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Adopted Rules: Closed to Comments

Adopted Rules Content: 
 
 

Statement of Basis and Purpose

 

Statutory Authority

The Board’s authority to codify these proposed amendments is found in Sections, 556, 558, and 1043 of the New York City Charter (the “Charter”). 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. 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.

Background

Article 43 of the New York City Health Code governs school-based programs for children aged three through five. The Board is amending Article 43 to add requirements for maintaining epinephrine auto-injectors on site and for certain teacher training. The basis for the changes is set forth below.

 

Emergency Medical Care and Epinephrine Auto-Injectors

The Centers for Disease Control and Prevention estimates that four to six percent of children nationally have a food allergy; such food allergies include ones that are life-threatening. Rapid administration of an epinephrine auto-injector following a life-threatening allergen exposure is critical to preventing significant negative outcomes, including death. Having epinephrine auto-injectors on the premises at all times can save the lives of children with life-threatening food allergies who do not bring an epinephrine auto-injector with them to the school-based program, and of children who have life-threatening food allergies identified for the first time while the child is there.

In 2016, the New York State Public Health Law was amended[1] to allow certain entities, including child care providers, to obtain non-patient specific epinephrine auto-injectors and to administer them in an emergency. This new State law creates the opportunity for such programs to have this critical, lifesaving program enrolling a child whose enrollment is paid for by federal child care subsidies.

The rule language is modified to include training regarding prevention of and response to emergencies related to food or allergic reaction, and prevention and control of infectious diseases (including immunization).

 

Other requirements

            In order to come into alignment with federal requirements and state policy regarding the vulnerabilities and special needs of children who are homeless or in foster care and thus require accommodations for compliance with certain rules, the proposed language has been modified to provide for a reasonable grace period for certain provisions pertaining to providing medical records.

Tooth Brushing

The provisions regarding tooth brushing that were included in the original proposal are not included in these amendments. The Department has determined that further consideration is warranted.

The Department’s authority to promulgate these proposed amendments is found in Sections 556, 558, and 1043 medication available. Accordingly, the amendments clarify requirements for emergency medical care and add a mandate that school-based programs maintain on site at least two unexpired epinephrine auto-injectors in each dosage appropriate for children who may be in the program, stored so they are easily accessible to staff and inaccessible to children. Whenever children are present, programs are required to have at least one staff person on site trained to recognize signs and symptoms of anaphylactic shock and to administer epinephrine as appropriate. The amendments also require programs to monitor the auto-injectors’ expiration dates and call 911 after any administration, as required by the medication directions; to obtain parental consent at the time the child is enrolled in the program; and to have all staff trained in preventing and responding to emergencies related to food allergies. 

The proposed language is modified to require that epinephrine auto-injectors have retractable needles and to clarify storage requirements.

Training requirements

The amendments expand teacher training requirements to enhance child safety and assure alignment with the health and safety training requirements in the federal Child Care Development Block Grant Act (CCDBG) Act of 2014. 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. 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.

                                                                 




[1][1] NYS Public Health §3000-C. Epinephrine Auto-injector devices. Effective March 28, 2017.

 
Effective Date: 
Thu, 07/12/2018

Proposed Rules: Closed to Comments (View Public Comments Received:14)

Agency:
Comment By: 
Wednesday, April 18, 2018
Proposed Rules Content: 
 
 

Statement of Basis and Purpose

Article 43 of the New York City Health Code governs school-based programs for children aged three through five. The Department of Health and Mental Hygiene proposes to add requirements for tooth brushing, for maintaining epinephrine auto-injectors on site and for certain teacher training. The basis for the proposed changes is set forth below.

 

Tooth Brushing

The Department is proposing to mandate that school-based programs for children aged three through five assist children with brushing their teeth at least once each day. Tooth decay (caries) is the most common chronic childhood disease. Consequences of early childhood caries include a higher risk of developing additional caries in both primary and permanent teeth,[1] difficulty eating and speaking,[2] increased hospitalizations and emergency room visits[3] and greater risk for delayed physical growth and development.[4] National data show that nearly one in four preschool-age children has had caries.[5] The Department’s 2014 Child Dental Health Survey (CDHS) found that at least 15 percent[6] of children in New York City child care programs had experienced caries and 45 percent of children consumed between-meal sugary snacks or sugary drinks four or more times a day, a major risk factor for caries. Caries prevalence increases as children get older, with 42 percent of third grade children having experienced caries.[7]

 

Caries is a preventable disease. Relatively simple measures such as tooth brushing can significantly reduce risk. The American Dental Association recommends that tooth brushing twice per day begin at the eruption of a child’s first tooth. Despite the established benefits of tooth brushing, the oral hygiene practices of young children in New York City remain inadequate.  According to the CDHS[8], among those surveyed, 40 percent of children aged 0 to 6 brushed their teeth only once a day or less frequently, and 45 percent of children aged 0 to 2 did not use fluoride toothpaste. 

Requiring tooth brushing for school-based programs will promote tooth brushing and help prevent caries. CDHS findings indicate that children with at least one tooth who are enrolled in Early Learn centers—which are required under the federal Head Start program to have a daily tooth brushing routine—are two and a half times as likely to brush their teeth the recommended two or more times per day than children in other programs. Including tooth brushing requirements in Article 43 will set children up for a lifetime of good oral hygiene practices.

