (i.e., material alterations requiring a revised certificate of occupancy) to have fire alarms approved by the Fire Department.  Also added is a requirement of the current Building Code that all new infant-toddler child care services and those undergoing material alterations be fitted with sprinkler systems. These requirements will significantly enhance safety.  

Permit posting

Health Code §47.73, which requires that a child care service permit must be posted “in a conspicuous place near its public entrance where staff, parents and others may review” it, has been amended to specify that the permit must be posted in a location where it will be more readily visible to parents and caregivers dropping off and picking up children. It is critical that parents know that a service has a Department permit and is not operating illegally and without oversight.

Statutory Authority

The authority for these amendments is found in §§ 556 and 558 of the New York City Charter (the “Charter”). Sections 558(b) and (c) of the Charter empower the Board of Health to amend the Health Code and to include all matters to which the Department’s authority extends. Section 1043 grants the Department rule-making authority.

Section 556 of the Charter provides the Department with jurisdiction to protect and promote the health of all persons in the City of New York.

Statement pursuant to Charter §1043

This proposal was not included in the Department’s Regulatory Agenda for FY ’16 since the need for the proposal was not known at the time the Regulatory Agenda was promulgated.

 

 

Effective Date: 
Fri, 10/21/2016

Proposed Rules: Closed to Comments (View Public Comments Received:7)

Agency:
Comment By: 
Wednesday, July 27, 2016
Proposed Rules Content: 
 
 

Statement of Basis and Purpose

 

          The Department’s Bureau of Child Care enforces Article 47 of the Health Code, which regulates non-residential-based child care centers for children under six years of age.   

          The Department is proposing that the Board amend Article 47 of the Health Code as follows to enhance the health, safety and supervision of children in regulated child care services.

Educational directors

            Department experience has shown that the consistent presence of an educational director is an important factor in providing quality, safe child care. The educational director is charged with developing a child care service’s curriculum, implementing teacher training and ensuring that all staff are aware of and compliant with the child care service’s written safety plan and the requirements of the Health Code. When there is no educational director present, or there is constant turnover in the educational director position, child care quality is diminished.

           The Department attempts to routinely inspect all the 2,000+ child care services annually. When it finds on inspection that there is no educational director present, it is often told that the person holding the position is “temporarily absent,” a statement which the Department cannot always corroborate.  The Health Code requires that a fully qualified State-certified group teacher be designated as an acting educational director when the educational director is temporarily absent.  The Department has no way of knowing, however, how long the educational director’s absence has been or will last.  To address these concerns, the Department is requesting that the Board amend Health Code §§ 47.13, 47.15 and 47.17 to require that child care service permittees notify the Department when educational directors are terminated or resign.  Notification means that Department staff can timely follow up with the child care service to determine if the educational director has been replaced, and whether there is an appropriate certified teacher supervising other teachers and assuming the duties required of the educational director.  When there is a temporary absence of an educational director, the Department is asking the Board to require that the permittee communicate in writing to teaching staff that there will be a temporary substitute educational director, and make such communication available for Department inspection.

Teacher and trainer qualification verification

      All teaching staff in Article 47 programs are required to hold certain educational credentials and certifications, and many teaching staff in current child care programs present foreign and domestic education institution credentials and teacher certifications that require Department staff to spend a great deal of time checking and verifying such credentials and certifications. Equally important are the qualifications of trainers.  The Department is proposing that the Board amend Health Code §§47.13, 47.15, 47.17 and 47.37 to require child care permittees to submit teachers’ and trainers’ documentation and certifications for review to an agency designated by the Department. The agent would review teaching staff certifications, diplomas, educational transcripts and trainers’ credentials to determine that education and training are in compliance with the Health Code.  

Teacher immunizations

      A new Recommended Adult Immunization Schedule was approved by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices and published in February 2016.  The Department’s requirements for child care staff and volunteer immunizations in Health Code §47.33(c) are being amended to be consistent with these recommendations. The major change is that having a history of measles and mumps will not be allowed to substitute for the vaccines for measles and mumps – the vaccines must still be administered even if a health care provider indicates that an individual has a history of these diseases. Vaccinations are not needed if there is laboratory proof of immunity.  Vaccinations are also not needed for people born on or before December 31, 1956, regardless of their vaccination history, as such old vaccination histories are unreliable and most people were already exposed to these diseases.

Permit suspensions and revocations

            These amendments also clarify circumstances that may result in suspension and revocation of child care service permits, provide child care services with more concrete information about the Department’s expectations and describe how the Department evaluates performance.

           The Department evaluates a child care service’s performance by comparing it to that of other child care services. Child care services found performing below standards may voluntarily enroll in a Department program to improve performance.  As part of this program, Department staff help permittees identify and address administrative and other factors that compromise child safety.  Department staff also work with the permittee to create a corrective action plan to remedy these factors. The Department proposes that this currently voluntary improvement process be made mandatory, amending §§47.21 and 47.77 and that failure to make required changes would result in a child care service being required to defend its permit at a hearing at the Office of Administrative Trials and Hearings (OATH).

          The Department also requests that the Board amend Health Code §47.77 to provide that, in addition to actions authorized by other provisions of the Health Code, the Commissioner may revoke a child care service permit in certain circumstances, including but not limited to:

  • having a history of prior or current child care permit, license or registration suspensions,
  • revocations or suspensions (whether by the Commissioner or other government agencies) or
  • failing to implement required corrective action plans.

It is also proposed that section 47.77 be amended to add that when a child care service permit is revoked by the Commissioner, any application for a new permit by any of the service’s individual or corporate managers or directors will not be accepted for at least five years following the date of revocation.

           

These measures would enable the Department to take expedited action against unsafe facilities and clarify the bases for taking regulatory actions.  

Fraud prevention

           Individuals who work or volunteer in or are in control of any child care service must be fingerprinted in accordance with Health Code §47.19.  Fingerprints are forwarded by the City Department of Investigation (DOI) to the New York State Division of Criminal Justice Services (DCJS). DCJS then reports on the individual’s criminal history to DOI, and DOI informs the permittee of the individual’s relevant criminal background.  In recent years, there have been a number of incidents where permittees claimed as staff members people who did not work in a child care service. Several permittees fraudulently submitted credentials of qualified persons or created false documents and certifications to show the Department that they have a full complement of cleared and/or qualified staff. One permittee allowed an otherwise unidentified individual to assume the identity and credentials of another person and passed her off as a qualified group teacher for many years.  In these cases, the fraud eventually results in revocation of the permits, in accordance with Health Code §5.13.  The Department would like to be able to require permittees to include identification numbers assigned to fingerprints (the New York State Identification or “NYSID” number) by DCJS when applications for permits and staff qualifications are submitted for approval, so that it can more easily verify individuals’ identities.  Accordingly, the Department requests that the Board amend Health Code § 47.09 (a) to authorize the Department to require provision of NYSID numbers by persons with ownership and other interests in child care services, and persons whose credentials the Department is being asked to approve.  

Early Intervention and CPSE services for disabled children

            Health Code §47.19 requires that all staff, volunteers, contractors and others in child care services obtain clearances every two years from the State Central Register of Child Abuse and Maltreatment (SCR), be fingerprinted and have employment references checked unless “such person is working under the direct supervision and within the line of sight of a screened employee of the child care service.”  The Department has been asked to exempt from these requirements persons conducting assessments of or providing services to individual children who are disabled or at risk for disability under the Department’s Early Intervention (EI) program (children under three years of age) or the City Department of Education’s committee on preschool special education (CPSE) (ages three through five). These individuals are already cleared and the Department would like to avoid unnecessary delay by requiring that child care service permittees also clear them.  The Department is asking the Board to amend this provision accordingly. 

