EARLY

HEAD

START

NATIONAL

RESOURCE

CENTER

U.S. Department of Health and Human Services

Administration for Children and Families 

Administration on Children, Youth and Families 

Head Start Bureau 

A Holistic 

Approach 

to 

Health 

and 

Safety

Technical Assistance Paper No.

7
4

A Holistic Approach 

to Health and Safety

Technical Assistance Paper No. 7

This document was developed by the 

Early Head Start National Resource Center (EHS NRC) @ ZERO TO THREE 

in collaboration with the Head Start Bureau. 

The contents of this paper are not intended to be an interpretation of policy.

The Early Head Start National Resource Center @ ZERO TO THREE

is funded under contract HHSP23320042900YC by the Head Start Bureau, 

Administration on Children, Youth, and Families

Administration for Children and Families

U. S. Department of Health and Human Services

E

First printing, October 2004

ARLY

HEAD

START

NATIONAL

RESOURCE

CENTER
1

A Holistic Approach to

Health and Safety

Technical Assistance Paper No. 7

TABLE OF CONTENTS

Introduction

Health in Everyday Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Health Is Everybody’s Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Health Promotion, Prevention, and Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . 4

First Things First: A Healthy Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Building Healthy Families. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Systems That Support Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Community Assessment and Partnership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Health Services Advisory Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Early Head Start National Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Special Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Health Services for Pregnant Women. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Oral Health for Infants and Toddlers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Health Screenings for Developmental, Sensory, and Behavioral Concerns. . . 16

Health Care in Rural Communities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Migrant and Seasonal Head Start Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Infant and Child Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Children With Special Health-Care Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Poverty and Obesity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Appendix A.1—Prenatal Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Appendix A.2—Newborn Health Visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Appendix A.3—Nursing Control Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Appendix A.4—Health Screening and Immunization Record . . . . . . . . . . . . 27

Appendix B—Additional Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Technical Assistance Paper No.

7
2

A Holistic Approach to

Health and Safety

Technical Assistance Paper No. 7

Introduction

Health is the primary prerequisite to school readiness and social competence because it provides the foundation

from which children can grow, develop, and learn. A child who is sick, tired, hungry, under emotional

stress, or in an unsafe environment is at a serious disadvantage. His or her energy for thinking, playing,

learning, and relating to others is sapped, leaving him or her at risk for additional problems. The more that we can

do to prevent health problems, intervene early, and provide an ongoing model of health and safety, the more likely it

is that the children in our care will enter school ready to learn and succeed in all areas of development.

Too often, we think about health only in relation to illness. A broader perspective on health and well-being recognizes that the environment and all areas of development—physical, emotional, social, cognitive—interact to support

or impede good health. When one of these areas is impaired, it affects every other. In fact, the World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of

disease or infirmity.”1 We need to pay attention to all aspects of individual development and to the environment to

promote health and well-being.

Following are some examples of the outcomes in the various dimensions of health that we want for infants, 

toddlers, and their families:

Physical—Absence of illness or injury; regularly scheduled and administered immunizations and well-baby care, including

oral health; well-maintained nutrition and hygiene; and opportunities for exercise and physical fitness

Emotional—The ability to cope with stress, the experience of and ability to express a range of emotions, and the ability to

engage in meaningful play or work

Social—A sense of belonging or community, the ability to have an effect on the world in work or play, and the ability to

sustain intimate relationships

Cognitive—The ability to concentrate, to remember, and to solve problems

Environmental—The experience of living, working, and playing in areas that are clean, safe, and pleasant

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER

1 Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June 1946; signed on

22 July 1946 by the representatives of 61 States (WHO, Official Records of the World Health Organization, Vol. 2, p. 100, Washington, D.C.:

Author) and entered into force on 7 April 1948.
Head Start programs that provide services to pregnant women and to families with infants and toddlers have the

opportunity to prevent health problems before they occur through health screening, parent education, and access to

a variety of resources. Ideally, programs can instill healthy habits and provide a model for good health practices that

will continue long after the children leave Head Start. 

In this paper, we will consider how Early Head Start and Migrant and Seasonal Head Start programs can have a

positive and lasting effect on the healthy growth and development of infants, toddlers, and their families. First, we

will examine how health contributes to the everyday practices and to the roles of staff and families. Next, we will

focus on systems that support health practices. Then we will turn to special topics, including health services for 

pregnant women, dental care for infants and toddlers, health screenings, and health care in rural communities.

3

TECHNICAL ASSISTANCE PAPER NO .7 
4

impression. Both formal and informal efforts to educate

families on health topics can promote healthy habits.

Obviously, a healthy environment should be clean and

safe. A dirty classroom or home will harbor conditions

that will lead to illness and safety hazards that will lead

to injury. Less obvious aspects of the environment that

contribute to good health include the following:

How the classroom or home is arranged. Even simple

things like the placement of furniture make a difference

in how children and adults move around the room,

find and use play materials, and interact with 

one another. A cluttered environment can lead to 

disorganization and can increase stress.

How the children are supervised and disciplined.

Close supervision ensures that children are using materials safely and helps prevent accidents. Discipline

should be used to guide children’s behavior and teach

social skills in a positive rather than a punitive manner.

How the curriculum promotes meaningful learning.

The choice of materials, activities, and experiences

should engage children and build on their emerging

skills in all areas of development. 

How the staff members communicate with one

another, the children, and the families. Tone of voice,

the choice of words, and body language should 

communicate respect for self and others. An emotionally

healthy environment includes open lines of communication, appropriate boundaries, and constructive 

problem solving. 

In center-based settings, the prevention of health

problems occurs when staff members provide nutritious

meals, ensure opportunities for rest and for active play,

encourage exercise and fresh air, and are diligent about

safety guidelines. For example, staff members store 

medications and cleaning supplies out of reach, check

playground equipment regularly for hazards, and follow

the Head Start Program Performance Standards requirements for group size and child:staff ratios. 

Health in Everyday

Practices 

The promotion of good health and prevention ofpoor health occurs in the daily experiences of staff

members, children, and families. The Head Start Program

Performance Standards emphasize the importance of 

prevention and early intervention by requiring health

assessments that are conducted in a timely manner and

systems that track the providing of health-care services 

(45 CFR 1304.20).

Health Is Everybody’s Business

Health in Head Start is a shared venture. The health

coordinator or the Health Services Advisory Committee

members are not the only ones to be concerned about,

committed to, and involved in health services. Front-line

staff members such as classroom caregivers and home 

visitors have a profound influence on many of the

dimensions of health that are listed above. A holistic

approach to health ensures that all aspects of a child’s

well-being is taken into consideration when planning

and delivering services for infants, toddlers, and their

families. The earlier in a child’s life that we can prevent

health problems from occurring and the sooner that we

can intervene when problems exist, the more likely it is

that children will grow and develop in ways that lead to

later success.

Health Promotion, Prevention, and Treatment

A useful approach is to think of health services along a

continuum of activities and services that promote

healthy habits, prevent health problems, and provide

treatment when necessary. Health promotion occurs on a

daily basis in all of the ways that are mentioned above.

