Ergonomics in NAEYC Accredited Child Care Centers

Running Head: ERGONOMICS IN ECE 1

Ergonomics in NAEYC Accredited Child Care Centers

Christina N. Kirsch

Loyola Marymount University

ERGONOMICS IN ECE 2

Ergonomics in NAEYC Accredited Child Care Centers

Working with young children, albeit any popular opinion about the physical job demand

is a labor-intensive job. Research demonstrates its relevance as physically taxing as rates of

musculoskeletal injury are often present in individuals who participate in activities with young

children. The musculoskeletal system in the body is comprised of the components that allow the

body to make movements; thus, it includes the skeleton, joints, tendons, ligaments, muscles,

nerves, and cartilage (Cleveland Clinic Foundation, 2015). Ergo, because young children require

a lot of physical assistance from adults (e.g. feeding, bathing, transporting, etc.) there is a lot of

pressure exerted on the musculoskeletal system. For example, Griffin and Price (2000) used

qualitative methods to investigate mother’s perceptions of lifting and the resulting lifting

practices. Data revealed that mothers tended to use lifting practices that took into consideration

the child’s needs and consequently did not lift in a way that took their own musculoskeletal

system into account (except in instances where they had a current musculoskeletal injury).

Specifically, the authors state that “mothers would give little or no thought to the way they were

lifting and carrying their children” and “previously learned methods of correct lifting and

handling were generally not transferred and applied to the home situation” (Griffin & Price,

2000, p. 18). The authors noted that “stoop” lifting was the most common form of lifting that

mothers used despite it being a catalyst for back pain and injury; and, the authors closed citing

the need for research on best lifting practices that can be used when caring for children (Griffin

& Price, 2000).

Quantitative methods have also been employed to study caring for children in the home.

Sanders and Morse (2005) used survey methodology to assess primary caregiver’s daily routines,

including those taking care of their children, to determine activities and practices that had an

influence on the development of musculoskeletal pain. Through descriptives, chi-square, and

ERGONOMICS IN ECE 3

regression analyses, Sanders and Morse (2005) found that 66 percent of respondents (N= 130)

reported that caring for their children resulted in musculoskeletal pain; that engaging in high-risk

child care practices (e.g. lifting a child onto a diaper table, lifting child in/out of crib, feeding in

an awkward posture/position, bending over to clean child, etc.) significantly predicted

musculoskeletal injury (p= 0.001); and, a strong association between perceptions of job demand

in caring for children and presence of musculoskeletal complaints and pain (p=0.003). The

authors closed by asserting the need for “addressing the biomechanical…risk factors in caring

for young children” (Sanders & Morse, 2005, p. 294); and, this investigation into the biophysical

aspects of our work is referred to as “ergonomics.”

According to the American Psychological Association (APA; 2015) ergonomics is a

science that investigates “human capabilities and limitations and uses this knowledge to improve

the design of things that people use and the ways in which they work” (p. 1). Essentially,

ergonomics studies the physical aspects of working conditions and its aim is to improve

productivity and efficiency by making those conditions optimal. This is achieved through

redesigning equipment, preventing illness and injury, and increasing user-friendliness (APA,

2015). This science is applicable to many arenas and is especially important when considering

the field of early childhood education (ECE). Because the population served in ECE is young

children, the design of classrooms is going to be heavily child-centered and the children will

require a great deal of physical assistance. This consequently leads to teachers exerting a lot of

physical, forceful movements throughout the day. It is not uncommon to see “bending, lifting up

to 50 pounds, squatting, sitting, standing, stooping, crawling” and other similar movements in the

necessary job qualifications for a position as an ECE educator. Thus, a teaching job in ECE is a

perfect space to explore human movement and how physical and environmental conditions

promote or inhibit efficiency and productivity.

