Working Toward a Healthier HomeInformation for Parents and Childcare Educators

Introduction

Boston Healthy Homes and Schools Collaborative (BHHSC) is a program of Health Resources in action. BHHSC’s work focuses on health conditions directly related to environmental hazards – specifically asthma and lead poisoning. We provide information, training, and other resources to family childcare providers to promote healthy home daycares.

Who We Are

Our mission is to promote healthy homes, schools, and childcare facilities in Boston, and enhance the well-being of individuals who live, work, and play in them.

Some of Our Members:

Boston Department of Neighborhood Development

Boston Public Health Commission

Clean Water Action

Boston Medical Center

Dorchester Environmental Health Coalition

MA Coalition for Occupational Safety and Health

Massachusetts Department of Public Health

Boston Tenants Organization

Massachusetts Affordable Housing Alliance

Children’s Hospital

US Environmental Protection Agency

Urban Edge

BHHSC is a Community Resource

Conducts trainings and educational sessions for parents, property

owners, and childcare providers

Provide information and referrals on questions from

parents, property owners and local

organizations

Creates a presence in the community through

collaboration, attending community events, partnerships

with youth organizations and local

universities

Convenes interested

organizations to coordinate work

Healthy Homes Concepts

What Hazards Exist in the Home?What comes to mind when you think of hazards to health and

safety in a home?

What Health Risks are related to the Home Hazards?

Potential Health Effects of Poor Quality Indoor Environment

Asthma TriggersSecondhand smokePestsMold/MoistureDust mitesPet danderChemicals/pesticidesPoisoningCarbon monoxideLead paintChemicals/pesticides

Respiratory and IAQ EffectsBuilding and Household ProductsChemicals

Injury/DeathFallsFire/electricalCOCarcinogensRadon gasChemicals/pesticidesWood smokeDevelopmental delaysLead paintChemicals/pesticides

MultipleDrinking water contamination

Creating a Healthy HomeThe Seven Principles of a Healthy Home

1. Dry – Damp houses attract mold and other asthma triggers

2. Clean – Clean homes reduce pests and other health risks

3. Pest-Free – Exposure to pests like cockroaches and mice can worsen asthma and cause other health problems. Pesticides are also dangerous to children’s health.

4. Safe – Most injuries occur at home and are usually falls, burns, and poisonings.

Creating a Healthy HomeThe Seven Principles of a Healthy Home

5. Contaminant-Free – Contaminants in the home include lead, tobacco smoke, and pesticides.

6. Ventilated – Increasing fresh air in the home can improve indoor air quality.

7. Maintained – Poorly maintained homes are at risk of pests, moisture, and other health risks.

Healthy Homes in Boston?

What do healthy homes issues look like in Boston?

Two major healthy homes issues that Boston residents are faced with are:

1. Lead poisoning

2. Asthma

Lead Poisoning Basics

What is Lead Poisoning?

Lead is a heavy metal that was used in paint, gasoline, and other things

Young children can become lead poisoned when they swallow or breathe something that contains lead. It is also dangerous for pregnant women.

There may be no visible symptoms of lead poisoning at the time of exposure so children should have their blood tested

In New England, lead based paint is the primary source of poisoning.

Most homes built before 1978 have lead based paint, and homes built before 1950 are likely to contain even more lead.

What is Lead Poisoning?No. 1 Source is Lead Paint Dust

Sources of Lead Poisoning?

Most lead poisoned children were exposed by inhaling lead paint dust

Children breathe in lead paint dust in the summer when windows are opened and closed frequently, and also when there are home renovations being done

Other Sources of Lead

Some plastic toy components and toy jewelry imported from China have tested high for lead levels

Tap water: Lead gets into water from leaded pipes, lead solder used to connect water pipes, and some brass faucets

Certain candies and spices from other countries

Effects at low levels:• Slower development

• Learning and behavioral problems

• Reduced motor skills

Effects at high levels: In addition to effects listed above, high levels of lead can result in seizures or a coma and can be potentially lethal

Health Effects of LeadLead poisoning is measured by the number of micrograms per deciliter

in the blood – called elevated blood lead levels.