In addition, staff members provide an important model

for children and families. How they pay attention to

their own health, carry out health policies and procedures,

and talk to families about health issues makes a strong

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER
5

Home visitors play an equally important role and can

have a powerful influence on health and safety in the

home. When staff members provide services in the

home, they are able to readily identify health and safety

issues that need to be addressed. For example, home visitors might educate parents on the dangers of baby

walkers or the importance of keeping accurate health

records, or they might provide practical support such as

helping parents find a safe crib for the baby, calling an

exterminator if there is a rodent or pest infestation, or

getting emergency heat turned on in the winter. They

can also support families by discussing neighborhood

crime issues and ways to make the community safer

through efforts such as Neighborhood Watch. Additional

important preventative functions that all programs 

participate in as required by the Head Start Program 

Performance Standards include providing screening and

assessment, ensuring that children have a continuous

source of coordinated care and are up-to-date on 

immunizations, and involving parents in health services.

The treatment of health problems is a priority and should

be addressed quickly in collaboration with parents and

health-care partners. Head Start Program Performance Standards

require a system for tracking health services to ensure

that services are provided in a timely manner and meet

child and family needs. Staff members may need to assist

families in following up on appointments or referrals to

specialists. 

First Things First: A Healthy Staff 

Staff members will have a hard time creating a healthy

environment for families if they do not experience a

healthy work environment for themselves. Some of the

important ways that program administrators support staff

health include

health insurance so staff members have access to

health care;

adequate sick leave so staff members can take time off

for doctor appointments and to recover from illness;

daily work schedules that are manageable and allow for

a physical or mental break from the demands of the job;

a work environment that is clean, safe, and pleasant;

work responsibilities that build on strengths and that

are appropriately challenging;

practical and emotional support in the form of regular

supervision, open lines of communication, and policies

and procedures through which to address grievances; 

individualized training and staff development;

posted emergency evacuation plans; and

safety guidelines for home visitors.

Taking care of young children is physically demanding,

and staff members should have access to resources to

help alleviate potential problems. For example, train staff

members on proper techniques for bending and lifting to

prevent back injuries. 

Of course, staff members need to be thoroughly trained

on health and safety guidelines and need to know how to

put them into effect. A helpful strategy is to post

reminders such as proper diaper changing and hand

washing techniques in the classroom. Make sure that

supplies—soap, tissues, paper towels—are well stocked

TECHNICAL ASSISTANCE PAPER NO .7 
and easily accessible. Policies and procedures for illness,

accidents, and emergencies should be clear and should be

known to both staff members and families. 

Every program should have a protocol to deal with

safety issues, and the safety of home visitors is the first

priority in a home-based program. For example, home

visitors might travel with a cell phone and a telephone

number where a supervisor or other support person is

readily available. In some communities, home visitors

might work in pairs to avoid being alone in unsafe

neighborhoods. Families can also help by identifying the

safest time of day to visit or streets that should be avoided. The local police department may also provide

additional protection if they are aware that home visitors

are in the community. The police may also provide selfdefense training. Home visitors should be trained to

anticipate when they are in danger and to create a plan

to protect themselves should the need arise. A crisis protocol is also important for the safety of children and

families. For example, Head Start staff members are

required by Head Start Program Performance Standards to

report suspected child abuse or neglect [45 CFR 1304.22(a)(5)]. 

Building Healthy Families

Parents have the primary responsibility for their children’s health, and Early Head Start programs support

parents in this role by involving parents in all aspects of

health services and by offering health education programs. An important point to remember is that health

topics can be very personal by nature; thus, staff members must take into account personal attitudes, family

and cultural norms and differences, religious beliefs, and

educational levels. 

One of the first and most important ways that staff

members collaborate with parents for their child’s health

is to ensure that each child has a “medical home”—a

continuous source of accessible, coordinated medical care 

[45 CFR 1304.20(a)(i)]. If families do not have a continuous

source of health care, a helpful strategy is to explore with

parents their attitudes and beliefs about preventative

health care and the barriers they may face in accessing

health care. They may be experiencing language or cultural barriers, financial issues, lack of transportation, or

trouble locating providers. Families may need assistance

Our agency has an incentive program

to promote physical fitness. Staff

members who complete and track

their exercise and health activities (e.g., having

a cholesterol screening) can enter weekly 

drawings for a prize. 

Bear River EHS 

PROGRAM VOICES

We work with families from diverse

cultural backgrounds. Our goal

as an organization is to provide

services in a culturally respectful manner. The

first step is to establish a trusting relationship

between the Home Visitor and the family. By

educating respectfully and modeling differences,

parents are willing to consider different ideas

and try new things. 

Otero Junior College EHS

PROGRAM VOICES

6

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER
applying for Medicaid or the State Children’s Health

Insurance Program (SCHIP). An additionally helpful

strategy is to identify pressing health needs of parents

and provide referrals if necessary. Parents with their own

health concerns may need additional support to create a

healthy environment for their children. The family partnership agreement process 2 can be an excellent way to

identify and address health concerns and to track

progress in meeting health-related goals.

The physical, emotional, and spiritual dimensions of

health care are strongly influenced by cultural values and

expectations. Culturally based differences may lead to

misunderstanding or conflict among families, health-care

providers, and programs. If tension occurs between the

program and the family, program staff members should

carefully examine how they are addressing those issues so

parents remain engaged and committed to the program.

For example, are there language barriers that need to be

addressed? Do parents fully understand their child’s 

diagnosis and treatment options? What are the family’s

attitudes and beliefs about health and healing? Does the

family have a strong spiritual or religious belief that

influences their approach to health care? Programs that

attempt to understand these cultural differences are

doing much to support the healthy development of

young children. 

We help parents to be their child’s

advocate for health care by giving

them tools to use to communicate

with their primary health provider. For example,

some families benefit when we model how to

call for an appointment, or how to check on 

the status of their child’s immunization. We

educate parents about their responsibilities as

health-care consumers and they see the 

rewards of developing a relationship with a

health-care provider. 

Otero Junior College EHS

PROGRAM VOICES

2 The family partnership agreement process refers to the Head Start Program Performance Standards requirement [45 CFR 1304.40(a)] to offer families the

opportunity to set individualized goals. 

TECHNICAL ASSISTANCE PAPER NO .7 

7
WORKING WITH PARENTS

Talk to parents about their child’s health history 

to determine whether they have a “medical home”

where their child receives ongoing health supervision. The source of health care should be easily

accessible and available after the child transitions

out of the program. 

Help parents locate a medical home by seeking 

recommendations from the Health Services

Advisory Committee on health professionals and

sources of funding; help families learn about and

access health-care assistance programs, if eligible;

and, if necessary, provide practical assistance such

as help with scheduling appointments and 

arranging transportation. 

Help parents prepare for health-care visits by

assembling a medical history with documentation

and any relevant records.

Prepare parents for what to expect during routine

health-care visits, offer them information about

patient rights and responsibilities, and provide support as they follow up on health recommendations.

Accompany families to health-care appointments

if necessary. Some parents or children may have

anxiety over particular health issues or procedures

and might benefit from additional support.