Lead in water

            The Department is requesting that the Board amend Health Code §47.43(a) (requiring child care service permittees to test water for lead) to specify that such testing must be done every five years and to require that test results be sent to the Department.  Elevated test results would have to be accompanied by a plan for remediation and until remediation is completed alternate sources of potable water provided.

Fire alarms and sprinklers

            Health Code §47.59 (c) requires that all child care services attended by 30 or more children have fire alarms. The Department is proposing that the Board amend this provision to require all newly permitted child care facilities and those undergoing extensive renovation (i.e., material alterations requiring a revised certificate of occupancy) to have fire alarms approved by the Fire Department, and to incorporate in the Health Code a requirement of the current Building Code that all new infant-toddler child care services and those undergoing material alterations be fitted with sprinkler systems. The Department believes that these requirements will significantly enhance safety.  

 

Permit posting

           Health Code §47.73 currently requires that a child care service permit must be posted “in a conspicuous place near its public entrance where staff, parents and others may review” it.  The Department is requesting that the Board amend this to specify that the permit be posted in a location where it will be more readily visible to parents and caregivers dropping off and picking up children. It is critical that parents know that a service has a Department permit and is not operating illegally and without oversight.

Statutory Authority

           The authority for these proposed amendments is found in §§ 556 and 558 of the New York City Charter (the “Charter”). Sections 558(b) and (c) of the Charter empower the Board of Health (the “Board”) to amend the New York City Health Code (the “Health Code”) and to include all matters to which the Department’s authority extends. Section 1043 grants the Department rule-making authority.

Section 556 of the Charter provides the New York City Department of Health and Mental Hygiene (the “Department”) with jurisdiction to protect and promote the health of all persons in the City of New York.

Statement pursuant to Charter §1043

This proposal was not included in the Department’s Regulatory Agenda for FY ’16 since the need for the proposal was not known at the time the Regulatory Agenda was promulgated.

 

 

Subject: 

Proposed resolution to amend Article 47 (Child Care Services) of the New York City Health Code.

Location: 
New York City Department of Health and Mental Hygiene, Gotham Center
42-09 28th Street 14th Floor, Room 14-43
Queens, NY 11101
Contact: 

Svetlana Burdeynik at (347) 396-6078 or resolutioncomments@health.nyc.gov

Download Copy of Proposed Rule (.pdf): 

Adopted Rules: Closed to Comments

Adopted Rules Content: 

  

Statement of Basis and Purpose

 

Statutory Authority

 

            These amendments to the New York City Health Code (the Health Code) are promulgated pursuant to §§558 and 1043 of the New York City Charter (the Charter).  Sections 558(b) and (c) of the Charter empower the Board of Health (the Board) to amend the Health Code and to include in the Health Code all matters to which the authority of the New York City Department of Health and Mental Hygiene (the Department) extends. Section 1043 grants the Department rule-making authority. 

 

Background

 

The Charter provides the Department with jurisdiction over all matters concerning health in the City of New York.  The Department’s Division of Environmental Health includes the Bureau of Child Care, which issues permits to non-residential based child care services in accordance with Article 47 of the Health Code, and which regulates school based programs for children aged 3-5 in accordance with Article 43 of the Health Code.  Child care providers who provide child care services in homes or apartments are regulated by the State Office of Children and Family Services, and are not subject to either Article 43 or Article 47.

 

The Board of Health is amending Article 47 of the Health Code in order to improve supervision of children in child care services regulated by the Article.

 

Promoting accountability for children’s whereabouts

 

The Board of Health is amending the Health Code to enhance child safety within child care services.  The amendments strengthen requirements to account for a child’s whereabouts at all times while in care, when children are transported to and from the child care services or during off-site trips, and when children arrive and depart from the child care service.  The Department has, on occasion, been notified by child care service permittees, the police, and parents that children have gone missing for a period of time during the child care day.  These incidents may have occurred because a child exited the service unobserved by staff, was left on transportation vehicles, or was left in a playground or at another off-site trip location.  Additionally, at least one child was discharged to an adult who did not have authority to take the child from the child care service. Though no child was harmed, these incidents are troubling and reflect a need for stronger procedures to monitor the whereabouts of children.

 

The Department has issued guidelines and provided training to assist child care services account for all of the children under their care at all times. When the Department learns that a child care service has been unable to account for a child for any period of time, the Department orders the service to cease operation. Only after the child care service demonstrates that it has determined why the incident happened and that it has instituted concrete measures to prevent it from happening again does the Department authorize it to reopen. 

 

The following amendments reflect best practices already in place at many child care services, and, when implemented at all other services, will help such services implement systems designed to prevent these incidents.

 

  • Written safety plan: Amends §47.11 to add procedural requirements that promote child safety in child care services, establish accountability so that child care services permittees know and can document where any child is at any given time, particularly when children arrive and leave the child care service, whether they are taken on trips offsite, on foot or by other means, or are leaving the service at the end of the day.

 

  • Criminal justice and child abuse screening: Amends §47.19 to add screening with the State Registry for Child Abuse and Maltreatment (SCR) and for criminal history for personnel of child transportation services under contract to a child care service. The former provision required screening for school bus drivers and all other staff employed by the permitted child care service, but not for personnel employed by transportation services operating under contract to a permittee.  The new provision explicitly excludes from screening requirements persons providing transportation arranged by parents. 

 

  • Health; daily requirements; communicable diseases: Amends §47.27(a), (c) and (d)  to require permittees to maintain child attendance records and obtain earlier parental notifications of absences to promote greater accountability for children.  The former provision required parents to contact permittees after their children were absent for three days in order to capture information about children who may have contracted certain communicable diseases. The new provision requires a parent to notify the child care service the same day that a child will not attend on a scheduled day to promote better accountability for children and more rapid investigation of children who fail to show up at the child care service or are lost on a day of scheduled attendance. In response to comments, further changes were made to paragraph (4) of subdivision (c) to clarify that the permittee must document that notification was made, and subdivision (a) was amended to eliminate the proposed requirement that parents or other escorts must sign children’s attendance records.

 

  • Indoor physical facilities: Amends §47.41 to add new subdivisions (k) and (l) to require monitoring of entrances and exits and establishing other security measures. The Department has found that the majority of incidents reported between 2008 to 2013 demonstrating poor child accountability occurred when children wandered out of the child care service entrance door, alone or with another child and that child’s parent, or were left at an off-site location. In some cases, children left the child care service unaccompanied because they were able to open the front door by themselves, even though that door was closed. Locking a means of egress, however, is not permitted under the New York City Fire Code. In order to secure the door in a manner that prevents a child from exiting while also maintaining emergency access, the child care service is being required to install a panic bar on all doors that lead to the outside. Panic bars allow adults to easily open a door but are too high or require too much force for young children. To allow time for compliance, this provision will become effective May 1, 2016.

 

  • Safety; general requirements: Amends §47.57 to establish requirements for adults escorting children out of the child care service and for enhanced off-site trip supervision, since such trips present a substantive risk of children being left behind.  From 2008 to 2013, incidents of inadequate child supervision occurred when children left child care services with adults who were not authorized by parents to take them out of the child care service or when children were left at playgrounds, parks or on other offsite trips.  Subdivision (h) of  this section is being amended to require that permittees maintain information on all adults authorized by parents to take children out of a child care service and a new subdivision (j) is added to require that the permittee appoint a staff member as a trip coordinator who will be responsible for assessing supervision needs, developing guidelines and procedures for when additional staff or volunteers should accompany children on off-site trips, and to incorporate those procedures in the written safety plan. Trip coordinators will also be required to accompany children on offsite trips to improve accountability and lower the risk of leaving children unsupervised. In response to comments that additional staff requirements would be burdensome, this section was revised to clarify that the coordinator is among the staff counted to determine whether the supervision ratios required by Health Code §47.23 are met.