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The relationship between ECE and ergonomics has been widely studied outside of the

United States and there has been some attention on teachers working in early intervention

settings. Horng, Hsieh, Wu, Feng, and Lin (2007) investigated ergonomic risk factors and

musculoskeletal pain and discomfort in a population of teachers (N= 85) working in a Taiwanese

child care center serving differently abled children; and, they used a questionnaire and site

visit/ergonomic assessment to gather data. The authors reported that two-thirds of participants

received treatment for musculoskeletal injuries and pain with a majority of pain being reported in

the neck, lower back, and shoulders; and, they attest to the fact that these particular workers are

at an increased risk for musculoskeletal injuries due to a greater amount of awkward postures

and movements in order to meet the needs of the special needs population. They suggested

supportive chairs, child-lifts, and education about ergonomic safety to reduce the risk and

prevalence of musculoskeletal injury (Horng et al., 2007). In a similar vein, Cheng, Cheng, and

Ju (2013) also investigated ergonomic conditions and musculoskeletal injuries in early

intervention child care workers in Taiwan (N= 417). Logistic regression analyses on the 323

completed participant surveys demonstrated that work-related musculoskeletal disorders were a

commonality in this population as 304 subjects reported suffering from a work-related

musculoskeletal disorder; specifically, 246 subjects reported shoulder pain, 241 reported lower

back pain, and 213 reported neck pain. Ergonomic risk factors included awkward, stressful body

movements and psychosocial stress. The authors conclude that rates of work-related

musculoskeletal disorder may be decreased by modifying the physical work environment,

providing workers with education on developing muscle strength/posture, and increased

manpower (Cheng et al., 2013).

Aside from early intervention settings, there has been international research focused on

teachers working in ECE classrooms. In Japan, Ono et al. (2002) investigated how the length of

ERGONOMICS IN ECE 5

employment in nursery school workers (N= 959) affects neck, shoulder, and arm pain. Through

cross-sectional analyses the researchers discovered that, regardless of the age group of the

children and encompassing many variables, all teachers experienced increased pain as time

elapsed (Ono et al., 2002). Similarly, Caroline, Vinod, and Arun. B (2014) investigated rates of

musculoskeletal injury and discomfort in teachers (N= 160) working in childcare centers in and

around the city of Coimbatore, India. Descriptive statistics showed that 44 percent of participants

experienced lower back pain; 18 percent experienced neck pain; 11 percent experienced shoulder

pain; nine percent experienced knee pain; seven percent experienced elbow pain; six percent

experienced wrist pain; and finally four percent reported pain in other body areas. This only left

one percent of the sample that did not report any musculoskeletal pain. Caroline et al. (2014)

conclude by also affirming the need for ergonomic adjustments to act as a deterrent to

musculoskeletal injuries, especially to the lower back. In New Zealand, McGrath and Huntington

(2007) used a survey design to determine ergonomic and health conditions in a population of

ECE teachers, kindergarten teachers, and home-based educators. Considering musculoskeletal

injury, the researchers found that lifting and consequently back strain was a common problem

among the child care center educators; and, they suggest ergonomic modifications, training, and

education to reduce the incidence of these injuries (McGrath & Huntington, 2007).

One of the first pieces of research on ergonomics in ECE in the United States was done

by Brown and Gerberich (1993). The authors accessed two sources of data on ECE teachers in

Minnesota in an effort to analyze injuries. Analyses showed that lower back injuries were the

most prevalent in the child worker population, and that cooks in child care settings reported the

most injuries. The action most identified as leading to injury was lifting, specifically lifting a

child. The authors concluded that more research was needed to investigate injury in ECE

teachers in order to develop necessary policies and protections (Brown & Gerberich, 1993).

ERGONOMICS IN ECE 6

Shortly after the Brown and Gerberich (1993) piece, Grant, Habes, and Tepper (1995)

investigated the ergonomic conditions at a Montessori school in the United States to determine

the risks for and presence of musculoskeletal injuries and complaints. The researchers analyzed

the physical aspects of the job as they examined the teacher’s postures while they completed

their everyday work activities in the classroom. The researchers also distributed a survey to the

school’s teaching staff all of which were women. The survey asked a series of qualitative and

quantitative questions about the teacher’s working conditions, beliefs about their jobs, and their

current bodily discomfort and pain. Analyses on 18 completed surveys indicated that

musculoskeletal pain was a common occurrence in this population. Out of the 18 respondents 14

of these individuals reported experiencing pain; and, back pain was the most frequent type of

