Vaccines and Developmental Milestones

Vaccines and Developmental Milestones: What You Can do to Help Young Children Stay on Track 

April Powell: Welcome, everyone, and thank you for standing by. My name is April Powell, and I am the resource program manager for the National Center on Early Childhood Health and Wellness, and I'm so pleased to welcome you all to today's webinar. But before we begin, I have just a few announcements.  

First, all participants will be muted throughout the entire presentation portion of the webinar. There will be a slide that's shown through the webinar system that only the presenters will have access to switching slides. If you have a technical or a content question, please type it in the Q&A box of the webinar in the bottom left-hand corner of your screen. There is a lot that we'll be covering within the next hour, but you can submit your questions at any time just by typing it in the Q&A box. Only the webinar staff will be able to see your questions, and some we'll be able to answer right away.  

Some, that we don't have time to cover, we'll answer via MyPeers, which we'll talk about later. There will be polls that will come up during the webinar. You can click directly on your screen to answer the polls. At the end of the webinar, please stay at your computer screen, and an evaluation will pop up. At the bottom of the evaluation, there will be a link for you to get your certificate. Additionally, before the close of business today, you'll get an email with a link to the survey in case you weren't able to get to it at the end of the webinar.  

Also, within that email, you'll get a PDF version of the slides and a handout. Today's webinar is also being recorded, and there will be a link to the recording in the email that you'll get today before the close of business. That takes care of all of our housekeeping items, so now I'm going to turn it over to Kimberly Clear-Sandor.  

Kimberly Clear-Sandor: Thank you, April, and welcome everybody, to our quarterly Child Care Health Consultant webinar. We are really excited. We had almost 1,400 people register for this webinar, and we're doing these quarterly webinars to support you in the work that you're doing, and we're excited to see that so many people are interested in the topics that we've been putting out there.  

We recently finished oral health, abusive head trauma, and our other webinar was on safe sleep. So, please look on the ECLKC website and look at those if you enjoy today's webinar and find that they will be helpful for you moving forward. So, we're excited you're here, and we're happy to have expert guests with us from the Centers for Disease Control and Prevention that are going to share their expertise with all of you today and all of the good work that they have. So, let me just take a minute and do some quickie introductions.  

My name is Kimberly Clear-Sandor. If you've been to other webinars, you've seen me there chatting with all the experts as they come in. I work as a senior training and technical assistance associate with the National Center on Early Childhood Health and Wellness, and as a nurse and family nurse practitioner, I've been working with children and families for more years than I can imagine now, mostly in underserved and early care and education programs.  

I also work—when I don't wear that hat—I work as a child care health consultant in the Connecticut and New York area, and I also work with the Connecticut Nurses Association. So, lots of stuff about health, and I get to match my two passions with nursing and children and families. So, that's a little bit about me. Our first speaker from the Center for Disease Control and Prevention is Jenny Mullen, and she is the co-lead for childhood immunizations at the Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases. In this role, Jenny helps lead efforts to develop research-based messages and materials to conduct communication activities that raise awareness among parents and health care professionals about the importance of vaccinating children according to the CDC's recommended immunization schedule.  

That's why we're lucky she's here with us today. Prior to joining the NCIRD, Jenny worked at CDC's Injury Center and the National Center for Health Marketing, and she's also worked in the private sector at different communication firms. She has a BA in English from Oberlin College and a master's in Public Health and in Health Behavior and Health Education from the University of North Carolina at Chapel Hill. And our second presenter is Katie Green. She is a health communications specialist with the National Center on Birth Defects and Developmental Disabilities at the Center for Disease Control and Prevention in Atlanta.  

Ms. Green provides health communication expertise to CDC's Learn the Signs, Act Early, and she's going to share all that good stuff with you today. It's a great national program to improve early identification of children with autism and other developmental disabilities. Her communications work focuses predominantly on research development and dissemination of information, tools, and resources to share and help parents learn about developmental milestones, warning signs of delay, and the importance of acting early. Ms. Green joined the Learn the Signs, Act Early in 2007 following five years as a health educator in the CDC's birth defect prevention efforts. Ms. Green received a Bachelor of Science in Behavioral Health from Pennsylvania, an MPH from Georgia State, and maintains professional certification as a health education specialist. So, we're really excited to have such great speakers from the CDC coming to share the wonderful work that they're doing.  