 

  • Transportation: Amends §47.65 to clarify parental consent requirements and adds new procedures for verifying children’s attendance and identity during transportation.  Several incidents of poor accountability have involved children who were left on a vehicle, dropped off at the wrong child care service or at a closed child care service, or simply left outside the child care service unsupervised.

 

Imminent or public health hazards

 

The list of imminent or public health hazards in the definition in §47.01(k) has been amended, modifying paragraph (10) to specify that use of a pillow only by a child younger than two years of age is a public health hazard; and deleting paragraph (13), which addresses holding potentially hazardous foods out of temperature.

 

Children can safely use pillows after age two, according to the safe sleep practices recommendations of the National Resource Center for Health and Safety in Child Care and Early Education Guidelines for Early Care and Education Programs.[i]  Section 47.55(b)(4) and (7) is also being amended to allow pillows to be used by children two years of age or older and to require that when pillows are used they must be stored with each child’s other bedding. 

 

Paragraph (13) of §47.01(k) is being deleted because requirements for holding food are addressed in more detail in Article 81, which is also applicable to child care services.

 

Medical records

 

Health Code §47.25(d) requires that permittees maintain a cumulative, comprehensive medical record for each child.  Section 47.33 requires that permittees also maintain staff physical examination certificates and vaccination records.  These provisions are being amended to clarify that comprehensive medical records of children and staff must be kept on the premises and made available to the Department upon request since Department Early Childhood Educational Consultants conducting inspections are frequently told that these records are not immediately available for review. 

 

Fire safety

 

Health Code §47.59(a), which requires that exit signs at child care services be clear and legible “when required by Department of Buildings” has been amended to reflect current Building Code requirements.  New York City Building Code §BC-1011 requires that all facilities housing child care services (occupancy use group E) have exit signs that are illuminated internally or externally.

 

Nutrition and physical activity updates

 

The Board of Health is amending §47.61(b) of the Health Code to update requirements limiting children’s juice consumption and §47.71(a) and (d) to further restrict sedentary time and television viewing.

 

       Dietary and lifestyle habits and preferences developed at a very early age can often persist and may have a profound impact on an individual’s health later in life. Among preschoolers enrolled in the Women, Infants and Children program in NYC in 2011, 14.5% of 3 year olds and 16.9% of 4 year olds were obese.[ii]  Obese children are more likely than normal-weight children to have risk factors for heart disease,[iii] type 2 diabetes,[iv] and many other disorders and conditions.[v] Obese children are more likely to become obese adults,[vi],[vii] and obesity in adulthood is associated with serious diseases and conditions, and with higher rates of death.[viii] Consequently, it is important to optimize the nutritional quality of the food and beverage offerings in early childhood settings and employ practices that serve to cultivate healthy lifestyle habits. The amendment is intended to update the current requirements for juice, sedentary time and screen time based on current expert recommendations and the best available evidence. 

  • Juice

Former Health Code §47.61(b) authorized child care services to provide children over the age of eight months up to six fluid ounces of 100% juice per day. The amendment  increases the age that 100% juice is permitted to 2 years of age, and reduces the amount of 100% juice that may be served to four ounces per day.

 

This amendment makes the Health Code provision consistent with current standards of the federal Child and Adult Care Food Program (CACFP), allowing four ounces of 100% juice per day for children ages 2 – 5 years old.[ix] Numerous health organizations including the United States Department of Agriculture (USDA)[x], the Institute of Medicine (IOM)[xi], the American Heart Association (AHA)[xii] and the American Academy of Pediatrics (AAP)[xiii] recommend limiting children’s intake of 100% juice. When consumed in moderation, 100% juice can be a healthy beverage; however, the USDA recommends that the majority of a child’s recommended fruit servings should come from whole fruit.[xiv] Despite this recommendation, current data suggest that 100% juice overconsumption by young children is commonplace. Daily per capita caloric intake from 100% fruit juice is increasing among children, including toddlers, and children who consume juice typically consume quantities that far exceed the cited recommendations.[xv],[xvi] A 2002 study of the sources of energy among over 3,000 infants and toddlers demonstrated that 100% fruit juice was the second largest source of energy among toddlers ages 12-24 months and the fourth largest source of energy among infants 4 to 5 months old.[xvii] Despite being offered 100% juice in small quantities, it is likely that children consume juice in multiple settings and at multiple occasions throughout the day, causing overall daily consumption to be above recommended levels.  Water and low-fat milk are the healthiest beverages for children over 2 years of age.[xviii]

  • Television viewing

 Health Code §47.71(d) prohibited screen time for children under 2 years of age and requires that screen time for children 2 years of age and older be restricted to 60 minutes per day of programming that is educational or actively engages children in movement. As amended,  the amount of screen time for children 2 years and older has been further limited to no more than 30 minutes per week.

 

Research suggests that more than 80% of children ages 6 months to 6 years are exposed to some type of screen-based media on a typical day,[xix] and caregivers report that preschool age children spend 2 to 3 hours per day on screen time,[xx],[xxi],[xxii] which exceeds recommended levels of screen time exposure.[xxiii] Surveys reveal that child care centers vary widely in the average amount of screen time provided, from small amounts or none at all[xxiv],[xxv],[xxvi] to 1 or more hours per day.[xxvii],[xxviii] Studies have found that increased screen time exposure in early childhood is related to risk of obesity later in childhood[xxix],[xxx],[xxxi],[xxxii],[xxxiii] and even into adulthood.[xxxiv],[xxxv],[xxxvi]  In recognition that children are exposed to screen time in various settings throughout the day, the AAP, American Public Health Association (APHA), and National Resource Center for Health and Safety in Child Care and Early Education Guidelines for Early Care and Education Programs, the First Lady’s Let’s Move initiative, and the USDA Provider Handbook for the Child and Adult Care Food Program recommend that early care settings limit screen time to 30 minutes per week.[xxxvii],[xxxviii],[xxxix] 

  • Sedentary time

Health Code §47.71(a) required that children not be allowed to remain sedentary or to sit passively for more than 60 minutes continuously, except during scheduled rest or naptime. The amendment reduces the amount of sedentary time to no more than 30 minutes continuously except during scheduled rest or naptime.

 

In an effort to combat early childhood obesity, the IOM recommends that child care providers and early childhood educators implement activities for toddlers and preschoolers that limit passively sitting or standing to no more than 30 minutes at a time.[xl] Limiting time spent on sedentary activities is important, as sedentary activities may take the place of time spent being physically active or otherwise actively engaged. Studies show that children spend a significant amount of time being sedentary in preschool and child care settings[xli],[xlii],[xliii] and that sedentary activities, such as television viewing, may be linked to increased BMI and adiposity in children.[xliv],[xlv]

 

The resolution is as follows.

 

Shall and must denote mandatory requirements and may be used interchangeably. 




[i] American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. 2011. Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. 3rd edition. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Also available at http://nrckids.org.

[ii] Centers for Disease Control and Prevention. Obesity prevalence among low-income, preschool-aged children — New York City and Los Angeles County, 2003–2011. MMWR 2013;62(2):17-22.

[iii] Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: The Bogalusa Heart Study. J Pediatr. 2007;150:12-17.e2.

[iv] Hannon TS, Rao G, Arslanian SA. Childhood obesity and type 2 diabetes mellitus. Pediatrics. 2005;116:473-480.

[v] Han JC, Lawlor DA, Kimm SY. Childhood obesity. Lancet. 2010;375:1737-1748.

[vi] Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med. 1997;37:869-873.

[vii] Serdula MK, Ivery D, Coates RJ, Freedman DS. Williamson DF, Byers T. Do obese children become obese adults? A review of the literature. Prev Med. 1993;22:167-177.

[viii] National Institutes of Health. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: the Evidence Report.Bethesda,MD: National Institutes ofHealth,U.S. Department of Health and Human Services; 1998.