Reduce some of the barriers parents may have to

accessing health care, for example, finding child

care for siblings, accessing transportation, or 

(for non-English-speaking families) arranging

interpretation services.

Create a program of education for parents on the

importance of health care (including dental

health) that takes into account differences in education, culture, attitudes, and fears. Use a variety

of mechanisms—workshops, home visits, field

trips, newsletters—to present positive, consistent

messages about the importance of health care.

Encourage parents to model good health-care habits

and create healthy routines for the whole family. 

Seek parent involvement in the Health Services

Advisory Committee.

S

ome of the families in our program lead

such stressful lives that health care is

not a priority. Home visitors work 

individually with families to remove the barriers

that are preventing them from recognizing the

importance of good health. We have to find a

way to make health important and meaningful

to them, to make it matter, before we can have

an impact. 

Bear River EHS

PROGRAM VOICES

8

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER
Systems That Support

Health Services

Management systems for quality health servicesinclude planning, communication, record-keeping

and reporting, self-assessment, human resource management, and fiscal management. Below we will consider

how a thorough community assessment, community partnerships, and a strong Health Services Advisory

Committee contribute to cohesive management systems.

Community Assessment and Partnership

The Head Start Program Performance Standards 

requirement for a community assessment 

[45 CFR 1305.3(b)] provides an opportunity to identify the

health needs of children and families in the community

and how well those needs are being met. This process

helps programs determine whether they should provide

health services through the program, broker with community partners for those services, or do some

combination of both. It also identifies gaps related to

health services—for example, low immunization rates,

inadequate prenatal care, or a lack of dental services—so

programs know where to focus their efforts. 

Community partnerships for health services should be

built and formalized with health-care providers, mental

health organizations, nutritional services, and organizations such as local health departments, child welfare

agencies, managed care organizations, medical or dental

schools, and professional associations. Ideally, services for

families should connect those families with the community so they can continue to find and use needed services

after they leave the Early Head Start program.

Health Services Advisory Committee

The Head Start Program Performance Standards require

that every Head Start and Early Head Start program

form a Health Services Advisory Committee (HSAC) to

guide in the planning, operation, and evaluation of

health services [CFR 45 1304.41.(b)]. This group is 

composed of volunteers from the community who are

involved in health-related professional roles—nurses,

pediatricians, dentists, early intervention providers, or

mental health professionals. Representatives from social

service agencies such as the nutrition program for

Women, Infants, and Children (WIC) as well as Early

Head Start staff members and parents also participate in

the committee.

The HSAC is an advisory group and can be a valuable

resource for the Policy Council. Members can help identify pressing health needs in the community and can

help programs design services that effectively meet those

needs. Members of the committee might share their

expertise either by offering their own services or by training staff members or parents. They can also be

instrumental in providing access to community resources. 

Each program’s HSAC will be set up and will operate

differently depending on local program and community

9
10

differences. Head Start programs that have a combined

Head Start and Early Head Start HSAC must ensure that

representation of expertise on health issues for pregnant

women and infants and toddlers is adequate. No specified

number of times per year is required for the committee to

meet; that number is determined by program and family

needs, local health conditions, and other variables. The

size and composition of the committee is similarly based

on local needs. However, despite this diversity among

HSACs, five elements of a successful HSAC are 3:

1. A clearly articulated mission;

2. Membership that represents the health needs of the

program and community;

3. A responsive recruitment and orientation process

for members;

4. An effective working environment, policies and

procedures for members; and

5. Continuous evaluation of how the committee is

functioning. 

Clearly, administrative support must exist for the

HSAC to be developed and maintained. Health services

managers need adequate time for planning and for 

supporting the committee; staff members need time to

participate; parents may need transportation or child

care. Program leaders can ensure the success of the

HSAC by nurturing community collaborations, creating

an open and inviting atmosphere, attending meetings,

and supporting health staff members to follow through W on committee recommendations.

e collaborate with a pediatric

clinic that will donate well-child

exams to families who do not

have a means to pay for health care. One of

the pediatricians at this clinic is a member of

our HSAC and was able to facilitate this 

partnership after learning about the number of

children who were not receiving health care 

due to lack of health insurance. 

Bear River EHS

PROGRAM VOICES

3 Head Start Bureau. (2003). Weaving connections: The Health Services Advisory Committee (p. 4). Washington, DC: Author.

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER
WORKING WITH COMMUNITY PARTNERS

Know your state’s Early and Periodic Screening,

Diagnosis, and Treatment (EPSDT) guidelines and

the schedule and procedures for preventative

health care. You can obtain these guidelines from

your State Medicaid office. The Health Services

Advisory Committee may make additional recommendations based on prevalent community health

problems [45 CFR 1304.20(a)(1)(ii)].

Work with health-care providers to create a

schedule to bring children up-to-date on ageappropriate preventative care.

Collaborate with your state’s early intervention

system for infants and toddlers with disabilities.

Develop systems of communication and tracking

with your health-care partners to ensure that children are examined and treated as necessary and

that families are fully involved in their children’s

health care. See appendix A for sample recordkeeping forms.

Enlist the help of health-care professionals to

develop educational programs for families.

Emphasize the importance of anticipatory guidance, early detection of health-care problems, and

the importance of follow-up care.

Involve health-care providers in your program. In

addition to participating on the Health Services

Advisory Committee, create less formal opportunities for collaboration, for example, a visit from a

health-care provider to your program to hear from

parents about their health concerns and questions.

Explore ways that your EHS program can contribute to the health-care provider’s practice, for

example, by providing parent education handouts

for the clinic or by giving a presentation to clinic

staff members on the particular health-care issues

and needs of the children and families with whom

you work. 11

TECHNICAL ASSISTANCE PAPER NO .7 
12

Early Head Start

National Evaluation

The Early Head Start Research and Evaluation Project 4 examined health status and access to

health care as part of the national evaluation of Early

Head Start. This study involved more than 3,000 families and 17 programs around the country. Families in

EHS were compared with a randomly assigned control

group. Some of the highlights of the report include the

following:

A higher percentage of children in EHS received

immunizations or visited a doctor for treatment of illness and were less likely to be hospitalized for accident

or injury than were children in the control group.

Overall, the majority of children in EHS were in very

good health. The youngest children were more likely

to have health problems.

Many children suffered from asthma and other respiratory problems. The incidence of household smoking

was also high and is a likely contributor to the high

rate of asthma and ear infections found in Early Head

Start children.

The use of car seats declined as children grew. Almost

all parents used car seats with their infants, but

approximately 30% of parents did not use car seats

with their 3-year-olds.

Children in EHS programs were more likely to have

health insurance than were children from low-income

families not participating in the program. Children not

covered by insurance were more likely to be from

Hispanic families and to have mothers who had not

completed high school. Children in center-based programs were more likely to have health insurance than

those in home-based programs. 

Hispanic families were at an increased risk for health

problems because they tended to lack either health

insurance or a regular health-care provider. This finding may reflect not only cultural or language barriers

but also concerns about legal immigration status.

Teenage mothers carried out fewer safety practices and

were less likely to have a regular source of health care

for their children. They more often used hospital

emergency rooms as their source of health care and

were less likely to report that their child received a

well-child exam.