So, now that you know a little bit about us, we'd just like to take one second to hear a little bit about you. And we're wondering—oftentimes our audience is very diverse and works in different places or may work in both places—we're just curious in who is attending today. Who is working in—primarily at a child care setting? Who works primarily in Head Start, Early Head Start? Or do you possibly work in both? So, you can go ahead and start ... Oh, you guys are good. You're already clicking away. I see those coming in. We have a lot of Early Head Start and Head Start and child care folks coming in.  

You guys are good—you're good at these polls. We're also going to be ... In addition to the poll feature, we will be using the Q&A box as we go along. So, it's good to watch you expertly use your fingers and typing into those little spots. So, I'm going to skip right to the results. I know some are still coming in as more and more folks are joining us, and we'll show you how that looks on a bar graph there. So, we have a great, great group. So, we're excited to have you here, and with that, I'm going to briefly show you the objectives for today.  

We're going to have ... Jenny and Katie are going to go over the importance of vaccines and developmental milestones, tracking for early childhood development, we're going to talk about some different strategies that all of you can use, and we're going to review a lot of wonderful resources that we hope you find helpful in all the great work that you do. And with that, I'm going to turn it over to Jenny.   

Jenny Mullen: Well hello, and thank you so much for having me on this webinar today. As Kim mentioned, my name is Jenny Mullen, and I'm the lead for CDC's childhood immunization campaign, and I'm really excited to speak with you today about the important contribution that immunization makes to early childhood development and resources that you can use in your work with Head Start and child care programs. So, first of all, I just want to share I have no financial relationships to disclose. Immunization is a critical component of early childhood development. When children are healthy, they can stay on track with meeting their developmental milestones, and my colleague, Katie Green, is going to be talking more about developmental milestones after I finish my presentation.  

It's also important to recognize that health and safety practices, including immunization, are the foundation of quality Child care settings. School readiness begins with good health. Immunizations are a key factor in early childhood development, and they can also provide protection from serious illnesses during the early years and beyond, and immunizations can prevent outbreaks of measles, flu, and pertussis in early child care settings.  

The CDC recommended schedule protects children ages 0 to 6 years old from 14 vaccine-preventable diseases, which are listed here on the slide. The schedule is designed the way that it is to provide protection early in life before children are exposed to potentially life-threatening diseases. The CDC schedule is officially endorsed by the American Academy of Pediatrics and the American Academy of Family Physicians. And over the years, CDC's audience research has revealed that many parents aren't aware of some of the diseases that can be prevented by vaccines, like Hib or pneumococcal disease, or they may be aware of diseases but they don't necessarily appreciate how serious they are, for example, in the case of chicken pox or flu. And we have a lot of resources to educate parents about vaccine-preventable diseases, including the listicle that you can see one image of on the slide here, and that's a piece that can be shared over social media.   

Kim: It's amazing to me, Jenny, that there are 14 diseases that are now preventable through vaccines, and I remember, as a child, adults having paralysis and mobility challenges from polio, but you don't see that anymore. It's been virtually eliminated in the United States. So, because you don't really see it anymore, a parent of a—I'm not going to reveal my age or anything—but a parent of a younger child, you may not have any of this in their recent memory, or, like you said about the seriousness of a disease like chicken pox or flu, if they'd had it themselves as a child, they may not really think about it. So, it is amazing that immunizations are able to make such strides in—in ensuring children don't get these diseases, so much so that we don't even see it or have it in our awareness.   

Jenny: Yeah, you're right. It is incredible, and we're really lucky that we can protect children from so many diseases now through the on-time vaccination. Outbreaks of vaccine-preventable diseases have occurred, though, in child care centers. In recent years, there have been outbreaks of measles, and whooping cough, and also of chicken pox. This screenshot shows a recent outbreak of measles in Johnson County, Kansas, which started in a child care center. Unvaccinated children in a child care center or home are at risk of getting diseases if they're not vaccinated, and that includes babies that are too young for a vaccination and children who cannot be vaccinated due to medical conditions. Children who are not caught up on their vaccinations may also be excluded from child care in the event of an outbreak.   

Kim: And Jenny, early care and education programs work so hard to track records, encourage folks to get their immunizations. How could outbreaks happen?   

Jenny: You know, that's a really good question, and we get that a lot, and you know, a really good way to understand how that can happen is to think about some of the measles outbreaks that we've had. Now, measles is a disease that thankfully we don't see a ton of in the U.S. anymore, but it is in circulation in a lot of countries in the world. So, when unvaccinated people in the U.S. travel outside of the country, they can get measles and bring it back into the United States, and measles is extremely contagious.  