[ix] New York State Department of Health, Child and Adult Care Food Program. Healthy Child Meal Pattern. March 2012. Available at: https://www.health.ny.gov/prevention/nutrition/cacfp/docs/cacfp-102.pdf. Accessed April 21, 2014.

[x] U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, December 2010.

[xi] Institute of Medicine (IOM). 2011. Early childhood obesity prevention policies. Washington, DC: The National Academies Press.

[xii] Gidding SS, et al; AHA; AAP. Dietary recommendations for children and adolescents: a guide for practitioners: consensus statement from the AHA. Circulation. 2005 Sep 27;112(13):2061-75.

[xiii] Committee on Nutrition. American Academy of Pediatrics: The use and misuse of fruit juice in pediatrics. Pediatrics. 2001 May;107(5):1210-3. Reaffirmed August 2013.

http://pediatrics.aappublications.org/content/107/5/1210.full

[xiv] U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, December 2010.

[xv] Wang YC, Bleich SN, Gortmaker SL. Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988-2004. Pediatrics 2008;121(6):e1604-e1614.

[xvi] Fulgoni VL, Quann EE. National trends in beverage consumption in children from birth to 5 years: analysis of NHANES across three decades. Nutr J 2012;11:92.

[xvii] Fox MK, Reidy K, Novak T, Ziegler P. Sources of energy and nutrients in the diets of infants. J Am Diet Assoc. 2006;106(1, suppl 1):S28-S42.

[xviii] Beverages Let’s Move Childcare. Available at: http://www.healthykidshealthyfuture.org/content/hkhf/home/nutrition/beve.... Accessed April 22, 2014.

[xix] Rideout V, Hamel E. The media family: electronic media in the lives of infants, toddlers, preschoolers and their parents. The Kaiser Family Foundation; May 2006.

[xx] Rideout V, Hamel E. The media family: electronic media in the lives of infants, toddlers, preschoolers and their parents. The Kaiser Family Foundation; May 2006.

[xxi] Common Sense Media. Zero to eight: children’s media use in America 2013. A Common Sense Media Research Study; Fall 2013.

[xxii] Christakis DA, Ebel BE, Rivara FP, Zimmerman FJ. Television, video, and computer game usage in children under 11 years of age. J Pediatr 2004;145(5):652-6.

[xxiii] American Academy of Pediatrics. Children, adolescents, and the media. Pediatrics 2013;132:958-961.

[xxiv] Christakis DA, Garrison MM, Zimmerman FJ. Television viewing in child care programs: a national survey. Communication Reports 2006;19(2):111-120.

[xxv] Christakis DA, Garrison MM. Preschool-aged children's television viewing in child care settings. Pediatrics 2009;124(6):1627-32.

[xxvi] Tandon PS, Zhou C, Lozano P, Christakis DA. Preschoolers' total daily screen time at home and by type of child care. J Pediatr 2011;158(2):297-300.

[xxvii] Christakis DA, Garrison MM, Zimmerman FJ. Television viewing in child care programs: a national survey. Communication Reports 2006;19(2):111-120.

[xxviii] Christakis DA, Garrison MM. Preschool-aged children's television viewing in child care settings. Pediatrics 2009;124(6):1627-32.

[xxix] Viner RM, Cole TJ. Television viewing in early childhood predicts adult body mass index. J Pediatr 2005;147(4):429-35.

[xxx] Reilly JJ, Armstrong J, Dorosty AR, et al. Early life risk factors for obesity in childhood: cohort study. BMJ 2005;330(7504):1357.

[xxxi] Proctor MH, Moore LL, Gao D, et al. Television viewing and change in body fat from preschool to early adolescence: The Framingham Children's Study. Int J Obes Relat Metab Disord 2003;27(7):827-33.

[xxxii] Danner FW. A national longitudinal study of the association between hours of TV viewing and the trajectory of BMI growth among US children. J Pediatr Psychol 2008;33(10):1100-7.

[xxxiii] Pagani LS, Fitzpatrick C, Barnett TA, Dubow E. Prospective associations between early childhood television exposure and academic, psychosocial, and physical well-being by middle childhood. Arch Pediatr Adolesc Med 2010;164(5):425-31.

[xxxiv] Landhuis C, Poulton R, Welch D, Hancox RJ. Programming obesity and poor fitness: the long-term impact of childhood television. Obesity 2008;16(6):1457-9.

[xxxv] Viner RM, Cole TJ. Television viewing in early childhood predicts adult body mass index. J Pediatr 2005;147(4):429-35.

[xxxvi] Hancox RJ, Milne BJ, Poulton R. Association between child and adolescent television viewing and adult health: a longitudinal birth cohort study. Lancet 2004;364:257-261

[xxxvii] American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. 2011. Caring for our children: National health and safety performance standards; Guidelines for early care and education programs, 3rd edition. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association.

[xxxviii] Screen Time. Let’s Move Child Care. Available at: http://www.healthykidshealthyfuture.org/home/activities/screentimes.html. Accessed March 21, 2014

[xxxix] U.S. Department of Agriculture and U.S. Department of Health and Human Services. Nutrition and Wellness Tips for Young Children: Provider Handbook for the Child and Adult Care Food Program. Alexandria, VA: 2012.

[xl] Institute of Medicine (IOM). 2011. Early childhood obesity prevention policies. Washington, DC: The National Academies Press.

[xli] Pate RR, McIver K, Dowda M, Brown WH, Addy C. Directly observed physical activity levels in preschool children. J Sch Health 2008;78(8):438-44.

[xlii] Bower JK, Hales DP, Tate DF, Rubin DA, Benjamin SE, Ward DS. The childcare environment and children's physical activity. Am J Prev Med 2008;34(1):23-9.

[xliii] Pate RR, Pfeiffer KA, Trost SG, Ziegler P, Dowda M. Physical activity among children attending preschools. Pediatrics 2004;114(5):1258-63.

[xliv] Proctor MH, Moore LL, Gao D, et al. Television viewing and change in body fat from preschool to early adolescence: The Framingham Children's Study. Int J Obes Relat Metab Disord. 2003;27(7):827-33.

[xlv] Janz KF, Burns TL, Levy SM. Tracking of activity and sedentary behaviors in childhood: the Iowa Bone Development Study. Am J Prev Med 2005;29(3):171-8.

Effective Date: 
Mon, 04/20/2015

Proposed Rules: Closed to Comments (View Public Comments Received:4)

Agency:
Comment By: 
Thursday, January 22, 2015
Proposed Rules Content: 

 

Statement of Basis and Purpose

Statutory Authority

These amendments to the New York City Health Code (the Health Code) are promulgated pursuant to §§558 and 1043 of the New York City Charter (the Charter).  Sections 558(b) and (c) of the Charter empower the Board of Health (the Board) to amend the Health Code and to include in the Health Code all matters to which the authority of the New York City Department of Health and Mental Hygiene (the Department) extends. Section 1043 grants the Department rule-making authority. 

Background

The Charter provides the Department with jurisdiction over all matters concerning health in the City of New York.  The Department’s Division of Environmental Health includes the Bureau of Child Care, which issues permits to non-residential based child care services in accordance with Article 47 of the Health Code, and which regulates school based programs for children aged 3-5 in accordance with Article 43 of the Health Code.  Child care providers who provide child care services in homes or apartments are regulated by the State Office of Children and Family Services, and are not subject to either Article 43 or Article 47.

The Department is proposing that the Board amend multiple provisions of Article 47 of the Health Code in order to improve supervision of children in child care services regulated by Article 47.