Epinephrine Auto-Injectors

The Centers for Disease Control and Prevention estimates that four to six percent of children nationally have a food allergy; such food allergies include ones that are life-threatening. Rapid administration of an epinephrine auto-injector following a life-threatening allergen exposure is critical to preventing significant negative outcomes, including death. Having epinephrine auto-injectors on the premises at all times can save the lives of children with life-threatening food allergies who do not bring an epinephrine auto-injector with them to the school-based program, and of children who have life-threatening food allergies identified for the first time while the child is there.

In 2016, the New York State Public Health Law was amended[9] to allow certain entities, including child care providers, to obtain non-patient specific epinephrine auto-injectors and to administer them in an emergency. This new State law creates the opportunity for such programs to have this critical, lifesaving medication available. Accordingly, the Department is proposing to add a mandate that school-based programs maintain on site at least two unexpired epinephrine auto-injectors in each dosage appropriate for children who may be in the program, stored so they are easily accessible to staff and inaccessible to children. Programs would be required to have at least one staff person on site, whenever children are present, trained to recognize signs and symptoms of anaphylactic shock and to administer epinephrine as appropriate. The proposal also requires the program to monitor the auto-injectors’ expiration dates and call 911 after any administration, as required by the medication directions. Programs would be mandated to obtain parental consent at the time the child is enrolled in the program. All staff would be required to be trained in preventing and responding to emergencies related to food allergies.

Training requirements

The Department is proposing to expand teacher training requirements to enhance child safety, and assure alignment with the health and safety training requirements in the federal Child Care Development Block Grant Act (CCDBG) Act of 2014, which apply to any program enrolling a child whose enrollment is paid for by federal child care subsidies.

The Department’s authority to promulgate these proposed amendments is found in Sections, 556, 558, and 1043 of the New York City Charter (the “Charter”). 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. 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.




[1] Al-Shalan TA, Erickson PR, Hardie NA. Primary incisor decay before age 4 as a risk factor for future dental caries. Pediatr Dent 1997;19(1):37-41.

[2] American Academy on Pediatric Dentistry; Policy on early childhood caries (ECC): classifications, consequences, and preventive strategies. Pediatr Dent. 2008-2009;30 (7 Suppl):40-3.

[3] Ladrillo TE, Hobdell MH, Caviness C. Increasing prevalence of emergency department visits for pediatric dental care 1997-2001. J Am Dent Assoc 2006;137(3):379-85.

[4] Acs G, Lodolini G, Kaminsky S, Cisneros GJ. Effect of nursing caries on body weight in a pediatric population. Pediatr Dent 1992;14(5):302-5.

[5] Dye BA, Thornton-Evans G, Li X, Iafolla TJ. Dental caries and sealant prevalence in children and adolescents in the United States, 2011–2012. NCHS data brief, no 191. Hyattsville, MD: National Center for Health Statistics. 2015.

[6] This is likely underreported as it is self-reported information and children may have had undiagnosed caries (of which parents were unaware) when parents responded to the survey.

[7] New York State Department of Health Third Grade Survey.

[8]DOHMH’s Oral Health Program conducted a survey to determine risk and protective behaviors for tooth decay among children in New York City group daycare centers. Over 1,800 parents and caregivers from 67 daycare centers reported risk and protective behaviors for tooth decay of their children and themselves.

[9][9] NYS Public Health §3000-C. Epinephrine Auto-injector devices. Effective March 28, 2017.

 
Subject: 

Proposed amendment to School Based Programs for Children Ages 3-5 (Article 43 of the NYC Health Code)

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, (347) 396-6078, 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) 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) and Article 43 (School-Based Programs for Children Ages Three through Five) which regulates health and safety aspects of school-based programs for children ages three through five.  

The Board of Health has amended Article 43 of the Health Code as follows to enhance the health, safety and supervision of children under six years of age attending school-based programs.

Physical facilities: testing drinking water supplies for lead; installing window guards

            Health Code §47.43, applicable to non-school based freestanding child care centers, currently requires that “Drinking water from faucets and fountains shall be tested for lead content and the permittee shall investigate and take remedial action if lead levels at or above 15 parts per billion (ppb) are detected.”[1]  There is no similar requirement in Article 43 or in Article 45 (General Provisions Governing Schools and Children’s Institutions).  Although schools may be testing lead levels in water voluntarily, there is no general requirement that schools test potable water supplies for lead. While no water supplies should have lead levels above 15 ppb, the youngest children are most at risk for lead poisoning resulting from any environmental lead source. Article 43 is amended to require testing by school-based programs for children ages three through five of potable water supplies for lead. One change was made to the proposal, to extend the amount of time schools 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.

            In addition, the Board is amending this article to require that window guards or other Department approved limiting devices be installed in windows in all areas of a school accessible to children under six years of age.  Since 1976, Chapter 12 of the Department’s rules has required window guards to be installed in all multiple dwelling units in which children 10 years of age and younger reside.  Section 47.41 (e) of Article 47 similarly requires window guards to be installed in child care services that are not located in school buildings. The Board finds that the same protections should be afforded the children of the same ages attending schools.

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 Board is amending the immunization requirements for child care teachers and volunteers in Article 47 and for staff teaching early childhood education programs who are covered by Article 43 to be consistent with these recommendations. The major change is that having a history of measles and mumps will not be acceptable substitutes for measles and mumps vaccinations – 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.

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 (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.

 




[1] This is the federal action level for lead in public drinking water supplies. See, US Environmental Protection Agency, “Lead and Copper Rule,” 40 CFR Part 141 Subpart I.

 

 

Effective Date: 
Fri, 10/21/2016