Lead and SAT ScoresThere is a strong relationship between SAT scores and blood lead levels. One study found that as children’s blood lead levels rose, SAT scores dropped, and vice versa. http://www.usatoday.com/news/education/2009-02-02-lead-SAT_N.htm

Lead and Violent CrimeAnother study found that even low levels of lead can cause or lead to permanent brain damage and a higher chance of

being arrested, particularly for violent crimes.http://articles.latimes.com/2008/may/28/science/sci-lead28

Long Term Effects of Lead PoisoningRecent Studies

Preventing Lead PoisoningUrgent Lead Hazards

The number one way to protect a child:

MAKE SURE THE HOME IS CERTIFIED LEAD SAFE

A house is ‘lead safe’ if it has been inspected and received a ‘letter of lead paint compliance’ from the MA

Dept of Public Health.

You can find out the ‘lead status’ of houses online for free.

Preventing Lead Poisoning

A home with a child under the age of 6 living there must be certified deleaded (lead safe) according to MA state law.

It is ILLEGAL for a landlord to refuse to rent to someone because they have a child under age 6.

It is the property owner’s responsibility to pay for a lead inspection and deleading if there is a young child living at the house.

Prevention Lead PoisoningThe MA Lead Law

Renovate Right

Renovate Right Regulation on Lead Safe Work Practices

The Environmental Protection Agency recently created a rule requiring ‘lead safe work practices’ while contractors are doing renovation, plumbing, and painting work. This should prevent lead dust from contaminating the living area.

This is called the Renovation Repair and Painting Rule.

Renovate Right Regulation on Lead Safe Work Practices

Took effect on April 22, 2010 Affects renovation, repair, or painting

work on child-occupied facilities built before 1978, including family childcare providers

Rule applies if disturbing 6 sq ft of painted surface on inside, or 20 sq ft of paint on the exterior

Renovate Right RegulationsHow to Comply

What must a Childcare Educator do?

Ask to see the contractor’s Renovation, Repair, and Painting training certification.

Make sure the contractor provides you with a copy of the Renovate Right booklet

Provide renovation notification to families of the children at your childcare

You should provide a copy of the Renovate Right booklet to all parents

Renovate Right Regulation Lead Safe Work Practices

What are lead safe work practices?Make sure contractors do the following things in order to keep your home free from lead contamination:

1) Contain the work area: cover furniture and floors, seal doorways leading into the work area

2) Minimize dust: spray or mist water on paint before scraping, use power tools with an attached filter to catch dust

Renovate Right Regulation How to Comply

3) Clean up thoroughly: contractors should clean daily with a wet mop and rinse water. Use a HEPA vacuum

Pay

Attention!

Follow the contractors’ progress to make sure they are working safely.

Ask them questions if you are concerned about something you see.

Many contractors will do better quality work if they know you are educated about lead safe work practices – so show them you know what you’re

talking about!

Asthma Basics

What is Asthma?

• Cannot be cured but it can be controlled• Produces recurring episodes of breathing

problems • Can be potentially life-threatening• In Boston, young children are more likely to

be hospitalized from asthma than other age groups

Asthma is a chronic respiratory disease and is the most common childhood chronic disease in the country.

Risk Factors for Asthma:• Obesity

• Family history of asthma

• Allergies

• Exposure to allergens like dust mites and second hand smoke

Who Gets Asthma?

Asthma can affect anyone, but young children are especially at risk. Children are also more likely to need to go to the emergency room.

Understanding the causes and symptoms of asthma are

important so the disease can be properly diagnosed, controlled,

and treated.

Undiagnosed Asthma

One tricky thing about asthma is that it often is undiagnosed.

How Asthma Affects the Lungs

An asthma attack occurs when:

This causes the airways to get smaller and it is more difficult for air to pass through.

• Bands around the airways in the lungs tighten and the airways swell

• There is extra mucus in the lungs

Asthma Symptoms

Symptoms of asthma include:

• Wheezing

• Coughing

• Shortness of breath

• Chest Tightness

In-Home Asthma Triggers

Many people with asthma also have allergies to these same triggers.

Dust and dust mites

Pests, likecockroaches

Allergens, mold,chemicals orpet dander

Secondhand Smoke

To control asthma, it is important to know what things in the home may trigger an attack.

Environmental Tobacco SmokeSecondhand smoke, also known as environmental tobacco

smoke, is the smoke that comes from a cigarette or cigar and the smoke that a smoker breathes out.