Promoting accountability for children’s whereabouts

The Department is proposing that the Board amend the Health Code to enhance child safety within child care services.  The proposed amendments strengthen the requirements to account for a child’s whereabouts at all times while in care, when children are transported to and from the child care services or during off-site trips, and when children arrive and depart from the child care service.  The Department has, on occasion, been notified by child care service permittees, the police, and parents that children have gone missing for a period of time during the child care day.  These incidents may have occurred because a child exited the service unobserved by staff, was left on transportation vehicles, or was left in a playground or at another off-site trip location.  Additionally, at least one child was discharged to an adult who did not have authority to take the child from the child care service. Though no child was harmed, these incidents are troubling and reflect a need for stronger procedures to monitor the whereabouts of children.

The Department has issued guidelines and provided training to assist child care services account for all of the children under their care at all times. When the Department learns that a child care service has been unable to account for a child for any period of time, the Department orders the service to cease operation. Only after the child care service demonstrates that it has determined why the incident happened and that it has instituted concrete measures to prevent it from happening again does the Department authorize it to reopen. 

To help child care services implement systems designed to prevent these incidents, the Department is proposing to amend Article 47 of the Health Code. The amendments reflect best practices already in place at many child care services. They would be required at all establishments if approved.

  • Written safety plan: Amend §47.11 to add procedural requirements that promote child safety in child care services, establish accountability so that child care services permittees know and can document where any child is at any given time, particularly when children arrive and leave the child care service, whether they are taken on trips offsite, on foot or by other means, or are leaving the service at the end of the day.
  • Criminal justice and child abuse screening: Amend §47.19 to add screening with the State Registry for Child Abuse and Maltreatment (SCR) and for criminal history for personnel of child transportation services under contract to a child care service. The current provision requires screening for school bus drivers and all other staff employed by the permitted child care service, but not for personnel employed by transportation services operating under contract with a permittee.  This provision would explicitly exclude from screening persons providing transportation arranged by parents. 
  • Health; daily requirements; communicable diseases: Amend §47.27(a), (c) and (d)  to require that permittees maintain child attendance records and obtain earlier parental notifications of absences to promote greater accountability for children.  This provision currently requires parents to contact permittees after their children are absent for three days in order to capture information about children who may have contracted certain communicable diseases. The Department is proposing that this be changed to require the parent to notify the child care service the same day when a child will not attend on a scheduled day to promote better accountability for children and more rapid investigation of children who fail to show up at the child care service and who may have been lost.
  • Indoor physical facilities: Amend §47.41 to add new subdivisions (k) and (l) to require monitoring of entrances and exits and establishing other security measures. The Department has found that the majority of incidents demonstrating poor child accountability reported between 2008 to 2013 occurred when children wandered out of the child care service entrance door, alone or with another child and that child’s parent, or were left at an off-site location. In some cases, children left the child care service unaccompanied because they were able to open the front door by themselves, even though that door was closed. Locking a means of egress, however, is not permitted under the New York City Fire Code. In order to secure the door in a manner that prevents a child from exiting while also maintaining emergency access, the Department is proposing that the child care service be required to install a panic bar on all doors that lead to the outside. Panic bars allow adults to easily open a door but are too high or require too much force for young children. To allow time to comply this provision will become effective May 1, 2016.
  • Safety; general requirements: Amend §47.57 to establish requirements for adults escorting children out of the child care service and for enhanced off-site trip supervision, since such trips present a substantive risk of children being left behind.  From 2008 to 2013, incidents of inadequate child supervision occurred when children left child care services with adults who were not authorized by parents to take them out of the child care service or when children were left at playgrounds, parks or on other offsite trips.  The Department proposes that the Board amend subdivision (h) of  this section to require that permittees maintain information on all adults authorized by parents to take children out of a child care service and add a new subdivision (j) to require that the permittee appoint a staff member as a trip coordinator who will be responsible for assessing supervision needs, developing guidelines and procedures for when additional staff or volunteers should accompany children on off-site trips, and incorporate those procedures in the written safety plan. Trip coordinators would also be required to accompany children on offsite trips to improve accountability and lower the risk of leaving children unsupervised.
  • Transportation: Amend §47.65 to clarify parental consent requirements and add new procedures for verifying children’s attendance and identity during transportation.  Several incidents of poor accountability have involved children who were left on a vehicle, dropped off at the wrong child care service or at a closed child care service, or simply left outside the child care service unsupervised.

Imminent or public health hazards

The Department is requesting that the Board amend the list of imminent or public health hazards in the definition in §47.01(k) to modify paragraph (10) to specify that use of a pillow by a child younger than two years of age is a public health hazard; and to delete paragraph (13), which addresses holding potentially hazardous foods out of temperature. Children can safely use pillows after age two.  The amendment to §47.01(k)(10) is intended to update the current definition of a public health hazard to incorporate the prohibition of pillows in infants’ sleep environments as required by the safe sleep practices of the National Resource Center for Health and Safety in Child Care and Early Education Guidelines for Early Care and Education Programs.[i]  Additionally, the Department is proposing that the Board amend §47.55(b)(4) and (7) to allow pillows to be used by children two years of age or older and to require that when pillows are used they be stored with each child’s other bedding.  In addition, the Department is requesting that the Board delete paragraph (13) of §47.01(k), because requirements for holding food are addressed in more detail in Article 81, which is also applicable to child care services.

Medical records

Health Code §47.25(d) requires that permittees maintain a cumulative, comprehensive medical record for each child.  Section 47.33 requires that permittees also maintain staff physical examination certificates and vaccination records.  The Department is requesting that the Board amend these provisions to clarify that comprehensive medical records of children and staff must be kept on the premises and made available to the Department upon request. Frequently, Department Early Childhood Educational Consultants who are conducting inspections are told that these records are not immediately available for review.  

Fire safety

Currently, Health Code §47.59(a) only requires that exit signs at child care services be clear and legible “when required by Department of Buildings.”  New York City Building Code §BC-1011 requires that all facilities housing child care services (occupancy use group E) have exit signs that are illuminated internally or externally. Accordingly, the Department is requesting that the Board amend this section to reflect current Building Code requirements.

Nutrition and physical activity updates

The Department proposes that the Board of Health amend §47.61(b) of the Health Code to update requirements limiting children’s juice consumption and §47.71(a) and (d) to further restrict sedentary time and television viewing.

Dietary and lifestyle habits and preferences developed at a very early age can often persist and may have a profound impact on an individual’s health later in life. Among preschoolers enrolled in the Women, Infants and Children program in NYC in 2011, 14.5% of 3 year olds and 16.9% of 4 year olds were obese.[ii]  Obese children are more likely than normal-weight children to have risk factors for heart disease,[iii] type 2 diabetes,[iv]and many other disorders and conditions.[v] Obese children are more likely to become obese adults,[vi],[vii]and obesity in adulthood is associated with serious diseases and conditions, and with higher rates of death.[viii] Consequently, it is important to optimize the nutritional quality of the food and beverage offerings in early childhood settings and employ practices that serve to cultivate healthy lifestyle habits. The amendment is intended to update the current requirements for juice, sedentary time and screen time based on current expert recommendations and the best available evidence.

  • Juice

Currently Health Code §47.61(b) authorizes child care services to provide children over the age of eight months up to six fluid ounces of 100% juice per day. The proposed amendment will increase the age that 100% juice is permitted to 2 years of age, and reduce the amount of 100% juice that may be served to four ounces per day.