complaint. Teachers also mentioned pain in the neck/shoulder area, lower extremities, and

wrist/hands. Finally, the activity analyses revealed that teachers working with younger children

were more engaged in straining postures compared to teachers working with older children. The

authors discussed the factors related to awkward postures and the presence of pain, noting that

interacting with small children, unavailability of adult-sized furniture, cleaning child-sized

furniture, and lifting weight to a degree too great for the individual were catalysts in the

development of musculoskeletal injury and pain. Finally, Grant et al. (1995) suggested changing

the physical nature of the work place, giving teachers information about using optimal

movements, and maintaining low teacher-to-child ratios to help protect against musculoskeletal

discomfort and pain in ECE settings. Erick and Smith (2011) elaborated on the Grant et al.

(1995) piece by reviewing rates of musculoskeletal injury and discomfort in the relevant

literature on the topic. Results indicated that nursery/preschool teachers often reported

musculoskeletal pain, especially in the lower back.

Though research has been established on ECE educators in general, no data exists on

ERGONOMICS IN ECE 7

teachers working in high-quality childcare centers in the United States, specifically those

working in child care centers with National Association for the Education of Young Children

(NAEYC) accreditation. The NAEYC is one of the most prominent national accreditation

organizations that has created a set of standards on high quality care and confers accreditation to

centers that consistently meet the required criteria. These standards go above and beyond public

licensing requirements for child care centers to ensure that staffs in NAEYC accredited programs

are using research-based practices to ensure optimal development for children and their families

(NAEYC, 1997). According to Child Care Aware of America (2012), only 10 percent of

childcare centers are nationally accredited, ergo making NAEYC accreditation prestigious. The

legitimacy of the NAEYC has been documented through research showing its positive effects on

work climate, staff retention, measures of quality care for children, and teacher behavior and

practices (Whitebrook, 1996; Bloom, 1996; Zellman & Johansen, 1996; Whitebrook, Sakai, &

Howes, 2004). Overall, NAEYC accreditation has proved to be a valuable tool in elevating

overall quality and effectiveness of early childhood education programs (McDonald, 2009).

One of the standards within NAEYC accreditation assesses a child-care center’s physical

environment (Standard 9). While many of the criteria within Standard 9 concern materials and

spaces for the children there are criteria whose focus are on conditions for the teaching staff. The

first criterion is 9.A.14, a: “Adults have a comfortable place to sit, hold, and feed infants”

(NAEYC, 2013, p. 74). This criterion ensures that teachers have an accessible adult-sized piece

of furniture or physical support to meet the infant’s needs; and, examples of this include a couch,

adult-sized chair, etc. The second criterion is 9.C.02:

The work environment for staff, including classrooms and staff rooms, is comfortable and

clean and is in good repair; the work environment includes: a place for adults to take a

break from children, an adult sized bathroom, a secure place for staff to store their

ERGONOMICS IN ECE 8

personal belongings, and an administrative area for planning or preparing materials that is

separated from the children’s areas.

This criterion ensures that the necessary accommodations are made for adults to ensure they need

not use the children’s spaces to meet their personal needs; furthermore, these accommodations

need to be sufficient and well maintained. The third criterion is 9.C.05, d: “The hand-washing

sinks are accessible to staff” (NAEYC, 2013, p. 78). This criterion ensures that teachers are able

to wash their hands at a sink that is adult-sized. Finally, criterion 9.D. assesses the environment

to make sure that health hazards like pests, poisons, and pollution are avoided at all costs for

children and child care center staff (NAEYC, 2013). Overall, it is clear that the NAEYC is

mindful of teacher’s well-being, and it is because of this attention to teaching staff’s needs that

this research project sampled from NAEYC accredited child care centers in order to examine

their rates of musculoskeletal injury and discomfort. Thus, this research piece sought to answer

the questions: 1) what are the rates of musculoskeletal injury and discomfort in teachers working

in NAEYC accredited childcare centers? 2) What factors predict the presence of musculoskeletal

injury and discomfort in teachers working in NAEYC accredited childcare centers?

Method

Participants

Stratified sampling techniques were used to develop a participant pool that included

teachers currently working in NAEYC accredited childcare centers across the United States.