The implications of this study for Head Start programs

include the need to monitor health insurance coverage

and the need to increase enrollment in appropriate 

programs. Programs should also educate parents on the

recommendations for car-seat safety and partner with

local resources to ensure that parents have car seats for

their toddlers and preschool-age children. Health education efforts are also needed on the relationship between

household smoke and children’s health problems to reduce

children’s exposure and prevent respiratory problems.

4 Mathematica Policy Research, Inc. (2002). Making a difference in the lives of infants and toddlers and their families: The impacts of Early Head

Start. Washington, DC: U.S. Department of Health and Human Services. Early Head Start evaluation reports are available on-line at

http://www.acf.dhhs.gov/programs/core/ongoing_research/ehs/ehs_intro.html

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER
Special Issues

The following section of this paper explores a number of health-care issues that are of particular

concern to Head Start programs that provide services for

pregnant women and families with infants and toddlers.

Health Services for Pregnant Women

Inadequate prenatal care is associated with low birth

weight, premature delivery, birth defects, and increased

risk for learning and behavioral problems. Thus, a focus

on maternal health is paramount for programs that provide

services to expectant families. 

Pregnant women and their families are not enrolled in

Head Start Program Options (45 CFR 1306) because the

Program Options describe the delivery of services to 

children. Program staff members and families have the

flexibility to determine how services will be provided to

pregnant women and their families through the individualized family partnership agreement process. For

example, although many services to expectant families

may be delivered through home visits, the frequency and

duration of home visits are determined by the needs,

resources, and goals of the family. 5

Early Head Start grantees must assist pregnant women,

through referrals, to access comprehensive prenatal and

postpartum care immediately after enrollment in the 

program [45 CFR 1304.40]. Some of these services include:

risk assessments,

nutrition counseling,

medical examinations,

dental care, and

mental health services.

A pregnant woman should be connected to a regular,

ongoing source of medical care (a medical “home”) to

have her health monitored during pregnancy and after

delivery. Oral health is also important for pregnant

women. The increase in hormones during pregnancy can

cause gums to swell and bleed more frequently, which

can lead to discomfort and additional oral health problems. Early Head Start funds may be used for professional

medical and dental services when no other source of

funding is available [45 CFR 1304.20(c)(5)].

5 Head Start Bureau. (2002). Services to pregnant women participating in Early Head Start (Information Memorandum, ACYF-IM-HS-02-04).

Washington, DC: Author.

13

TECHNICAL ASSISTANCE PAPER NO .7 
In addition to the above, Early Head Start programs

must provide pregnant women with prenatal education on:

fetal development,

the risks of smoking and alcohol,

labor and delivery,

postpartum recovery,

maternal depression, and

breastfeeding.

Community collaboration is essential for ensuring

access to this comprehensive array of services. Early

Head Start programs might collaborate with health 

clinics, birthing centers, mental health programs, food

banks, transportation services, or translation services for

non-English-speaking families. The Health Services

Advisory Committee plays a vital role in locating 

community resources and establishing linkages for 

services to pregnant women. 

Early Head Start staff members can help expectant

families prepare for the arrival of the baby by creating a

plan for getting to prenatal appointments; preparing for

the delivery, including packing an overnight bag for the

hospital or birth center; organizing transportation to the

hospital; and ensuring that the family has a car seat to

transport the baby home from the hospital. This preparation period is also a good time to identify environmental

hazards such as secondhand smoke and to take the necessary steps to eliminate these problems before the baby

arrives. Another task to accomplish before the birth of

the baby is finding a pediatrician or clinic where the

baby will go for regular medical care after delivery. Ideally, expectant parents can familiarize themselves with the

medical practice where they will take their child and

share important prenatal history. Establishing a “medical

home” for the baby right from birth is the best way to

ensure ongoing, comprehensive health care throughout

infancy and childhood.

The Head Start Program Performance Standards require

that programs “must arrange for health staff to visit 

each newborn within 2 weeks after the infant’s birth to

ensure the well-being of both the mother and child.” 

[45 CFR 1304.40(i)(6)]. Ideally, the staff member who 

conducts this visit has had a relationship with the 

family during the mother’s pregnancy. This individual

may be a staff member of EHS who has the appropriate

medical background or may be with a public health or

other collaborating community agency. In some cases, it

may be helpful for health staff members to conduct this

visit jointly with another service provider such as a

home visitor to minimize disruptions in family life. The

first postnatal visit is an important time to assess the

baby’s feeding, sleeping, and growing; the parents’ physical

health and emotional adjustment; and family’s needs and

resources. 

Oral Health for Infants and Toddlers

Oral health is an important component of overall health

and development. Poor oral health can lead to tooth

decay, infections, and disease. These problems are largely

preventable by providing parents and caregivers with the

skills to properly clean and care for young children’s

teeth. Oral health services begin from birth and include

guiding families to oral health service providers, building

families’ capacity and interest in caring for the oral

health of the family, educating families about the role of

oral health professionals, and teaching children good oral

hygiene and healthy eating habits.

Most infants receive their oral health care during regular well-baby exams from the health professionals who

provide their well-child care. Health-care practitioners

such as doctors, nurses, or physician assistants can screen

for dental problems, conduct risk assessments, educate

parents on oral health and development, and refer children to a dental professional if needed. 

State Early and Periodic Screening, Diagnosis, and

Treatment (EPSDT) guidelines provide recommendations for a child’s first dental exam. In some

communities, pediatric dental professionals encourage

preventive dental visits beginning at the age of 1 year or

even as early as the eruption of the first tooth. In other

14

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER
15

I

try to visit the family during the time they already have scheduled with their Family Educator,

in order to disrupt their already hectic lives as little as possible. I take the infant scale and

weigh the baby (especially if I’ve heard any concern at all about the baby’s feeding) and the

OAE to do a hearing test on the visit. I use a form (see appendix A.2) to guide the discussion. I

ask every question on the front of the form. New moms usually enjoy telling their birth stories,

and then I use the checklist on the back according to the needs of the family.

I ALWAYS check carefully how feeding is going. Especially important questions to ask a 

breastfeeding mom are how frequently and how long the baby is nursing and how many wet and

poopy diapers the baby is producing. It is also important to ask a mom who is bottle-feeding, how

much she is feeding and how she is preparing the formula. I think it’s also important to ask about 

circumcision and how it is healing, and if the baby was not circumcised, to be sure the parents

know proper care and cleaning. These are all issues that MANY parents are not informed about

before they leave the hospital.

I also always discuss baby blues and postpartum depression, and leave a short pamphlet on the

topic. I have breastfeeding and formula preparation handouts as well as baby safety handouts, a

pamphlet on how dads can help with the baby, etc., and leave the information that will best meet

each family’s needs.

A parent on the Health Services Advisory Committee recommended making a follow-up phone

call to each family 2–4 weeks after the newborn visit, an excellent suggestion. So now I make an

informal call just to ask how things are going and if they have any questions. The moms really

seem to appreciate this. 

Bear River EHS

PROGRAM VOICES

TECHNICAL ASSISTANCE PAPER NO .7 
communities, dental professionals treat patients under

the age of 3 years only if a dental problem is evident.