This amendment would make the Health Code provision consistent with current standards of the federal Child and Adult Care Food Program (CACFP), allowing four ounces of 100% juice per day for children ages 2 – 5 years old.[ix] Numerous health organizations including the United States Department of Agriculture (USDA)[x], the Institute of Medicine (IOM)[xi], the American Heart Association (AHA)[xii] and the American Academy of Pediatrics (AAP)[xiii] recommend limiting children’s intake of 100% juice. When consumed in moderation, 100% juice can be a healthy beverage; however, the USDA recommends that the majority of a child’s recommended fruit servings should come from whole fruit.[xiv] Despite this recommendation, current data suggest that 100% juice overconsumption by young children is commonplace. Daily per capita caloric intake from 100% fruit juice is increasing among children, including toddlers, and children who consume juice typically consume quantities that far exceed the cited recommendations.[xv],[xvi] A 2002 study of the sources of energy among over 3,000 infants and toddlers demonstrated that 100% fruit juice was the second largest source of energy among toddlers ages 12-24 months and the fourth largest source of energy among infants 4 to 5 months old.[xvii] Despite being offered 100% juice in small quantities, it is likely that children consume juice in multiple settings and at multiple occasions throughout the day, causing overall daily consumption to be above recommended levels.  Water and low-fat milk are the healthiest beverages for children over 2 years of age.[xviii]

  • Television viewing

Currently Health Code §47.71(d) prohibits screen time for children under 2 years of age and requires that screen time for children 2 years of age and older be restricted to 60 minutes per day of programming that is educational or actively engages children in movement. The proposed amendment would further limit the amount of screen time for children 2 years and older to no more than 30 minutes per week.

Research suggests that more than 80% of children ages 6 months to 6 years are exposed to some type of screen-based media on a typical day,[xix] and caregivers report that preschool age children spend 2 to 3 hours per day on screen time,[xx],[xxi],[xxii]which exceeds recommended levels of screen time exposure. [xxiii] Surveys reveal that child care centers vary widely in the average amount of screen time provided, from small amounts or none at all[xxiv],[xxv],[xxvi] to 1 or more hours per day.[xxvii],[xxviii]Studies have found that increased screen time exposure in early childhood is related to risk of obesity later in childhood[xxix],[xxx],[xxxi],[xxxii],[xxxiii] and even into adulthood.[xxxiv],[xxxv],[xxxvi] In recognition that children are exposed to screen time in various settings throughout the day, the AAP, American Public Health Association (APHA), and National Resource Center for Health and Safety in Child Care and Early Education Guidelines for Early Care and Education Programs, the First Lady’s Let’s Move initiative, and the USDA Provider Handbook for the Child and Adult Care Food Program recommend that early care settings limit screen time to 30 minutes per week.[xxxvii],[xxxviii],[xxxix]

  • Sedentary time

Currently Health Code §47.71(a) requires that children not be allowed to remain sedentary or to sit passively for more than 60 minutes continuously, except during scheduled rest or naptime. The proposed amendment would reduce the amount of sedentary time to no more than 30 minutes continuously except during scheduled rest or naptime.

In an effort to combat early childhood obesity, the IOM recommends that child care providers and early childhood educators implement activities for toddlers and preschoolers that limit passively sitting or standing to no more than 30 minutes at a time.[xl] Limiting time spent on sedentary activities is important, as sedentary activities may take the place of time spent being physically active or otherwise actively engaged. Studies show that children spend a significant amount of time being sedentary in preschool and child care settings[xli],[xlii],[xliii] and that sedentary activities, such as television viewing, may be linked to increased BMI and adiposity in children.[xliv],[xlv]

 




[i] American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. 2011. Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. 3rd edition. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Also available at http://nrckids.org.

[ii] Centers for Disease Control and Prevention. Obesity prevalence among low-income, preschool-aged children — New York City and Los Angeles County, 2003–2011. MMWR 2013;62(2):17-22.

[iii] Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: The Bogalusa Heart Study. J Pediatr. 2007;150:12-17.e2.

[iv] Hannon TS, Rao G, Arslanian SA. Childhood obesity and type 2 diabetes mellitus. Pediatrics. 2005;116:473-480.

[v] Han JC, Lawlor DA, Kimm SY. Childhood obesity. Lancet. 2010;375:1737-1748.

[vi] Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med. 1997;37:869-873.

[vii] Serdula MK, Ivery D, Coates RJ, Freedman DS. Williamson DF, Byers T. Do obese children become obese adults? A review of the literature. Prev Med. 1993;22:167-177.

[viii] National Institutes of Health. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: the Evidence Report. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services; 1998.

[ix] New York State Department of Health, Child and Adult Care Food Program. Healthy Child Meal Pattern. March 2012. Available at: https://www.health.ny.gov/prevention/nutrition/cacfp/docs/cacfp-102.pdf. Accessed April 21, 2014.

[x] U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, December 2010.

[xi] Institute of Medicine (IOM). 2011. Early childhood obesity prevention policies. Washington, DC: The National Academies Press.

[xii] Gidding SS, et al; AHA; AAP. Dietary recommendations for children and adolescents: a guide for practitioners: consensus statement from the AHA. Circulation. 2005 Sep 27;112(13):2061-75.

[xiii] Committee on Nutrition. American Academy of Pediatrics: The use and misuse of fruit juice in pediatrics. Pediatrics. 2001 May;107(5):1210-3. Reaffirmed August 2013.

http://pediatrics.aappublications.org/content/107/5/1210.full

[xiv] U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, December 2010.

[xv] Wang YC, Bleich SN, Gortmaker SL. Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988-2004. Pediatrics 2008;121(6):e1604-e1614.

[xvi] Fulgoni VL, Quann EE. National trends in beverage consumption in children from birth to 5 years: analysis of NHANES across three decades. Nutr J 2012;11:92.

[xvii] Fox MK, Reidy K, Novak T, Ziegler P. Sources of energy and nutrients in the diets of infants. J Am Diet Assoc. 2006;106(1, suppl 1):S28-S42.

[xviii] Beverages Let’s Move Childcare. Available at: http://www.healthykidshealthyfuture.org/content/hkhf/home/nutrition/beve.... Accessed April 22, 2014.

[xix] Rideout V, Hamel E. The media family: electronic media in the lives of infants, toddlers, preschoolers and their parents. The Kaiser Family Foundation; May 2006.

[xx] Rideout V, Hamel E. The media family: electronic media in the lives of infants, toddlers, preschoolers and their parents. The Kaiser Family Foundation; May 2006.

[xxi] Common Sense Media. Zero to eight: children’s media use in America 2013. A Common Sense Media Research Study; Fall 2013.

[xxii] Christakis DA, Ebel BE, Rivara FP, Zimmerman FJ. Television, video, and computer game usage in children under 11 years of age. J Pediatr 2004;145(5):652-6.

[xxiii] American Academy of Pediatrics. Children, adolescents, and the media. Pediatrics 2013;132:958-961.

[xxiv] Christakis DA, Garrison MM, Zimmerman FJ. Television viewing in child care programs: a national survey. Communication Reports 2006;19(2):111-120.

[xxv] Christakis DA, Garrison MM. Preschool-aged children's television viewing in child care settings. Pediatrics 2009;124(6):1627-32.

[xxvi] Tandon PS, Zhou C, Lozano P, Christakis DA. Preschoolers' total daily screen time at home and by type of child care. J Pediatr 2011;158(2):297-300.

[xxvii] Christakis DA, Garrison MM, Zimmerman FJ. Television viewing in child care programs: a national survey. Communication Reports 2006;19(2):111-120.

[xxviii] Christakis DA, Garrison MM. Preschool-aged children's television viewing in child care settings. Pediatrics 2009;124(6):1627-32.

[xxix] Viner RM, Cole TJ. Television viewing in early childhood predicts adult body mass index. J Pediatr 2005;147(4):429-35.

[xxx] Reilly JJ, Armstrong J, Dorosty AR, et al. Early life risk factors for obesity in childhood: cohort study. BMJ 2005;330(7504):1357.

[xxxi] Proctor MH, Moore LL, Gao D, et al. Television viewing and change in body fat from preschool to early adolescence: The Framingham Children's Study. Int J Obes Relat Metab Disord 2003;27(7):827-33.

[xxxii] Danner FW. A national longitudinal study of the association between hours of TV viewing and the trajectory of BMI growth among US children. J Pediatr Psychol 2008;33(10):1100-7.