Childcare centers include facilities serving children aged zero to six years old. Teachers currently

working in a classroom in a NAEYC accredited child care center were invited to participate in

this study and other child-care center staff (administrators, cooks, janitorial staff, etc.) were not

included in the participant pool. Subjects were not paid for their participation; however, upon

survey completion, participants could provide an email address to be entered in a raffle to win

ERGONOMICS IN ECE 9

one of 10 Amazon gift-cards valued at $15.00 each. Participants completed an anonymous online

survey via the Qualtrics platform that took approximately 10 minutes of their time. Participants

were free to take the survey at their leisure and were not prompted to emulate special conditions

in order to take the survey.

The final participant pool included teachers working in 73 NAEYC accredited childcare

centers across the United States (N= 332). No information about specific state location was

gathered. The majority of participants were in their thirties (28.1 percent) with the following

groups comprising the rest of the sample: late teens (0.3 percent), twenties (22.2 percent), forties

(16.3 percent), fifties (23.6 percent), sixties (8.7 percent), and seventy or older (0.7 percent). The

average number of years worked in the field of ECE in this sample was roughly twelve years (

M Years=12.3, SD= 9.6). The majority of participants were full time employees (M Hours / week= 35.9,

SD= 10).

Demographic information was also gathered considering the participants’ classroom

conditions. The majority of respondents noted working in a preschool-aged classroom (55.3

percent) while 32.8 percent reported working in an infant-toddler classroom and 11.8 percent

reported working in a mixed-age classroom. The average number of teachers (at any one time)

and children (on a daily basis) in each of the three classroom categories were as follows: infant-

toddler (M Teachers = 3.0, M Children= 10.3), preschool (M Teachers = 2.7, M Children = 15.9), and mixed-

aged (M Teachers = 3.9, M Children= 17.7). These numbers represent adherence to the NAEYC’s policy

on appropriate teacher-to-child ratios required in NAEYC accredited childcare centers. Finally,

the majority of participants reported being in “very good” health (42.5 percent) and exercised

three times a week (25.9 percent) at a moderate intensity (65.2 percent).

Materials

The quantitative survey used in this research (ECE Ergonomics; see Appendix A) was

ERGONOMICS IN ECE 10

a heavily modified version of the questionnaire used in Grant et al. (1995; see Appendix B). The

questions on ECE Ergonomics were either taken (and modified) from the Grant et al. (1995)

survey or developed according to the research on ergonomics in ECE. The first set of questions

on ECE Ergonomics gathered demographic data on teacher’s age, years worked in ECE, and

hours per week worked. Though these questions represent concepts from the Grant et al. (1995)

survey they were not taken verbatim from the Grant et al. (1995) survey. The second set of

questions asked teachers about classroom conditions including type of classroom worked in, age

of children worked with, and child-to-teacher ratios. Again concepts from the Grant et al. (1995)

survey were used to design questions; and, one question from the Grant et al. (1995) survey was

taken verbatim: “What is the age range of children you are responsible for?” (Grant et al., 1995).

The third set of questions asked teachers about their health and exercise routines. The Grant et al.

(1995) survey did not ask any questions similar to these. The inclusion of these questions was

based on concepts related to ideas of personal health and health practices demonstrated in the

research by Ono et al. (2002) and Caroline et al. (2014). The fourth set of questions asked about

working conditions, specifically beliefs about job demand, amount of ergonomic training, and

available furniture in the classroom. The question about job demand was taken loosely verbatim

from Grant et al. (1995); for, the concept of the question remained the same, the wording of the

question was altered but close to the original, and the wording of rating scale used in Grant et al.

(1995) was taken verbatim and applied to a Likert scale. The questions about amount of

ergonomic training received and type of furniture used by the teacher were not taken directly

from the Grant et al. (1995) survey but instead developed out of the recommendations Grant et

al. (1995) suggest in the discussion section of their piece. The final section of questions asks

teachers about their musculoskeletal injuries and discomforts. All questions were developed from


questions and concepts in the Grant et al. (1995) survey. One question was taken verbatim “What

part of the body did you injure?” (Grant et al., 1995) and the rating scale used in the question

about current musculoskeletal discomfort was taken verbatim from Grant et al. (1995; 0 = no

discomfort, 1= uncomfortable, 2= very uncomfortable, 3= extremely uncomfortable).