So, if they come into contact with an unvaccinated child or maybe a baby who's not old enough yet to get vaccinated, they can easily spread that disease, and then if that child goes to a child care center, it's easy for measles to then spread to other unvaccinated children or adults, or even to those babies that are too young to have received their MMR vaccine yet.  

So, you know, the contagiousness of these disease and how quickly they can spread when they're introduced into a community where not everyone is fully protected through immunization is really kind of the core of how we often see these outbreaks occur. But the good news is that, for example, in the case of measles, our MMR vaccine is highly effective at preventing measles. We see very, very few cases of measles among fully-vaccinated individuals. So, we do have this really important tool to help prevent outbreaks in child care centers, as well as other community settings. So, that's a great question.   

Kim: Thank you. Yeah. 

Jenny: Whether you're a child care health consultant in child care, or a Head Start program, making sure that children are immunized according to CDC's recommended immunization schedule is the best way to ensure that they're protected from 14 very serious diseases. The recommended schedule provides immunity early in life before children are exposed to potentially life-threatening diseases. Each vaccine is tested during the licensing process to be sure that it's safe and effective for children to receive at the recommended ages, and when children get behind schedule, just for one reason or another, that can put them at risk of becoming ill with a disease during that time that they're unprotected. So, making immunization a priority in the early child care setting really is critical, and it's all about fostering an environment that promotes health.  

And today, I'm going to talk with you about three different ways to do this. One is checking immunization records to make sure each child is up to date on their vaccinations. Also, we're going to talk about educating staff about immunization and ensuring that staff are vaccinated themselves, and also talking about educating parents in Head Start and Child care programs. So, let's talk first about checking immunization records. As a CCHC, you could ensure the program is aware of which children are up to date and those that are due for immunizations. Checking immunization records is really an ongoing process.  

You may receive health forms at the beginning of the school year or as children receive their annual exams throughout the year. And it's really important to work with the program to develop a strategy that ensures all children are up to date. If a child is behind on her vaccines, consultants can work with the program to decide the best way to follow up and inform the child's family. And actually, here on the slide there's a URL for CDC's Easy to Read schedule, which is a great way to check and look at what vaccines children should receive at each age. Parents should request a vaccine record from their doctor as official proof of vaccination to show their child care program, and they should keep this record in a safe place. It can also be helpful for parents to track shots themselves in order to see what's coming up and what shots their child may be missing, and then they can discuss upcoming or missing shots with their child's doctor.  

This slide shows a tool that parents can print out from our website and use to record and track both their children's immunizations and their developmental milestones. But your state immunization program or doctors in your community may also have other versions of immunization trackers that they hand out, and those are definitely an option to use, as well. All doses of the recommended vaccines are needed for the best protection possible against these diseases, and that includes the third and fourth doses of vaccines. But we do know from our immunization coverage data that many parents find it challenging to get these final doses. By encouraging them to get these final doses, child care centers can help ensure that the children get fully immunized. As children get older, different vaccines are recommended at different ages. Head Start and child care programs can help ensure that parents are aware of this, and a tool like this can help.   

Kim: This is really nice, Jenny, and I think it's such a nice opportunity, as health consultants work, to get to work with the program, with the families, to get everybody up to date. It's nice to give families a couple different strategies, and I love the idea of a parent keeping their own record and thinking about what's coming up as they go to the doctor's visit so that they're not surprised, and they have that opportunity to ask some really thoughtful questions instead of getting ... I get text messages from my husband when he brings the kids in, "Hey, what am I doing?" So, if you're thinking about it before you go, it allows the program to provide some information, and then it helps them have a successful visit.  

And I think you know it's also ... Families are busy and the well-child exam is really busy, and encouraging families up front to get copies of those immunization records is such an important piece of our work and our support of families because those visits are quick, they're frequent, and it's hard to remember everything that you might want to bring back to the program. And now we even have some health care provider offices that charge for duplicate records. So, it's nice to support our families and let them know ahead of time what we're going to need as they do fulfill their immunization requirements.   