According to the Centers for Disease Control, secondhand smoke contains more

than 4,000 chemicals

• At least 250 of these chemicals are known to be harmful

• More than 50 of these chemicals are known to cause cancer

Environmental Tobacco Smoke

Secondhand smoke is a major health concern because of the many health risks associated with breathing it in:

o Asthma attacks/flare-ups and asthma symptoms that happen more often and are more severe.

o New cases of asthma in children who have not shown asthma symptoms in the past.

Third-Hand SmokeWhat is third-hand smoke?

Third-hand smoke is a term for the chemicals, gases, and other toxins left behind in hair, carpets, sofas, clothes and other materials long after a cigarette is put out.

Why is third-hand smoke a concern?

Third-hand smoke can make asthma worse.

Babies are also at an increased risk of swallowing or breathing in these toxins because they spend more time closer to floors and other surfaces.

Dust and Dust MitesDust mites are tiny bugs that are too small to see.

o Dust mites feed on human skin flakes, which are commonly found in dust, bedding, furniture, stuffed toys, clothes, and other fabrics and fabric-covered items

o Breathing in body parts and droppings of dust mites can trigger asthma symptoms.

o Dust mite exposure can also increase the risk of a child developing asthma.

Pests• Saliva, body parts or droppings from cockroaches, mice, rats, and

other pests can trigger asthma symptoms.

• Pests can get into homes and cabinets through cracks and openings.

• Dirty dishes, crumbs, spills attract them if they aren’t cleaned up quickly.

Other AllergensAllergens include mold, pet dander, and chemicals.

Mold Grows in wet or moist areas and create spores that can float throughthe air.Breathing inthese sporescan trigger asthma symptoms.

Pet danderOr pet skin flakes, can also float through the air and get stuck in furniture and clothing. Breathing in pet dander cantrigger asthma symptoms.

Other AllergensStrong household chemicals can irritate airways and trigger

asthma symptoms if they are inhaled.

These household chemicals are found in cleaning supplies, pesticides, air fresheners, and perfumes.

Besides having the ability to trigger asthma and allergies, these chemicals may be toxic, especially for young children.

Break

Managing Asthma

Asthma Action Plans

Parents and child care educators can help control asthma by making sure the child has an asthma action plan.

This individualized asthma action plan will help the child care educator know right away how to treat an asthmatic child and what their triggers are.

An asthma action plan is a written plan developed by a person who has asthma and his/her doctor to help better control his/her asthma.

Asthma Action PlansAn asthma action plan is a great tool for:

o Assessing a child’s asthma. How bad is the child’s asthma? What are his/her triggers?

o Controlling a child’s asthma. Administer the proper medications. Know, reduce, and avoid asthma triggers.

o Monitoring a child’s asthma. Know what to do in case of an asthma attack. Keep emergency phone numbers handy

Asthma Action Plans

Asthma MedicationsThere are two types of asthma medication.

In most cases, a child care educator should have reliever medication, and the parent would administer the controller medication at home.

Relievers

o Used for fast relief of symptoms. Relief in 10-20 minutes

o Effective for 4-6 hours.o Relax muscles around airways.o Examples: Albuterol, levalbuterol,

Proventil, Ventolin, ProAir

Controllers

o Used daily to prevent asthma symptoms

o Reduce irritation, swelling, and mucus that block airways

o Do NOT provide quick relief for asthma attacks.

o Examples: Budesonide, Fluticasone, Beclomethasone

Administering Asthma MedicationIf a child in your care has asthma or asthma-like symptoms, it is

important to understand how to administer medication. Medication may be given through a nebulizer or an inhaler.

Always have a parent or a healthcare professional demonstrate the correct way to administer medication.

If using an inhaler, be sure to use a spacer.

If using a nebulizer, you’ll need a mask and pump.

The resource guide includes step-by-step instructions on how to administer asthma medication.

Types of Asthma Medication

Source: Neighborhood Health Plan

Strategies for Creating a Healthy Home

Providing a Healthy Family Childcare Environment

If you take a close look at your home, there are many easy and inexpensive things you can do to

make it a healthier learning environment for children in your

care.

Air QualityHave a smoke-free home

Keeping tobacco products out of the home in the first place is the best way to have a smoke-free

home. Consider asking people to smoke outside of your home or

vehicle, even at times when children aren’t there.