ECE Ergonomics also contained content unrelated to Grant et al. (1995). It included three

statement pieces at the beginning that described the study, provided the Informed Consent Form,

and provided the Subject’s Bill of Rights. At the end of the survey was a statement and space for

the subject to voluntarily provide his or her email address to be entered in a raffle to win one of

10 Amazon gift-cards. Additionally, this survey was completed via the online survey platform

Qualtrics in contrast to the Grant et al. (1995) survey that was completed with paper and pen.

Overall, the survey used in this research, albeit many modifications and additions, still relied

heavily upon the questionnaire used in Grant et al. (1995) and therefore cites that questionnaire

as a primary source in the ECE Ergonomics development.

Procedure

The public facility search database on the NAEYC website was used to find NAEYC

accredited childcare centers in each state. Childcare center directors were first contacted in order

to attain permission to survey the teaching staff. With the necessary permissions granted a

second email with study information and the survey link was sent to child-care centers directors;

and, the directors were asked to forward the email to their teaching staff. This ensured increased

confidentiality as the teacher’s email addresses remained anonymous. Participants could then

decide to assent or dissent to taking the survey.

Participants were prompted to visit a link to the survey on the Qualtrics platform. Before

beginning the survey subjects had to read a description of the study, consent or dissent to

participating in the study, and acknowledge reading the Subject’s Bill of Rights. Once the


aforementioned were completed, participants moved through a series of questions that asked

them about their demographics, classroom conditions, health practices, working conditions, and

musculoskeletal injuries and discomforts. Once a participant completed the survey he or she had

the opportunity to voluntarily provide an email address to be entered in a raffle to win one of 10

Amazon gift-cards valued at $15.00 each. The survey ECE Ergonomics opened to participants on

February 10, 2015 and permanently closed to participants on February 28, 2015.

Once the survey closed all the voluntarily offered email addresses were entered into an

Excel spreadsheet and each email address was randomly assigned a number between one and 186

according to a random number generator. Then, the numbers and emails were concurrently

sorted according to the numbers (lowest to highest) and the first ten email addresses were

selected to receive the gift-cards. The Amazon gift-cards were sent electronically to the provided

email address of each of the 10 winners. This completed the participant’s involvement in the

research project.

Design

Regression analyses and ANOVA designs were initially selected to analyze relationships

between the independent variables ‘age’, ‘years worked in ECE’, ‘hours per week worked’, ‘type

of classroom worked in’, ‘number of teachers at any one time, ‘number of children on a daily

basis’, ‘general health’, ‘amount of exercise per week’, ‘intensity of exercise routine’,

‘perception of job demand’, ‘amount of job-related ergonomic training received’, and finally

‘type of furniture used to accommodate the self in the classroom’ and DV1: ‘number of work-

related musculoskeletal injuries.’ Upon testing for normal assumptions for the variables analyses

showed that DV1 was not normally distributed and had a strong positive skew (skew score

=3.666). A log10 transformation was attempted to normalize the distribution but proved

ineffective and returned a skew score above one (log10 skew score = 1.309). Further attempts


were made to find a normal distribution by removing outliers and examining the population of

individuals close to the mean age of the sample; however, the skew before and after log10

transformations still exceeded one. Thus, because a normal distribution was not found DV1 was

only analyzed using frequency and descriptive statistics.

DV2 in this study was ‘presence of work-related musculoskeletal discomfort’ and it was

measured in a dichotomous manner (i.e. ‘yes’ or ‘no’); thus, binary logistic regression models

were used to analyze relationships between the aforementioned independent variables and DV2.

Binary logistic regression models allowed for an investigation into factors that had predictive

value in relationship to the presence of musculoskeletal discomfort. Descriptive and frequency

statistics were also used to analyze DV2.