Jenny: Oh absolutely, and one thing that can make that a little easier, actually, are immunization information systems. These are also known as immunization registries, or as IIS's, and they can just really make the whole process of tracking immunizations for a program much, much easier. IIS's are confidential, computerized databases that record all the immunization doses administered by participating medical providers. So, in other words, what that means is that when a health care provider, like a nurse, gives a vaccine to a child, they enter this information into their state's IIS. Every state has an IIS, except for New Hampshire's, who is actually under development now.  

The IIS is probably the best way to get the most accurate, up-to-date immunization information for a given child. Head Start programs may already be using IIS, but this may not be the case for child care programs. Child care staff will likely find it far easier and faster to just look up the immunization records for children in their program through the IIS rather than go through the process of reaching out to parents to get the information and then all the follow up and the record keeping that goes along with that.  

In some states, child care providers may be able to access the IIS to see which immunizations children have already gotten. And parents can ask their child's doctor for immunization records from the IIS. You can contact your state or local health department if you have questions about how to access your state's IIS, and your state immunization program or your state immunization coalition may be able to provide training on the IIS.  

Kim: That's really great information and really great to know because as families are moving around or you have difficulty communicating, either with letters, or phone calls, or however you may do it, it gives somebody direct access. And I know there's tons of variability between the states on who can access and get the information. It's also good to think about when you're learning how to use the system or how—if you're able to use it and how it works—it's good to know how the information is put in, if there is any lag time. Especially with those infant, those first two years of life, there is such a frequent and large amount immunizations going on every couple of months that you would hate to think somebody was unimmunized, but just—the record-keeping system at the registry wasn't yet caught up. So, it's good to even understand how do you access it and then understand how does that data get input so that you're ensuring that you're interpreting it the right way on the other end.   

Jenny: Oh, absolutely. Let's move on and talk about the importance of educating Head Start and child care staff about immunizations. I encourage Head Start and child care staff to become educated about vaccines, and they don't have to become experts on this topic, but there are materials that can help them be prepared to answer some of the more common questions that parents ask about vaccines, and I'm going to highlight some of those materials in just a moment. But going through these ahead of time may help staff feel more comfortable discussing the importance of following the immunization schedule when they're talking with parents.  

So, to be more specific, I encourage staff to learn about vaccine-preventable diseases, including their symptoms, what to do if a child gets a vaccine-preventable disease, for example, some diseases, like measles and whooping cough, are notifiable, meaning that you must report them to the health department, and there may also be special procedures that you'll need to follow in the case of a disease outbreak. And your state or local health department can provide you with that guidance.  

I also encourage staff to learn about vaccine requirements for your state and CDC's recommended vaccine schedule, which may include more vaccines than those that are actually required in the state. Also, encourage folks to learn about common questions parents may have about vaccines and vaccines that are recommended for Head Start or child care staff. And then, when you're talking with parents, key messages for child care providers to tell parents include look into your state's child care vaccination requirements.  

Also, tell parents that vaccines protect infants and children from 14 serious diseases, and vaccines protect their children, but they also protect other children in the Head Start or child care program. For example, some children are too young to be vaccinated with immunization, for example, the measles example we discussed earlier, or they can't be vaccinated due to medical conditions, such as cancer, and vaccines help protect those children, as well. And let parents know that the Vaccines for Children Program provides eligible children with vaccines at low or no cost, and I'll talk a little bit more about this program a little later in my presentation. So, a great place to start learning about childhood vaccines is the CDC's Vaccine Website for Parents. This website is a one-stop shop for vaccine information, including information about the immunization schedule, vaccine-preventable diseases, how to prepare for a vaccine visit, records and requirements, and just really a whole lot more.  

It's also a great place to find resources to share with parents, like infographics, or videos, or posters, or listicles, and I'm going to also go over some of those resources in more detail in just a moment. And there's also additional ways that you can learn about immunization if you're a child care health consultant in a child care or Head Start program. You can contact the local or state immunization coalition or health department to see if they can provide in-person training to Head Start or child care programs in your state.  

Many state-level coalitions and health departments organize annual immunization conferences and those may be helpful to attend. If you're a clinician, you can take advantage of CDC's free online trainings for health care professionals. We offer a variety of trainings that are available on demand or live, and many of these offer CE credit. You can refer to websites of other credible organizations as well, such as the American Academy of Pediatrics, the Children's Hospital of Philadelphia's Vaccine Education Center, or Vaccinate Your Family. These are all good resources that you can share with parents, especially those who may not trust the CDC.   