If you notice smoke drifting in from a neighbor’s apartment, consider talking to your landlord

about creating a smoke free policy for your building. It is completely legal and can save your landlord

money.

Control Moisture

Make sure your home is well-ventilated using fans or open windows. Excess moisture can create mold and mildew growth and mold spores can trigger asthma.

If you notice mold or mildew in high moisture areas like the bathroom, try to clean it up as soon as possible.

Preventing Lead Exposure

Use cold water Pay attention to paint

Make sure your home has no chipping or flaking paint, especially if the house was built before 1978.

Scraping or sanding this paint could create a major lead dust hazard.

Make sure that the person doing renovations on yourhome is using leadsafe work practices.

Older homes may have lead water pipes. Even in newer homes, some brass faucets or plumbing fixtures

may contain lead.

To avoid lead in your drinking water, let the water run for 30 seconds (until you canfeel the water temperature change), and always use cold water fordrinking and cooking.

Preventing Lead Exposure

Supply a doormat Feed healthy foods

Check toys for lead

Lead dust in soil can come into the house on people’s shoes.

Doormats can help remove dust, dirt, and debris from shoes.

This can help keep your home cleaner and healthier.

Lead looks like iron and calcium to the body, so look for foods that

have iron or calcium. Examples: Beans, spinach, and lean red

meats.

Sometimes old toys, or toys imported from other countries may contain lead. Check your toys by purchasing a lead testing kit or

visit: www.healthytoys.org.

Controlling Dust

Use a HEPA vacuum Clean with a damp cloth

Clean and wash surfaces with wet wipes or wet towels, not dry ones.

This will pick up lead dust (which can cause lead poisoning), pet dander, and other allergens that can trigger asthma symptoms.

Rugs and carpets can trap and hold allergens like dust mites,

pollen, and pet dander.

If you can’t remove carpeting, cleaning them regularly and using

vacuums with HEPA filters can reduce the amount of allergens in carpeting

(and remove lead dust) because it traps very

small particles that normal vacuums may not pick up or

even spread around.

Pest Prevention

Don’t feed pests Avoid pesticides

Chemical pesticides can make asthma worse and are especially

toxic to young children.

Instead of pesticides, try to find any holes in the walls/ducts/vents that pests may be using to get in, and use sticky traps orother pest trapsrather than pesticides.

Remove pests’ food and water by:1) Storing food in strong

containers that are hard to get into or chew through

2) Washing dirty dishes as soon as possible, and

3) Using trash bins that can be sealed tightly with a lid.

Household ChemicalsUse ‘green cleaners’ Avoid strong scents

Green cleaners are alternatives to traditional, chemical cleaners,

which can worsen asthma. If you must use bleach, use it only in the

recommended concentration – never more.

.

Examples of Brands: J. R. Watkins, Eco-Me, Shaklee, Seventh

Generation, Begley’s

It is easy and inexpensive to make your own green cleaners usingbaking soda andvinegar.

Try to avoid strong scents, including perfumes, scented candles, and air fresheners. Some people are allergic or sensitive to the chemicalsin scented products.

Other Things to Consider

Safely dispose of mercury Check for radon

Mercury is a heavy metal that can be toxic if ingested. The most

common place to find mercury in the home is in compact fluorescent

(CFL) light bulbs. .

Make sure CFL light bulbs arekept away from children and recycled properly. Many hardware stores (including Home Depot) accept used CFLs, or you can bring them to the city’s hazardous waste drop off day.

Radon is a radioactive gas that can cause cancer. It comes from the soil

and can be found anywhere.

You can’t see or smell radon in your house, so the onlyway to know if there is radon is to have your home tested. Radon testing is easy and inexpensive, and tests are available at hardware stores, or by hiring a professional testing company.

Radon remediation

Safe and Healthy Family ChildcareCertification Program

During the Summer of 2012, BHHSC will be launching the Safe and Healthy Family Childcare certification program.

This program will recognize family childcare educators who have taken the extra time to create a safe and healthy childcare environment that supports a healthy learning environment for children.

Participants will:• Receive a Safe and Healthy Family Childcare window decal for their home• Certificate• Have their name added to the Safe and Healthy Family Childcare list for parents.