Results

Rates of musculoskeletal injury were apparent in this sample population (N= 264). Over

one third (33.7 percent) of respondents reported between one and three work-related

musculoskeletal injuries; and, 4.2 percent of respondents reported between four and ten work-

related musculoskeletal injuries. Of those who reported a work-related musculoskeletal injury,

61 individuals reported back injuries, 37 individuals reported lower extremity injuries, 31

individuals reported neck/shoulder injuries, and 22 individuals reported hand/arm injuries.

Furthermore, 17.3 percent of individuals (N= 260) reported sustaining a work-related

musculoskeletal injury at their previous child care related jobs. 13 individuals reported hand/arm

injuries, 18 individuals reported neck/shoulder injuries, 58 individuals reported back injuries, and

19 individuals reported lower extremity injuries. The overwhelming majority of these previous

child care related musculoskeletal injuries occurred in child care center settings.

Considering DV2, 40.5 percent of individuals (N= 259) reported experiencing work-

related musculoskeletal discomfort. The most common incidence was in the back with a majority


reporting their musculoskeletal discomfort as ‘uncomfortable.’ Table 1 provides a description of

the locations of reported musculoskeletal discomfort and the levels of pain associated with each.

Binary logistic regression was used to explore relationships between the IVs and DV2. Analyses

revealed that the IV ‘perception of job demand’ had moderate predictive value in identifying the

presence of musculoskeletal discomfort (67.6 % classification, p= 0.000). The other IVs did not

show any predictive value in relationship to DV2.

Finally, two additional variables must be given consideration. First, a question on ECE

Ergonomics asked participants to describe the amount of training they have received on how to

properly execute the physical aspects of their job on a five point Likert scale with ‘none’ and

‘more than enough’ as the anchors. The majority of participants (34 percent) reported receiving

no training at their current place of work. Second, another question on ECE Ergonomics asked

participants what type of furniture they used to accommodate themselves in the classroom with

the options: adult-sized furniture, child-sized furniture, no furniture (sitting on the floor), and no

furniture (standing). 82 individuals reported using adult sized furniture, 136 individuals reported

sitting on the floor without furniture, 53 individuals reported standing without furniture, and an

overwhelming majority of 209 individuals reported using child-sized furniture.

Discussion

This research study sought to examine the following research questions 1) what are the

rates of musculoskeletal injury and discomfort in teachers working in NAEYC accredited child

care centers? 2) What factors predict rates of musculoskeletal injury and discomfort in teachers

working in NAEYC accredited child care centers? Statistical analyses provided insight into the

fact that rates of musculoskeletal injury and discomfort in this population of teachers working in

NAEYC accredited child care centers is comparable to the rates of injury found in previous

research. Binary logistic regression models demonstrated that perception of job demand had a


moderate predictive value in relationship to the presence of musculoskeletal injury.

In considering the results about rates of ergonomic training and furniture use in the

classroom previous research sheds light on the reality of these variables. First, the

aforementioned research on ergonomics in ECE points to the fact that education/training and

access to adult-sized furniture is important in preventing teacher injury. Thus, the sample in this

study may be at an increased risk for injury and discomfort. Second, it is important to note the

aforementioned NAEYC standard mandating adult-sized furniture in classrooms where teachers

must have a comfortable place to “sit, hold, and feed infants” (NAEYC, 2013, p. 74). In this

sample population of infant-toddler teachers, the majority reported using child-sized furniture to

accommodate themselves in the classroom. This begs the question of weather these teachers have

access to adult-sized, supportive furniture or are instead choosing to use child-sized furniture for

alternative reasons.

There are limitations that must be taken into account when considering the results

presented in this paper. First, no specific information about subjects body mass index (BMI) was

gathered from the survey. According to Viester, Verhagen, Hengel, Koppes, van der Beek, and

Bongers (2013) and da Costa and Vieira (2009) there exists a relationship between a high BMI

and the presence of work-related musculoskeletal disorder. Thus, the prevalence of

musculoskeletal injury and discomfort may have been influenced by high BMI of participants in

the sample. However, though no specific question was asked about BMI, participants were asked

to provide an estimate of their overall health as they described it based on a Likert scale with

“poor” and “excellent” as the anchors. Thus, this question may have served to capture high BMIs

(as well as other chronic conditions) if the participant considered his or her high BMI as being

poor in health. Second, the survey used in this research did not ask specific questions related to

psychological factors (e.g. job stress), which according to the research done by Ono et al. (2002)


can have negative consequences on musculoskeletal health. However, ECE Ergonomics did ask a

question about the respondent’s perceptions of the physical demand of his or her job. Third, no

information was gathered about gender; thus, characteristics related to specific genders (e.g.

pregnancy, musculature, etc.) were not assessed and considered in the analyses. Lastly,

respondents were sampled from NAEYC accredited child care centers across the United States;

however, some states within the United States have significantly more NAEYC accredited child

care centers than others so the sample in this project may not represent all 50 states.