Kim: Jenny, I just want to jump in there. I know you're showing so many great resources with the links on your slides. I do want to let you know that ... Just reiterate that April will be sending out a PDF of the PowerPoint after the webinar with your evaluation link. So, you will ... I don't know if many of you are trying to write them down really fast right now, but you will be getting them in the PDF of the slide presentation, so maybe you can give your hands a little bit of a rest.

Jenny: Oh, that's great. I'm so glad you mentioned that because there are a lot of URLs in these slides and it's great for people to be able to locate those resources later on after this webinar, so, thank you so much for mentioning that because some of them are long, they might be hard to jot down quickly.  

So, I'm on this slide now about the Vaccines for Children Program, and this is something that I just mentioned briefly a moment ago and I want to take a minute just to talk about it in more detail. The Vaccines for Children Program, or VFC, is a federal program. It's managed by CDC, and it provides vaccines at no cost for children who are age 18 years old or younger who meet certain criteria, which are listed here on the slide. If a family gets vaccines through the VFC program, the vaccines themselves are free, but families may be asked to pay a fee for the office visit. 

 Across the country, there are 44,000 VFC providers, and these include private doctors, private clinics, hospitals, public health clinics, community health clinics, and schools. If a family falls into one of the categories that is listed here on this slide, they can ask their providers if they participate already in VFC. While CDC doesn't have a national online VFC locator, unfortunately, many state health departments do have online locators. But if your state does not have an online locator, you can get a list of VFC providers for your state by contacting your state's immunization program manager, and a link here on this slide will take you to the contact information for all those state immunization program managers. So, those are the folks you can reach out to find all the VFC providers in your state.  

Head Start and child care workers should also be vaccinated themselves, and that's both to protect themselves from these diseases, as well as to avoid spreading them to the children that are in their care. And child care workers can find out what vaccines they may need by taking CDC's adult vaccine quiz. Some states also require that child care workers be vaccinated against certain diseases. California, for example, passed a law in 2015 that requires child care workers to be vaccinated against flu, measles, and whooping cough. Rhode Island has a law that requires child care workers to be vaccinated against flu, measles, whooping cough, and also chicken pox. So, you definitely want to check in to what the requirements may be in your state. 

Kim: Yeah, and I always spend some extra time with the teachers in the infant rooms, the toddler rooms, and those that float in and out, just trying to give them the ... Stressing the extra importance with the little ones who ... Our 6 months and under children can't get the flu shot, so they really depend on their caregivers to be the ones protecting them by not ... From them, not passing it to the children themselves. And with the whooping cough, they start that series, but that immunity doesn't really kick in until they're further along in the series.  

So, you know, that I think over the years we've seen so much more awareness about the need for vaccination of adults with whooping cough, especially those that are around young children. And I think child care health consultants can really play a special role in talking to the teachers, explaining why it's important, not only for themselves. Teachers are often all about the kids, and when you share that how important it is for the health of their kids—you know, there's a lot of myths around so many different vaccines that being able to talk to somebody about it is really great. So, I love that they have that little adult quiz online because that becomes something you could do with your staff and then use that as a concrete something to talk about it with.

Jenny: Yeah. That is a great tool, and it's also great because adults need to protect themselves from these diseases. So, it just is so important for so many different reasons. Educating parents about the importance of immunization as soon as they enter a Head Start or child care program is a great idea. But there are also several specific times during the year when CDC has a special focus on promoting immunization. These immunization observances provide another opportunity to educate parents and encourage vaccination, and some of these include National Infant Immunization Week, which we just wrapped up in late April, and coming up soon, National Immunization Awareness Month, which is during August, and you can find out more about these events by visiting the websites that are listed here on the slide.   

Kim: And consultants may think about working with their programs to do different things when—when these observances are going on. That's a great time for you to propose maybe hosting a lunch and learn, or attending a PTO meeting, or putting up a bulletin board, because there's often so many great messaging and posters and things that are easy to share that becomes an easy—an easy thing for a health consultant to be able to take that and work with the program to see if they want to promote some of that information.   

Jenny: Oh, definitely. So finally, let's talk about how Head Start and child care programs can educate parents about immunization and connect them to credible resources. And we all know there is a lot of information out there online about childhood vaccines, and unfortunately not all of it is accurate. Head Start and child care staff can encourage parents to seek information from credible sources.  