[xxxiii] Pagani LS, Fitzpatrick C, Barnett TA, Dubow E. Prospective associations between early childhood television exposure and academic, psychosocial, and physical well-being by middle childhood. Arch Pediatr Adolesc Med 2010;164(5):425-31.

[xxxiv] Landhuis C, Poulton R, Welch D, Hancox RJ. Programming obesity and poor fitness: the long-term impact of childhood television. Obesity 2008;16(6):1457-9.

[xxxv] Viner RM, Cole TJ. Television viewing in early childhood predicts adult body mass index. J Pediatr 2005;147(4):429-35.

[xxxvi] Hancox RJ, Milne BJ, Poulton R. Association between child and adolescent television viewing and adult health: a longitudinal birth cohort study. Lancet 2004;364:257-261

[xxxvii] American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. 2011. Caring for our children: National health and safety performance standards; Guidelines for early care and education programs, 3rd edition. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association.

[xxxviii] Screen Time. Let’s Move Child Care. Available at: http://www.healthykidshealthyfuture.org/home/activities/screentimes.html. Accessed March 21, 2014

[xxxix] U.S. Department of Agriculture and U.S. Department of Health and Human Services. Nutrition and Wellness Tips for Young Children: Provider Handbook for the Child and Adult Care Food Program. Alexandria, VA: 2012.

[xl] Institute of Medicine (IOM). 2011. Early childhood obesity prevention policies. Washington, DC: The National Academies Press.

[xli] Pate RR, McIver K, Dowda M, Brown WH, Addy C. Directly observed physical activity levels in preschool children. J Sch Health 2008;78(8):438-44.

[xlii] Bower JK, Hales DP, Tate DF, Rubin DA, Benjamin SE, Ward DS. The childcare environment and children's physical activity. Am J Prev Med 2008;34(1):23-9.

[xliii] Pate RR, Pfeiffer KA, Trost SG, Ziegler P, Dowda M. Physical activity among children attending preschools. Pediatrics 2004;114(5):1258-63.

[xliv] Proctor MH, Moore LL, Gao D, et al. Television viewing and change in body fat from preschool to early adolescence: The Framingham Children's Study. Int J Obes Relat Metab Disord. 2003;27(7):827-33.

[xlv] Janz KF, Burns TL, Levy SM. Tracking of activity and sedentary behaviors in childhood: the Iowa Bone Development Study. Am J Prev Med 2005;29(3):171-8.

 

Subject: 

Proposed resolution to amend Child Care Services of the New York City Health Code (Article 47) in order to improve supervision of children in these services.

Location: 
New York City Department of Health and Mental Hygiene, Gotham Center
42-09 28th Street, Room 8-25
Queens, NY 11101-4132
Contact: 

Svetlana Burdeynik at (347) 396-6078 or resolutioncomments@health.nyc.gov

Download Copy of Proposed Rule (.pdf): 

Adopted Rules: Closed to Comments

Adopted Rules Content: 

 

 

Statement of Basis and Purpose of the Amendment

 

The authority for this amendment is found in §§556 and 558 of the New York City Charter.   Sections 558(b) and (c) of the Charter empower the Board of Health to amend the Health Code and to include in the New York City Health Code (the “Health Code”) all matters to which the Department’s authority extends. Section 1043 grants the Department rule-making authority. 

 

    The Charter provides the New York City Department of Health and Mental Hygiene (the “Department” or “DOHMH”) with jurisdiction to protect and promote the health of all New Yorkers.

The Bureau of Child Care, in the Department’s Division of Environmental Health, enforces Article 47 (Child Care Services) of the Health Code, which regulates all public and private group day care services providing care for children under six years of age. Health and safety standards for school-based programs for children ages three through five are established in Article 43 of the Health Code.     

At its meeting on December 10, 2013, the Board of Health amended Articles 43 and 47 to add a new requirement that children between 6 and 59 months of age attending school based programs and child care services receive annual influenza vaccinations.  The resolution as adopted contained a drafting error in §47.25(a)(2)(C), which used the term “school” instead of “permittee,” to refer to the entity holding a child care service permit.   

The Board of Health is amending Article 47 to correct the error and substitute the term “permittee” for “school” in this provision.

 

Effective Date: 
Mon, 07/21/2014

Proposed Rules: Closed to Comments

Agency:
Comment By: 
Monday, April 21, 2014
Proposed Rules Content: 

Statement of Basis and Purpose of the Proposed Amendment

 

The authority for these amendments is found in §§556 and 558 of the New York City Charter.   Sections 558(b) and (c) of the Charter empower the Board of Health to amend the Health Code and to include in the New York City Health Code (the “Health Code”) all matters to which the Department’s authority extends. Section 1043 grants the Department rule-making authority. 

 

    The Charter provides the New York City Department of Health and Mental Hygiene (the “Department” or “DOHMH”) with jurisdiction to protect and promote the health of all New Yorkers.

The Bureau of Child Care, in the Department’s Division of Environmental Health, enforces Article 47 (Child Care Services) of the Health Code, which regulates all public and private group day care services providing care for children under six years of age. Health and safety standards for school-based programs for children ages three through five are established in Article 43 of the Health Code.     

At its meeting on December 10, 2013, the Board of Health amended Articles 43 and 47 to add a new requirement that children between 6 and 59 months of age attending school based programs and child care services receive annual influenza vaccinations.  The resolution as adopted contained a drafting error in §47.25(a)(2)(C), which used the term “school” instead of “permittee,” to refer to the entity holding a child care service permit.   

The Department is requesting that the Board amend Article 47 to correct the error and substitute the term “permittee” for “school” in this provision.

 

Subject: 
Download Copy of Proposed Rule (.pdf): 

Adopted Rules: Closed to Comments

Adopted Rules Content: 

 DEPARTMENT OF HEALTH AND MENTAL HYGIENE

Statement of Basis and Purpose

       The Charter provides the Department with jurisdiction over all matters concerning health in the City of New York. The Bureau of Child Care, in the Department’s Division of Environmental Health, enforces Article 47 (Day Care Services) and Article 43 (School-Based Programs for Children Ages Three Through Five) of the Health Code. Article 47 regulates all public and private group day care services for children less than six years of age. Article 43 contains health and safety standards for school-based programs for children ages three through five.  

       The Board is amending Articles 47 and 43 to require that children attending child care services and school-based programs under the Department’s jurisdiction receive annual vaccinations against influenza, and to add immunization against pneumococcal disease to the list of required pre-admission immunizations in these Articles.  Full citations for reports and studies cited in the section on influenza vaccination are listed at the end of this Statement of Basis and Purpose.

 Influenza vaccination

       Influenza causes an estimated 200,000 hospitalizations and an average of 36,000 (range 3,000-49,000) deaths annually in the United States (CDC, 2010). Approximately 20,000 hospitalizations and 30-150 deaths occur in children under 5 years of age each year.  Children typically have the highest attack rates of influenza, which can be as high as 40%, and children serve as a major source of transmission within communities.  Each year, an estimated 15%-42% of preschool children contract influenza, and 38 million school days are missed due to influenza illness (CDC/ National Center for Health Statistics, 1999).

        Influenza strains vary from year to year. The US Food and Drug Administration annually licenses influenza vaccines for administration based on a scientific consensus identifying “virus strains  likely to cause the most illness during the upcoming flu season” (generally October through April in the middle Atlantic states). (USFDA, 2012) Vaccination only protects against the strains specifically included in the approved vaccine. Therefore, immunization is only effective for the year in which it is given, and a different influenza vaccine generally needs to be administered each year. The effectiveness of influenza vaccine varies with the severity of flu season, circulating influenza viruses, vaccine composition, and the age group studied. In children less than 6 years of age, influenza vaccine efficacy, ability to prevent influenza infection, ranged from 59%-82%; effectiveness, a measure of how vaccine performed in real world settings in preventing influenza, ranged from 24%-36%.(T Jefferson, 2005; M Fujieda, 2006; Jefferson, 2008; Hoberman, 2003; Longini I, 2012) Belshe et. al. showed that live attenuated influenza vaccine (LAIV) was 55% more effective than trivalent inactivated vaccine (TIV) in preventing laboratory-confirmed influenza in children 6-59 months old (Belshe, 2007).