Because this preventive care varies by community, the

Health Services Advisory Committee should take an

active role in determining how the oral health needs of

infants and toddlers can adequately be met given the

particular circumstances of the community. Especially

important in communities that do not have pediatric

dentists is to increase the capacity of other health-care

professionals to provide prevention-based oral health

care for infants and toddlers. For example, pediatricians

can include oral health screenings as a part of routine

well-baby care, dental hygienists can conduct screenings

and preventative services, and partnerships with dental

schools may lead to opportunities for students to provide

services and gain experience.

Early Head Start programs can educate parents and

caregivers on oral hygiene for babies and toddlers as well

as provide guidance on the use of bottles and cups, injury

prevention, and dietary habits. A serious but preventable

condition called “baby bottle tooth decay” is linked to

propping bottles in a baby’s mouth or letting him or her

fall asleep with a bottle. Health professionals also 

recommend weaning a baby from a bottle to a cup at

approximately the age of 12 months. In addition to 

formal parent education efforts, both center- and homebased staff members can use naturally occurring routines

such as meal and nap time to discuss and demonstrate

healthy practices.

A number of valuable resources are available to support

programs in their oral health services. Most states have a

government office for oral health that partners with

other state organizations and recommends oral health

policy. In addition, various national and state organizations

for dentists, dental hygienists, dieticians, and physicians

focus on oral health issues. The National Oral Health

Resource Center (http://www.mchoralhealth.org), funded

by the Maternal and Child Health Bureau in the Health

Resources and Services Administration of the Department

of Health and Human Services, develops and disseminates

valuable information about emerging public oral health

issues. The center supports health professionals, program

administrators, educators, policymakers, and others with

the goal of improving oral health services for infants,

children, adolescents, and their families. Resources

include listservs, bibliographies, and fact sheets, as well

as practice and policy guidelines.

Health Screenings for Developmental, Sensory,

and Behavioral Concerns

The Head Start Program Performance Standards require

that, within 45 days of entry into the program, EHS 

programs must perform or obtain screening procedures

for developmental, sensory, or behavioral concerns 

[45 CFR 1304.20(b)(1)]. These screenings must be done in

collaboration with parents and must be linguistically

appropriate, culturally sensitive, and age-appropriate.

Each of the three types of health screenings are described

further here

Developmental screening measures a child’s progress in

reaching age-appropriate developmental milestones in

gross and fine motor skills, language and speech development, or thinking and problem solving. Screening

instruments and procedures vary. Some screening instruments might consist of a checklist of items that the

16

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER
screener observes or elicits from the child; others might

consist of parent-completed questionnaires. The Head

Start Program Performance Standards do not specify a 

particular strategy to be used but encourage an approach

that is comprehensive and systematic, includes multiple

sources of information, and conforms to sound early

childhood practice.

Sensory screening refers to evaluations of vision and

hearing. Vision and hearing screenings should be conducted by trained health professionals. Frequently, Early

Head Start programs can obtain preexisting information

such as the results of a recent vision or hearing test that

was performed at the child’s last well-child health visit. If

it is impossible to obtain a record of a prior screening,

then efforts should be made to have the appropriate

screenings performed at the next scheduled well-child

visit. The frequency of vision and hearing screenings is

determined by each state’s Medicaid agency as specified

in the EPSDT program. The EPSDT guidelines represent

a program of the state Medicaid agency for preventative

and primary well-child care. Each state Medicaid agency

sets its own guidelines. To determine a child’s health 

status, Early Head Start programs should follow those

guidelines in conjunction with (a) the latest immunization

recommendations issued by the Centers for Disease 

Control and (b) the recommendations of the Health

Services Advisory Committee that reflect specific 

community needs.

Behavioral screening refers to social and emotional

functioning. Few screening instruments exist for infants

and toddlers in this area; thus, the screening process

should consist of observation of the child’s behavior;

interactions with family, peers, and staff members; health

and developmental status; and consultation with family,

caregivers, and health or mental health professionals.

An important point to remember is that screening for

developmental, sensory, and behavioral concerns determines only whether further evaluation is necessary. It

does not lead to a decision about whether a child has a

developmental, sensory, or behavioral problem. If the

results of the screening indicate a potential concern,

then a referral for an in-depth evaluation is warranted.

For more in-depth information on screening and assessment,

please see the resources in appendix B.

Health Care in Rural Communities

Rural communities face a number of unique challenges

in accessing health care. Doctors and other health-care

professionals may be scarce, and families may have to

travel long distances to obtain care. Finding pediatric

professionals who are skilled in working with infants and

toddlers may be especially challenging. Under these 

circumstances, families will have difficulty visiting health

professionals for preventative care, so parents might seek

help only after a health problem occurs. In addition,

There are few pediatric dental providers

in our rural community. Before children begin dental exams at the age of

2, we educate parents on proper dental care for

infants and toddlers. We model good oral

hygiene and encourage, support and expect 

parents to brush children’s teeth after all meals

and snacks served at our socializations. We are

participating in an oral health grant where we

hope to increase the dental care available by

increasing the number of dental providers in the

area. We are working with the Kids In Need of

Dentistry (KIND) organization to bring their

mobile dental clinic to the area to provide 

services for the children in our programs. 

Otero Junior College EHS

PROGRAM VOICES

17

TECHNICAL ASSISTANCE PAPER NO .7 
families might not have the means to travel great distances. Public transportation may be nonexistent or too

costly, and securing time off from work creates additional

barriers. In addition, for immigrant populations that

often live in rural areas, language and cultural differences

further complicate access to health care.

EHS can help offset these challenges by focusing

efforts on preventive health services and by developing

community partnerships that help minimize some of

these barriers. Effective strategies are described in the

following sections.

Educate parents on preventive health care. Many health

problems can be prevented if parents are armed with

information and have supportive guidance. For example,

much can be done in the daily environment to decrease

the incidence of tooth decay, or dental caries, in infants

and toddlers. Teach parents procedures for properly cleaning an infant’s or toddler’s teeth, and warn them about

the hazards of propping a bottle in a baby’s mouth. Toothbrushing activities can be a part of each home visit or

part of the daily routine in center-based programs. 

Use the home environment to teach parents basic health

and safety techniques, for example, storing medications

and cleaning solutions out of children’s reach. Demonstrate

how to “child proof” a home so safety is a priority. 

Teach parents the warning signs of potential health

problems; for example, an infant who becomes increasingly fussy and frequently tugs on his

ear may be developing an ear infection. Make sure parents know basic

first aid as well as signs and symptoms

that warrant a call to a doctor. Conduct

hands-on workshops for parents to

“make and take” their own first aid

kits. The community fire and police

stations may offer speakers or materials

on relevant topics.

Provide information and training to

health-care providers. Help health-care providers 

understand the needs of the children and families in your

program and how to meet them. For example, inform

health-care providers of cultural issues such as strong

religious beliefs that may influence the family’s approach

to health care. Provide language translation for nonEnglish-speaking families. Effective systems of communication among your program, families, and health-care

providers will minimize potential misunderstandings.