As I mentioned earlier, the CDC, the American Academy of Pediatrics, the Children's Hospital of Philadelphia, and Vaccinate Your Family are all credible websites that you can feel comfortable pointing parents to for more information about vaccines. And there's also some other ideas listed here on this slide about ways that child care programs can share credible information with parents. You can put CDC immunization schedules and fact sheets in new parent packets, hang posters and print ads where parents can see them. Also, you may want to consider sharing CDC immunization articles and emails that are sent out to parents, or we can put a CDC web button on their website, and that will be something parents can click on and it just points them directly to CDC's Vaccine Website for Parents.  

And you can share digital materials and immunization messages over Facebook and Twitter. This slide shows CDC childhood immunization resources that can be shared with parents via Head Start or child care newsletters, websites, or social media channels, and we have lots of stuff. We've got fact sheets, infographics, listicles, and a lot more. CDC also has fact sheets on vaccine-preventable diseases and vaccine safety that staff can download and copy for parents, and you can access these resources by the URL that's listed here on this slide. And CDC also has resources available in Spanish, including disease fact sheets, a listicle, an infographic, and a growth chart for health care provider offices, and you can access these at the URL listed on this slide.  

And I mentioned earlier that it's a good idea for Head Start and child care staff to be familiar with common questions that parents ask about vaccines, and this slide shows screenshots of CDC's frequently asked questions about infant immunizations, and a few examples of some of the questions that are covered in this piece include, are vaccines safe?  

Can vaccines overload my baby's immune system? What's wrong with delaying my baby's vaccines if I'm planning to get them all eventually? This fact sheet is written for parents of children ages 0 to 2 years old, and CDC developed this together with the American Academy of Pediatrics and the American Academy of Family Physicians, and it's available in English and Spanish, and you can either view the questions online or you can download a PDF that you can print out and make copies of. Head Start and child care programs can also link to this page from their websites. It's a really great resource. I encourage folks t check it out. I'd also encourage Head Start and child care staff to review CDC's immunization schedules, which are updated every year and endorsed by the American Academy of Pediatrics and the American Academy of Family Physicians.  

CDC has easy-to-read, parent-friendly versions of these schedules available in both English and Spanish. And CDC also has a new online quiz that parents can take to find out which vaccines their child may need. It provides information for children from age birth through 18 years old, and it's a really nice resource that you can promote to parents as they're entering Head Start and child care programs. Another good resource is CDC's 60-page Parent's Guide to Childhood Immunizations, and you can order up to 25 hard copies to distribute, or you can also encourage parents to order a copy for themselves.   

Kim: Yeah. You are sharing so many awesome resources, and I know there's some questions about answering those hard questions. And I think all of these infant fact sheets and these parent's guides are going to be wonderful resources that consultants can bring to their program, talk to staff, talk to their director, and think about how they can support their families individually, you know, in the program. So, I'm glad everyone's getting a copy of the PDF so they can get all the links.   

Jenny: Yeah. There are certainly many. So, just to summarize what I've shared today, immunization is a key component of early childhood development, and it's very important for Head Start and child care programs to make immunization a priority and foster an environment of health by tracking immunizations, educating staff, and educating parents. And there are many ways that you can educate parents using CDC's resources, as well as resources from other credible organizations.  

So, I know that we have limited time, so maybe I'll just take a few quick questions now—just one or two—and then we may have more time at the end to cover some additional questions. Let me take a look here at some of the questions that have come in through the chat. I am seeing, as you mentioned, Kim, a number of questions about how to talk to parents that may have concerns about vaccines for their children, or questions about the safety, or importance of vaccinating according to the schedule.  

And, you know, parents, we have found, really fall along a broad spectrum of interest, and concern, and acceptance around childhood vaccination. So, I think it's important to know that some parents may have just some questions that they need answered, and then some are going to perhaps require a number of conversations over a period of time to help them feel really comfortable with the decision to immunize on schedule. I did highlight a number of resources earlier, such as the Frequently Asked Questions and the Parent's Guide, also the content on our website, that you can use to help answer some of the common questions that you may get about are vaccines safe, are these diseases still really a threat in the U.S., which are, I think, probably some of the more common questions. But I would also just try to remain empathetic to parents, understanding that really everyone is trying to make the best choice for their child. All these parents want is to keep their children as safe as possible and bring them up with the best possible health.  