        Influenza vaccination has been found to be safe for use in children (Hambridge SJ, 2006; Glanz JM, 2011; France EK, 2004; Bernstein DI, 1982, Skowronski DM 2006). Based on the scientific evidence, the federal Advisory Committee on Immunization Practices – which sets the standard of care for the United States – recommends that everyone 6 months of age and older receive an annual influenza vaccination. Trivalent inactivated vaccine (TIV) is licensed for use in all children >6 months of age, and live attenuated influenza vaccine (LAIV; delivered as a nasal spray) is licensed for use in children >24 months. 

         Vaccinating children produces “herd immunity” in the general population. This means that. vaccinating children against influenza reduces the number of influenza infections in everyone else, regardless of whether they were vaccinated or not (Piedra PA, 2005). Vaccinating younger children may also protect against secondary cases (Reichert, 2001). One study looked at respiratory illness in household contacts of vaccinated and unvaccinated children attending daycare. Among study participants, vaccine efficacy  in preventing  proven influenza infection by measuring protective levels of antibodies was 45% for influenza B and 31% for influenza A (H3N2) during the 1996-97 influenza season.  The greatest effect of vaccination was seen in household contacts 5 to 17 years of age; household contacts of vaccinated children  had a 50% reduction in respiratory illnesses and an 80% reduction in febrile respiratory illness compared to unvaccinated children.  Statistically significant declines in illness were not seen for household contacts of younger children or adults, though the study was limited by small sample size (ES Hurwitz, 2000).  A second paper found a correlation between states with higher influenza immunization coverage among 19-35 month-olds and reduced influenza and pneumonia hospitalizations rates among adults over the age of 65 (based on claims records for Medicare eligible P&I hospitalizations) (SA Cohen, 2011).  This analysis was conducted before routine pediatric influenza vaccination; summary coverage estimates rose from 8.3% in 2002-2003 to 33.5% in 2005-2006.

         Despite active promotion of influenza vaccination for children, coverage rates have risen slowly in New York City. As of March 26, 2013, 61.0% of children ages 6 months through 59 months received at least one dose of influenza vaccine compared to 56.7% at the same time in 2012.  This still leaves nearly 4 out of every 10 young children unprotected. Furthermore, young children are at high risk of influenza-related complications and hospitalization, making this vulnerable group especially important to protect.[1]

        Finally, while child day care permittees and persons in charge of schools are required by Health Code §§47.27(e) and 43.19(e) to report to the Department within 24 hours any instance of a vaccine preventable disease, the Department does not expect individual cases of seasonal influenza to be reported. Reports by schools and day care facilities will, however, continue to be required as provided in Health Code §11.03 (a) and (b) of cases of a novel strain of influenza with pandemic potential, the influenza related death of a child under 18 years of age, or an outbreak of influenza.

 Pneumococcal disease immunization

        The Board is also amending Health Code §§43.17(a)(2) and 47.25(a)(2) to add “pneumococcal disease” to the list of required immunizations. This immunization, which is required by Public Health Law §2164(2), was inadvertently omitted from these sections. 

 References:

Belshe, R, Edwards K, Vesikari T, et. al. Live attenuated versus inactivated influenza vaccine in infants and young children. NEJM. 2007;356(7):685-696.

Bernstein DI, Zahradnik JM, DeAngelis CJ, et. al. Clinical reactions and serologic responses after vaccination with whole-virus or split-virus influenza vaccines in children aged 6 to 36 months. Pediatrics. 1982;69:404-408.

CDC. Estimates of Deaths Associated with Seasonal Influenza - United States, 1976-2007. MMWR. 2010;59(33):1057-1062.

CDC/ National Center for Health Statistics. Current estimates from the National Health Interview Survey, 1999.  Series 10, No 200.

Cohen G, Nettleman M. Economic impact of vaccination in preschool children. Pediatrics. 2000;106(5):972-976.

France EK, Glanz JM, Xu S, et. al. Safety of the trivalent inactivated influenza vaccine among children: a population-based study. Arch Pediatr Adolesc Med. 2004;158(11):1031-1036.

Fujieda M, Maeda A, Kondo K, et. al. Inactivated influenza vaccine effectveness in children under 6 years of age during the 2002-2003 season. Vaccine. 2006;27(7):957-963.

Glanz JM, Newcomer SR, Hambidge SJ, et. al. Safety of trivalent inactivated vaccine in children aged 24 to 59 months in vaccine safety datalink. Arch Pediatr Adolesc Med. 2011;165(8):749-755.

Hambidge SJ, Glanz JM, France EK, et. al. Safety of trivalent inactivated influenza vaccine in children 6 to 23 months old. JAMA. 2006;296(16):1990-1997.

Hoberman A, Greenberg D, Paradise J, et. al.  Effectiveness of inactivated influenza vaccine in preventing acute otitis media in young children. 2003;290(12):1608-1616.

Hurwitz E, Haber M, Chang A, et. al. Effectiveness of influenza vaccination of day care children in reducing influenza-related morbidity among household contacts. JAMA. 2000;284(13):1677-1682.

Jefferson T, Rivetti A, Harnden A, et. al. Vaccines for preventing influenza in healthy children. Cochrane Database Syst Rev. 2008;(2):CD004879.

Jefferson T, Smith S, Harnden A, et. al. Assessment of the fficacy and effectiveness of influenza vaccines in healthy children: systematic review. Lancet. 2005;365:773-780.

Longini I. A theoretic framework to consider the effect of immunizing schoolchildren against influenza: implications for research. Pediatrics. 2012;129(S2):S62-S67.

Piedra PA, Manjusha GJ, Kozinetz CA, et. al. Herd immunity in adults against influenza-related illnesses with use of the trivalent-live attenuated influenza vaccine (CAIV-T) in children. Vaccine. 2005;23(13):1540-1548.

Reichert TA, Sugaya N, Fedson DS, et. al. The Japanese experience with vaccinating schoolchildren against influenza. NEJM. 2001;344(12):889-896.

Skowronski DM, Jacobsen K, Daigneault J, et. al. Solicited adverse events after influenza immunization among infants, toddlers, toddlers, and their contacts. Pediatrics. 2006;117(6):1963-1971.

US Food and Drug Administration. News Release, FDA approves vaccines for the 2012-2013 influenza season.  www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm315365.htm


 

[1] Seasonal influenza vaccinations are currently required for children aged 6 months through 59 months attending any child care or preschool facility in New Jersey and Connecticut. Since 2008, the New Jersey Department of Health and Senior Services has required administration of at least one dose of influenza vaccine to these children between September 1 and December 31 each year (New Jersey Administrative Code §8:57-4.19). Since 2010, the Connecticut Department of Public Health pursuant to its commissioner’s authority to establish vaccination schedules (see, Connecticut General Statutes §19a-7f) has required children aged 6 months through 59 months attending day care to receive at least one dose of influenza vaccine between September 1 and December 31 each year. Connecticut preschoolers (aged 24-59 months) are required to have one dose between August 1 and December 31 each year. Connecticut day care and preschool enrollees receiving influenza vaccine for the first time are required to have two doses of vaccine, administered at least 28 days apart. Connecticut children attending kindergarten classes are not required to have influenza vaccinations.

Effective Date: 
Tue, 01/21/2014