Help health-care providers understand how the developmental needs of infants and toddlers have an effect on

health care. For example, an 8-month-old in the throes

of stranger anxiety can be expected to strongly resist

being taken out of her parent’s arms and placed on an

examining table by a stranger. The doctor can minimize

the child’s (and parent’s) distress by allowing a parent to

hold the baby on his or her lap during the examination. 

Develop collaborative relationships with health-care

assistance programs. Many low-income families 

do not know how to find resources such as 

Medicaid or the SCHIP to help defray the costs of

health care. Identify local, state, and federal sources of

health-care funding, and develop collaborative processes

that help parents navigate a potentially confusing 

system. Parents may need help compiling information,

completing applications, or locating participating healthcare providers.

18

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER
Provide specialized training to EHS staff members.

Help staff members gain health-related skills such as

training to be a doula 6 or a lactation consultant or the

skills necessary to conduct health-related screenings. The

investment of time and money is well worth the benefit

to the EHS program and the community.

Migrant and Seasonal Head Start Programs

Migrant and Seasonal Head Start programs face unique

challenges in providing health services to families.

Migrant families live in a number of different locations

throughout the year as they move from crop to crop for

seasonal farm work. The vast majority of migrant workers

do not speak English as their native language. Some of

the challenges for these Head Start programs include the

following 7:

High mobility. Children and families have inconsistent access to medical care and usually do not have a

primary health provider. Thus, it is challenging for

service providers to obtain a medical history, and it is

difficult for parents to track and follow up on services.

Exposure to pesticides. Environmental toxins can be

especially damaging to a developing fetus. Pesticides

not only are a danger to the workers in the field but

also can be found in food and can be transmitted to

infants in breast milk. Children may be more susceptible than adults to the toxic effects of pesticides

because of their lower weight and higher metabolism.

Long, labor-intensive work hours. Farm work is 

physically demanding. Parents are often in the field for

many hours each day, in all weather conditions. The

work demands standing, bending, and lifting heavy

loads. Bathroom facilities are usually inadequate, 

posing additional health concerns.

Substandard living conditions. Migrant workers live

in extreme poverty. Housing may be overcrowded and

unsanitary, and diseases are easily transmitted from one

person to the next. These stressful living conditions,

combined with poor nutrition and limited access to

health care, leave families particularly vulnerable to

health problems.

Immigration status. Families may fear using public

health services if it will put them at risk for deportation

or compromise their ability to attain citizenship.

Health screenings are particularly valuable given that

many parents of migrant children do not have their 

children’s medical records. The screenings provide an

opportunity to examine how children are currently functioning and to make referrals as needed. It is also of great

benefit when programs use their record-keeping and

tracking systems to ensure that parents are able to follow

up on appointments and treatment plans. Parents may

need assistance in locating providers, making appointments, accessing translation services, and coordinating

transportation.

Emerging concerns with respect to the health of

migrant families include social and behavioral issues such

as substance abuse, family violence, and children’s

behavioral problems. Head Start programs, providing a

comprehensive and individualized program of services,

can mitigate these issues by reducing the social isolation

that often accompanies a migrant lifestyle, mobilizing

the community to offer culturally sensitive supports and

services for all family members, and working in partnership

with families to identify and meet their needs.

Infant and Child Mental Health 

The Head Start Program Performance Standards require a

comprehensive array of services related to mental health,

including prevention, assessment, and early identification

of mental health needs; professional mental health 

consultation; and the delivery of mental health services.

Infant mental health refers to social and emotional

development in very young children. Although the term

mental health often conjures negative images of mental

6 A doula provides professional labor support and childbirth education. 

7 U.S. Department of Health and Human Services. (1999). Descriptive study of children and families served by Migrant Head Start programs.

Washington, DC: Author.

19

TECHNICAL ASSISTANCE PAPER NO .7 
illness or dysfunction, infant mental health is a term 

that encompasses a continuum of experience. Infants and

toddlers can experience the full range of mental health

functioning—from secure, nurturing relationships and

the ability to feel the spectrum of human emotion to

dysfunction and disorders of early childhood. 

Infant mental health is firmly tied to every other area

of growth and development: physical growth and health,

communication and language development, and cognitive

skills and the ability to learn. In fact, the most recent

research on early brain development suggests that early

nurturing relationships are different from later relationships

because they provide a foundation from which “all

meaningful development unfolds.” 8 Thus, when considering infant mental health, it is important to look at the

child’s unique social and emotional attributes as well as

at all aspects of the child’s development and environment

such as significant relationships in the child’s life, the

status of the child’s physical development and health,

and whether the environment supports the child’s 

capacities and challenges him or her appropriately. 

Some of the common mental health challenges that

Early Head Start programs confront include the following:

Depression

Substance abuse

Parental stress from a variety of issues such as economic

concerns, violence in their communities, immigration

issues, relationship stressors, low-self esteem, and a

lack of understanding about child development

History of unresolved grief or loss

Attachment issues between children and families

Parents with developmental delays

Domestic violence 

Child behavior problems

Early Head Start programs deliver services to families

in both center-based and home-based program options or

in a combination of the two. Staff members may have

backgrounds in early childhood development, social

work, health care, or other human service fields. Thus,

the manner in which infant mental health is integrated

in the program can vary a great deal. Some of the 

strategies that Early Head Start programs use include 

the following:

Hiring mental health professionals on staff

Using mental health consultants to provide training,

consultation, or crisis intervention

Focusing on prevention and early identification of

mental health problems

Developing partnerships with university training programs that provide services through trainees in the

fields of counseling, psychology, or psychiatry

Collaborating with local mental health agencies

In addition to working closely with community mental

health programs, Early Head Start is able to provide

ongoing, intensive mental health support to children and

families through the close, trusting relationships that

grow out of the parent involvement and family partnership opportunities available to all participants in Early

Head Start. 

8 National Research Council & Institute of Medicine. (2000). From neurons to neighborhoods: The science of early childhood development. (p. 27).

Washington, DC: National Academy Press.

20

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER
Children With Special Health-Care Needs

Early Head Start must make 10% of their funded enrollment available to children with disabilities [45 CFR 1305.6 (c)].

Children may come to EHS with an already identified

disability or chronic health issue, or the problem may be

discovered as a result of the screening and assessment

process required by EHS programs. All EHS programs are

expected to partner with local agencies that provide

early intervention services to infants and toddlers with

special needs. 

Some of the challenges for programs include 

the following:

Training for staff members. Staff members should be

adequately trained to create an environment that is welcoming and individualized for each child; they may need

training on specific skills, for example, the proper use and

care of devices such as heart monitors, oxygen dispensers,

or feeding tubes; those who have not had experience

with children with special needs may need extra support

to examine any fears or concerns they have. 

Support for parents. Parents need support as they go

through the process of evaluating and identifying

potential problems; they may experience a wide range

of normal reactions, including denial, anger, and grief.

Program staff members should be sensitive to the 

challenges and needs of the parents and of the child. 

Gap between those who are eligible and those who

are served. There is a gap between the number of 

children who are identified as eligible for Part C early

intervention services and those who actually receive

services.9 Families in particular groups—such as teen

parents, Hispanic parents, and families with many risk

factors—were particularly unlikely to use the services.