So, your taking the time to really understand their questions and help them find resources to help answer them is really important to build trust over time. And if parents have questions about their specific child, I would direct them to have those conversations with their child's health care professional because they'll be in a great position to talk about the health around that specific child and whether a particular vaccine is safe for that particular child.  

The other thing I would mention is I think it's really helpful to kind of reframe the conversation away from, are these vaccines safe, because we know there's lots of great safety data collected over many, many, many years, but then to talk about kind of why are these vaccines important and to talk about the fact that children that are not vaccinated are at risk for these diseases, and many of these diseases still occur in the U.S. and the risk that's taken by not following the schedule. Try to kind of reframe it around kind of what are the advantages of vaccinating on schedule, and those advantages really have to do with protection and knowing that your child is less likely to get one of these very serious diseases.  

So, this was kind of a long answer to that question. But I think that there are a number of questions kind of along those topics. I'm seeing, also, some questions about the 60-page parent guide that I just mentioned. I guess I should have started what I was saying about resources to clarify that all of the resources I'm sharing with you today are all free of charge. They can be downloaded from our website and printed, and made copies of—as many as you'd like to give out for free. And the things that can be ordered from our warehouse are also available free of charge, so feel free to use those, and I welcome and encourage you to do so.  

So, in the interest of time, I think I'll go ahead and just stop there and just briefly put up this slide, which has my email address, and please feel free to reach out to me if you are looking for resources you can't find and I can point you to them, or if you have additional questions, feel free to reach out to me. And with that, I will pass it along to my colleague, Katie Green.   

Kim: Thank you. Thank you so much, Jenny. I also want to encourage folks ... We will be answering questions that we can't get to on the MyPeers Child Care Health Consultant online community, and if you're not a member of MyPeers, we'll show you how you can become a member of MyPeers. But I don't want you to feel like your questions won't be answered. There are a lot of great questions that came in, so we'll be sure to get those up for you. So, as we turn over to Katie Green, I was just wondering ... She's going to share with us the Learn the Signs, Act Early materials that CDC has. I'm wondering if any of you have used them in your program—a quick yes or no just to give us an idea of who our audience is out there today. I know it's a great resource. It's colorful. It's easy to read. It's really parent friendly. And oh, look at those numbers coming in, Katie. Doesn't that warm your heart to see all these folks?   

Katie Green: It's great, and I think we're going to flip some of you today, I hope. 

Kim: That's right. All right, I'll move you ahead there because I know we're starting to run late on time. So lots and lots of new folks to bring on board.   

Katie: OK. Good. Good. I love a challenge, and thank you for those of you who are using the materials, and those of you who may be using the materials but don't know them by their official name of Learn the Signs, Act Early. So, my name is Katie Green, and I've been with Learn the Signs for well over 10 years now—and yes, the program has been around that long—and we get better every year, I have to say.  

And I'm thrilled to be talking with you this afternoon because apart from my 4 and 6 year olds, Learn the Signs, Act Early is really my favorite thing to talk about. So, the way that I explain what Learn the Signs, Act Early is, even to my parents over and over again, is basically our work is to empower parents and other care providers to learn the signs of typical development—that's what we call developmental milestones—and to act early on developmental concerns so that children and family can get the services and support that they need as early as possible, and that's what we're all about. OK. So, the focus of Learn the Signs, Act Early and how we go about that is really all about engagement and empowerment, and that's really why I love Learn the Signs as much as I do. 

Our goal is to develop and disseminate high-quality, research-based, parent-friendly, and, by the way, free materials to engage parents and providers in ongoing developmental monitoring from birth through age five. We want to encourage parents and caregivers to celebrate their children's milestones. This isn't just about looking for developmental delays or looking for signs of a developmental disorder. This is about engaging in your child's development, keeping track, stimulating, looking for opportunities to help support their development, and to celebrate along the way because this is a big deal. Your child's earliest years are so very important, as you all well know.  

And then, of course to provide clear and concrete guidance about what to do if anyone ever does become concerned about a potential developmental delay or disability. OK, so family engagement is huge, and that's really, you know ... Learn the Signs, Act Early tools and resources, the app that I'll be talking about, is really a tool for family education and family engagement.  

And we know that monitoring a child's development is really a partnership between the family and the early care and education provider, as well as the health care provider and others, and really anyone who knows the child and spends time with the child. It's really a big group effort to monitor a child's development and make sure they're on track for their age. So, engagement with families can really be key in identifying concerns early and connecting families to services. Parents with more knowledge of child development are more engaged and have positive parent-child interaction, better observation skills, tend to be more empowered to identify developmental concerns at home, and monitoring development may increase the likelihood of taking action if there ever is a need to follow up after developmental screening.  