Safe and Healthy Family ChildcareCertification Program

Requirements:

• Complete BHHSC Healthy Homes for Family Childcare Educators training

• Follow at least 15 out of 20 healthy homes activities from the SHFC checklisto These activities are based on the information from the training

• Have someone who is not a family member or employee sign your application, certifying that you follow the activities

• Pay the $20 registration fee to cover administration and materials

The certification will last for two years.

Role Playing Activity

Scenario 1: Yvette the cleaning machine

Yvette is a 40-year-old family childcare educator, a Haitian immigrant who prides herself on her small, spotless apartment. Her home is orderly and "spick and span." Not surprisingly, Yvette even hates the thought of rodents, but she lives next door to an apartment she refers to as a "cockroach hotel."

Yvette is thrilled that the childcare regulations require the use of bleach, as she's always been a big fan. She uses the same highly concentrated solution often, and on all surfaces, from the toilet to the changing table to the children's lunch tables.

Yvette uses pesticides to keep the neighbor's bugs out of her unit, spraying along the one kitchen wall shared with the adjoining apartment. So far so good – no rodents, and by keeping doors closed, the smell is usually limited to the kitchen.

For Yvette, the clean and pest-free space she offers is a major point of pride. Her client parents –mainly from Haiti themselves—love and appreciate it too. One recently commented on how clean the house always smells and another noted, "My child could eat off her floors!"

Yvette is now expecting a new child to start at her daycare the next week. The child has a serious case of asthma. Yvette knows it will be that much more important to offer a clean and pest-free space. She plans to really give the place a good scrubbing over the weekend.

Your tasks are:A. Create a persuasive argument that explains:(1) proper use of bleach and appropriate alternatives to bleach that are safe and as effective(2) alternative actions or products to prevent pests(3) the hazards of bleach and pesticides to individuals with asthma B. Create a storyboard for your presentation using information from the slides and your own information, if applicable.

Scenario 2: Sylvia and her handy husband

Sylvia is a good friend who is about to open her own family childcare. She's blessed with a husband who can build and fix almost anything. He'll soon start the work, beginning with replacing some old windows and window frames. She's thrilled that her husband's great work will avoid the huge expense of hiring an outside person. Moreover, his skill and her excellent and thorough cleaning means no need for a government inspector to come into their house to test for lead. Between his hammer and her vacuum cleaner, they are good to go! After the windows are done, Sylvia's husband will start on the old shed in the backyard, converting it into a little playhouse. The work will begin once her daycare is operating, but he plans to do the work only on weekends and, after all, the shed is outdoors.. Your tasks are:

A. Create a presentation that explains:(1) lead dust hazards involved in replacing the old windows (2) keeping lead dust confined to work space.(3) safe and effective clean up procedures and equipment (3) why it is important for a government inspector to test for lead. B. Create a storyboard for your presentation using information from the slides and your own information, if applicable.

Scenario 3: Reina's Best Intentions Go up in Smoke

Reina has been a family childcare educator for 2 years. Reina is a smoker but would never consider smoking inside her apartment, the middle unit of a triple decker. Rather, she steps outside on the porch to smoke, keeping the door and adjacent windows tightly closed. Reina smokes in her car during the colder months –which are most for her, as a relatively recent immigrant of the Dominican Republic. She only does so on weekends and evenings, so that the car is clear of smoke by the time she picks up children on weekday mornings. After all this care she takes to ensure her young charges are not exposed to her cigarette smoke, she's terribly frustrated with her new neighbor downstairs, who obviously smokes –a lot—inside his unit. The smoke seeps through the ceiling and into her apartment all day long. He might as well be smoking his cigarette right in her living room it smells so strongly of tobacco. Your tasks are:A. Create a presentation that explains:(1) hazards of second- and third-hand smoke(2) how Reina could further improve her own smoking-related behaviors to protect the children in her care.(3) how she could approach the problematic situation of the smoking neighbor. B. Create a storyboard for your presentation using information from the slides and your own information, if applicable.

Having a healthy and safe home helps children live healthier and more productive lives.

Davida AndelmanProject Director, Healthy Homes(617) 279-2240 x 513dandelman@hria.org

Elizabeth TanefisProgram Manager617-279-2240 x530etanefis@hria.org

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