Although the reason for the gap is unknown, programs

should identify any obstacles that might interfere with

a family following through on a referral for early intervention, for example, language or cultural barriers, a

lack of transportation, inconvenient times or places

that services are available, or financial concerns.

Program staff members can support families by accompanying families to medical or related appointments, by

sharing important information with early intervention or

medical staff members about children’s strengths and

challenges, and by allowing early intervention services to

be provided in the EHS classroom or during home visits.

The respectful, supportive relationships that staff members

build with families will allow all partners in this effort to

negotiate the challenges that arise and to foster the 

successful inclusion of children with special needs. 

Poverty and Obesity

Concern has been growing in the scientific community

about the relationship between poverty and obesity 10.

Obesity and related diseases such as diabetes and hypertension are on the rise in those who are economically

disadvantaged. Of special concern is the rising rate of

obesity and related health problems in children. At the

same time, children in poverty face hunger and food

insecurity because of a lack of food or an uncertain or

limited supply of food. The apparent paradox that children

are both hungry and growing overweight has much to do

with the high cost of healthy eating. The least expensive

food choices are processed items and convenience foods

that are high in fats, sugars, and calories. Healthier foods

such as lean meat, fish, and fresh vegetables and fruits

cost more. Thus, families with limited financial resources

may deliberately choose the less expensive—and unhealthy—

food choices to save money and ward off hunger. 

In addition to the diseases associated with obesity

mentioned above, children who are overweight can also

suffer nutrient deficiencies that lead to developmental

concerns such as limited growth and brain development

as well as reduced immune functioning. Obesity also has

negative social and emotional consequences, affecting

behavior and self-esteem.

9 Mathematica Policy Research, Inc. (2002). Making a difference in the lives of infants and toddlers and their families: 

The impacts of Early Head Start. Washington, DC: U.S. Department of Health and Human Services. 

10 Food Research and Action Center. (2003). The paradox of hunger and obesity in America. Washington, DC: Author.

21

TECHNICAL ASSISTANCE PAPER NO .7 
Head Start programs can address hunger and lack of

adequate food by helping families access food programs

such as (a) WIC, the special supplemental nutrition program for women, infants, and children; (b) the Child

and Adult Care Food Program, which provides food to

children in child-care programs; and (c) the Food Stamp

Program for families in poverty. In addition, Head Start

programs may be able to locate other community

resources such as food banks that are run by churches or

nonprofit associations. Parent education efforts should

focus on helping families learn how to make low-cost but

nutritious meals. Another helpful effort would be to

explore how families can access stores and restaurants

that sell healthier food choices. Low-income neighborhoods

may have only fast-food restaurants or small grocery

stores with a limited selection of fresh food, 

presenting additional barriers for families.

Of particular concern is the nutritional status of pregnant women because their nutrition has such a direct

effect on the health of their developing babies. And

pregnant women who have other children may be at

increased risk; research has shown that mothers first sacrifice their own nutrition by restricting their food intake

to protect their children from hunger. 11 In addition,

breastfeeding mothers have extra nutritional needs for

their own health and for the health of their baby. 

A physically active lifestyle is also related to health.

The National Association for Sports and Physical Education released the first ever physical activity guidelines for

infants and toddlers,12 linking sedentary habits with the

rising rate of childhood obesity. These guidelines warn

that confining babies to infant seats, strollers, and

playpens for extended periods not only encourages

sedentary practices but also may lead to delayed motor

and cognitive skills. Caregivers and parents should 

promote and foster the enjoyment of movement and

competence in motor skills by interacting with infants in

daily activities that encourage them to explore their

environment. Furthermore, toddlers and preschoolers

need daily structured physical activity to practice movement skills in a variety of activities and settings. 

Children acquire habits for eating and exercise early in

life. Parent involvement plays a significant role in children

developing motor competence, enjoying physical activity,

and cultivating healthy eating habits. The sooner we 

can teach and model a healthy lifestyle for children, the

more we enhance their health now and provide a strong

foundation for the future.

Conclusion

Clearly, effective health services in Early Head Startrequire the commitment of every staff member to

do his or her part in creating and sustaining a healthy

environment for infants, toddlers, and their families. The

depth and breadth of the health services that are

required by the Head Start Program Performance Standards

ensure that participating families experience a comprehensive and coordinated approach to health and

well-being that encompasses all aspects of infant and

family development during a child’s earliest years.

Attaining the ultimate goal of getting each and every child

ready to reach his or her fullest potential begins here.

11 Radimer, K. L., Olson, C. M., Greene, J. C., Campbell, C. C., & Habicht, J. (1992). Understanding hunger and developing indicators to assess it in

women and children. Journal of Nutrition Education, 24, 36–45.

12 National Association for Sports and Physical Education. (2002). Active start: A statement of physical activity guidelines for children birth to five

years. Washington, DC: Author.

22

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER
23

Early Head StartPRENATAL WORKSHEET Program YearMom’s Name Start EDC Nutrition Prenatal Prenatal Mental Health Prenatal Health Education Newborn

Date Date Assesment Care, Care, Substance Abuse Smoking Breast Labor & Visitation

Physical Dental prevention and Alcolhol, Feeding, Delivery, visit by

Baby’s Name exam exam treatment Drugs, SIDS Post-Partum health staff

caffeine depression

TECHNICALASSISTANCEPAPERNO .7 

Appendix A-1
24

Newborn Health Visit 

Bear River Early Head Start Date: 

Name: DOB: Gender: 

Parent’s Name:

Baby’s HCP: Mother’s HCP: 

BIRTH WEIGHT LENGTH @ BIRTH BABY MOTHER

 active, good color  Good

 sleeping, good color  OK

 jaundiced, lethargic  Fair

 other  Poor

Interval History:

Gest. Age at delivery:

APGAR score: 1 min. 5 min.

Medications:

Injury or illness: 

Special health care needs:

Visits to health care providers or facilities: 

Change/stressors in family or home: 

Notes:

Questions for Parent:

How are you feeling?

How did the delivery go?

Delivery location:

 Hospital  BC  Home  Other

Type of Delivery:

 Vaginal  Cesarean Section

Length of baby’s hospital stay:

 Routine  Non-routine (< one week) 

 one week to one month 

 over one month

Reason for non-routine hospital stay:

What do your other children think about the new baby?

What are your questions about feeding the baby?

What questions or concerns would you like to discuss today?

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER Appendix A-2
25

Anticipatory Guidance

Healthy Habits

 Car seat

 Crib safety

 Sleep on back

 Water temperature <120∞

 Keep hand on baby

 Smoke-free environment

 Hot liquids, cigarettes

 Signs of illness

 Emergency procedures

Nutrition

 Successful breastfeeding practices 

(positioning, latching on, feeding on cue)

 6-8 wet diapers per day

 Maternal care (rest, nipple care, eating properly, 

follow-up support

 Formula (preparation, equipment, semi-sitting position)

 No bottle in bed or microwave

Infant Care

 Cord

 Intact penis or circumcision care

 Vaginal discharge, bleeding

 Skin, nails

 Crying

 Sneezing, hiccups

 Burping, spitting up

 Thumbsucking, pacifiers

 Sleep patterns, arrangements

 Meconium to transitional stools

 Thermometer use

 Layers of clothing

Parent/infant interaction

 Baby’s temperament

 Console baby

 Hold, cuddle, rock

 Talk, sing

Family Relationships

 Partner involvement

 Rest, fatigue, depression

 Support from family/friends

 Siblings’ reactions

Other Needs

Offer materials for review at home on child safety, 

childproofing home, breastfeeding.