There are two participants (Participant A and Participant B) in this sample that must be

given special consideration. The highest number of reported musculoskeletal injuries was 10;

and, this number was twice reported by individuals who identified themselves as being in their

twenties and who have worked in the field of ECE for an average of only five years. The only

other participant to report 10 musculoskeletal injuries was in his/her fifties and has worked in the

field of ECE for 22 years; and, albeit a high number of injuries, the rate of 10 injuries is more

plausible given the age of the participant and the number of years worked in ECE. Again

considering Participant A and B, 10 injuries is markedly high especially when compared to other

participants in their age group whose average rate of musculoskeletal injury was less than one (

M reported MSI∈20 year olds= 0.39). Their survey responses highlighted some factors that may have led to

this high number of injuries, including high teacher-to-child ratios and workweeks above 40

hours.

Conclusion

The strong positive skew in reported musculoskeletal injuries in this population has nodes

of promise because it signifies that most of the teachers in this sample were not getting hurt at

their current place of work (62.1 percent reported no musculoskeletal injuries). However, the fact

that over one third of the educators in this sample experienced musculoskeletal injury and about


40 percent experienced discomfort shows that their rates of injury and discomfort are comparable

to teachers working in child care centers without NAEYC accreditation. Future research is

needed to better understand the factors that predict musculoskeletal injury and discomfort. This

may be accomplished by: 1) increasing sample sizes in order to run meaningful statistics and

generalize results to the larger population, 2) comparing teachers across different types of child

care centers (e.g. accredited, public, private, home-based, etc.) and 3) conducting research that

goes beyond providing ergonomic suggestions and instead tests the viability of ergonomic

interventions in ECE classrooms. This research is needed because it is conspicuous that working

in ECE poses musculoskeletal injury and discomfort risks and it begs the question of whether

these injuries and discomforts can be prevented or are merely “part of the job.”

Research by Pillastrini, Mugnai, Bertozzi, Costi, Curti, Mattioli, and Violante (2009)

provides a real-world example of a plausible prevention effort regarding musculoskeletal injury

and discomfort in teachers working with young children. The researchers demonstrated that an

at-work exercise program was an effective measure in lower back pain prevention and symptom

improvement in a sample of 72 nursery school teachers in Italy. However, this was conducted as

research and calls into question the practicability of at-work exercise programs for all ECE

educators outside of research settings. Yet, the results are promising and research must be done

to create at-work exercise programs that are easily accessible to ECE educators. In closing, there

is a crucial need for more data on ergonomics and ECE to ensure optimal working conditions for

teachers. Healthy teachers may lead to healthier classrooms and consequently ideal learning

environments for the early youth in the United States and around the world. En masse, if we

want children to be at their best then their teachers need to be at their best as well.


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4-14-238


Table 1

Locations and Rates of Musculoskeletal Discomfort (MS) Based on Valid Percentages.

Body Area N No MS discomfort

MS discomfort is uncomfortable

MS discomfort is very uncomfortable

MS discomfort is extremely uncomfortable

Hand/Arm 88 64.8% 25% 10.2% 0%

Neck/

Shoulder

92 22.8% 47.8% 22.8% 6.5%

Back 99 6.1% 49.5% 33.3% 11.1%

Lower extremity

91 44% 39.6% 8.8% 7.7%


Appendix A

ECE Ergonomics Survey


Appendix B

Questionnaire by Grant, Habes, and Tepper (1995)

Ergonomics in NAEYC Accredited Child Care Centers

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Transcript of Ergonomics in NAEYC Accredited Child Care Centers