Suggest resources to help with breastfeeding.

Provide information about parenting classes or support groups.

Suggest community resources.

Discuss how to access health care.

Referrals

 Health insurance/Medicaid

 SSI

 Part C

 WIC

 Food Stamps

 Social Services

 Housing

 Other: 

Mother’s Signature

Father’s Signature

EHS Health Staff Signature

TECHNICAL ASSISTANCE PAPER NO .7 
26

Pregnant

Start Date

Date of Birth

P C P

Dentist

Medicaid / Wic

Health History

Lead Screen

Height and Weight 

Head Circumference

Blood Pressure > 15 mo

Vision Screen

Hearing Screen / Tymp

Hgb / Hct > 9 mo

Dental Screen

2wks, 2mo

4mo, 6mo

9mo, 12mo

15mo, 18mo

2yrs, 3 yrs

IZ Complete at 2 & 4 mo

IZ Complete at 6 & 15 mo Name of Child Nursing Control Form- Otero Junior College Early Head Start Home Visitor Well Child Exams Vaccination Health Screenings once / year

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER Appendix A-3
OJC/CDS Early Head Start

Health Screening and Immunization Record

Child’s Last Name First Middle DOB Sex

IMMUNIZATIONS (due at 2, 4, 6, and 15 months)

Enter date each immunization was given.

VACCINE Copy dates from child’s record and update with any IZ given.

DTaP

IPV

Hib (One dose must be after 1st birthday)

Measles

Mumps

Rubella

HB (Hepatitis B)

Varicella (Or parents report of disease)

PCV

Hepatitis A

Screening Results and/or Date Done

B.D. 2 wks 2 mos. 4 mos. 6 mos. 12 mos. 15 mos. 18 mos. 2 yrs. 3 yrs.

Well Child Evaluation, Physical Exam

Head Circum.

Height/ Weight

Hgb (Once a year) 

Blood Pressure (Once a year)

Eye-Vision Screen (Once a year)

Hearing Screen (Once a year)

Denver II

Ages & Stages

Dental Screen (Once a year)

Lead Screen (Once a year)

27

TECHNICAL ASSISTANCE PAPER NO .7 Appendix A-4
Appendix B

Additional Resources

Head Start Training Guides

The Head Start Bureau Training Guides are available 

on the website of the Head Start Information and 

Publications Center. 

http://www.headstartinfo.org>publications>Training Guides 

Caring for Children With Chronic Conditions (1998)

Enhancing Health in the Head Start Workplace (1996)

Laying a Foundation in Health and Wellness (2000)

Preventing and Managing Communicable Diseases (1996)

Promoting Mental Health (1998)

Safety First: Preventing and 

Managing Childhood Injuries (2000)

Sustaining a Healthy Environment (1997)

Well Child Health Care (1998)

Additional Publications

Early Head Start National Resource Center. (1999). 

Giving children the earliest head start: Developing an individualized approach to high-quality services for pregnant women 

(EHS NRC Technical Assistance Paper No. 3). 

Washington, DC: Head Start Bureau.

Early Head Start National Resource Center. (2000). 

Developmental screening, assessment, and evaluation: Key

elements for individualizing curricula in Early Head Start

programs (EHS NRC Technical Assistance Paper No. 4).

Washington, DC: Head Start Bureau.

Early Head Start National Resource Center. (2003). 

Early Head Start program strategies: Responding to the 

mental health needs of infants, toddlers, and families.

Washington, DC: U. S. Department of Health and

Human Services, Head Start Bureau.

Early Head Start National Resource Center. (2004). 

Pathways to prevention: A comprehensive guide for supporting infant and toddler mental health. Washington, DC: U.S.

Department of Health and Human Services, Head Start

Bureau.

Harden, B. J. (1997). 

You cannot do it alone: Home visitation with psychologically vulnerable families and children. 

Zero to Three, 17(4), 10–16.

Head Start Bureau. (2003). 

Adult health. Head Start Bulletin, 75.

Head Start Bureau. (2003 ).

Weaving connections: The Health Services Advisory

Committee. Washington, DC: Author.

Head Start Information and Publications Center. 

Health tool kit. Available on-line: http://www.headstartinfo.org/infocenter/health_tkit.htm.

Mann, T. (1998). Promoting the mental health of infants and

toddlers in Early Head Start: Responsibilities, partnerships,

and supports. Zero to Three, 18(2), 37–40.

National Center for Cultural Competence. (2002). Rationale

for cultural competence in primary health care (policy brief).

Washington, DC: Author.

National Center for Cultural Competence. (2003). A guide to

choosing and adapting culturally and linguistically competent

health promotion materials. Washington, DC: Author.

Taylor, L., and Willes-Jacaobo, L. (2003) The culturally competent pediatrician: Respecting ethnicity in your practice.

Contemporary Pediatrics, 20(6), 83-105.

Tonniges, T. F. (1997). Promoting optimal health in child-care

settings. Healthy Child Care America, 1(3), 1–5. 

U.S. Department of Health and Human Services. (2002). 

Bright futures: Guidelines for health supervision of infants,

children, and adolescents (2nd ed., rev.). Washington, DC:

Maternal and Child Health Bureau. Available on-line:

http://www.brightfutures.org

28

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER TECHNICAL ASSISTANCE PAPER NO .7 
EARLY HEAD START NATIONAL RESOURCE CENTER

National Organizations

The American Academy of Pediatrics 

141 Northwest Point Boulevard

Elk Grove Village, IL 60007 

Phone: 847-434-4000

Web: www.aap.org

KidsHealth (Created by the Nemour’s Foundation)

Web: www.kidshealth.org

La Leche International

P.O. Box 4079

Schaumburg, IL 60168

Phone: 847-519-7730

Web: www.lalecheleague.org

National Immunization Program 

Centers for Disease Control and Prevention 

1600 Clifton Road, NE 

Mailstop E-52 

Atlanta, GA 30333

National Immunization 

Information Hotline: 1-800-232-2522 (English); 

1-800-232-0233 (Spanish)

National Maternal and Child Oral Health Resource Center

Georgetown University

Box 571272

Washington, DC 20057

Phone: 202-784-9771

National SIDS and Infant Death Program

1314 Bedford Avenue, Suite 205B 

Baltimore, MD 21208 

Phone: 410-415-5093 or 1-800-638-7437

NICHD/Back to Sleep

Building 31, Room 2A32, MSC 2425

31 Center Drive

Bethesda, MD 20892-2425

Phone: 1-800-370-2943

Web: www.nichd.nih.gov

15
EARLY HEAD START NATIONAL RESOURCE CENTER