So, it's ... If you think about going to your doctor's office or in a child care setting, having your developmental screening, this is the first time you've ever been asked these questions about your child, and depending on your responses, it may indicate that there's a developmental concern, and it's the first time you've really thought about that or considered the possibility of a challenge or concern. And I think your process of that and being ready to deal with that and take action may be different if all along you were engaged from day one and you were given parent-friendly tools to use at home and to share among other care providers, so you can see for yourself and track for yourself their progress in different areas, their strengths, as well as potential concerns or areas that they will need more support.  

So, Learn the Signs, Act Early materials can help with this engagement and really work to increase parent knowledge. The checklists are tools that facilitate positive two-way communication. The parent, of course, can use the tools at home and be prepared to talk about what they observed. And it helps keep the conversation positive when the care provider has something objective to talk from. So, these are really an important tool to be using in conversations about—about development on a regular basis, and especially when there is concerns. So, working closely, I want to encourage you all, as soon as you have the chance, to check out the Learn the Signs, Act Early web page that is targeted for child care providers and early educators. And on that page, you will find the information for two fact sheets and really sort of framing up Learn the Signs, Act Early, its resources, and its value to both Child Care Development Fund grantees, as well as Early Head Start and Head Start programs and other types of child care providers and early educators.  

So, working closely with our partners at the Administration on Children and Families, we worked hard to ensure that our materials would be responsive to the new Child Care Development Fund requirements, as well as the Head Start Program Performance Standards. And these fact sheets, the tip sheets on there, the primers, they sort of make that connection very clear so that you all, and the folks that you're talking with Learn the Signs about, have a clear understanding of how these tools and resources can help address both those requirements and those standards.   
Kim: I think it's so great that you have those because—and that you've thought about it—because the two ... If you're in child care or you’re a Head Start, Early Head Start program, the systems are ... Not that the immunizations ... A child grows and develops in a different way, but just depending on that setting, you may be required to do different things. So, I think it's really thoughtful that you do have such forms that really can clarify that for folks.   

Katie: Yeah absolutely, and as hard as we tried to make this really easy and intuitive for parents, we really do the same for our key partners in child care and early care and health care places. So, we want to sort of introduce it in a frame that you are familiar with, give you some concrete examples of how you might be able to use these tools and resources in your setting, and provide you information about how to obtain the resources.  

So, you'll find all of those on that web page, and on the two primers that I'm showing you there. OK. Next slide. So, I'm giving you just a sneak peek. This is our bread and butter of Learn the Signs, Act Early and really a big and fun part of my job, and that is producing the parent-friendly, research-based, high-quality materials. So, I'll take you through a very quick tour, but I'll invite you to check them out on our website as well. In the top left-hand corner, you'll see—which is really the core of our materials—and that is the developmental milestone checklist. You'll see the one, your baby at 9 months, there, and it covers all domains of development. It includes warning signs or potential red flags, so when you should especially bring up a concern to your health care provider. And on the back of this new version, it includes tips for how you can support your child's development. 

And so, we have the individual tip sheets and checklist that can be photocopied over and over and shared with parents, and then we have the "Milestone Moments" booklet, which is our most comprehensive piece, and that includes all of the checklists from birth through age 5, as well as those parenting tips and activities and when to act early and what to do when you have a concern, also very popular and free in packs of 10 on our CDC website. We have some really fun materials, "The Amazing Me," and "Where is Bear?" children's books. So, these are children's books that are intended for 2 year olds and 3 year olds, and they're really just a fun story for 2 and 3 year olds, but at the same time, they're kind of sneaky and genius in that as the parent or caregiver is reading to the child, they're learning about the milestones that your 2 year old or 3 year old should be showing.  

So, in the form of a story and kind of calling out for the parent or the child care provider some milestones that you should be looking for, so that the character in the book is displaying as part of the story and things that you should also be seeing in your 2- or 3-year-old child. And we're excited that we're working on a book for 1 year olds right now as we speak. Right there in the middle is also something very important I'd love to encourage you to check out if you're not familiar with it already. It is promoted on the ECLKC site, and that is our "Watch Me" training. "Watch Me, Celebrating Milestones, and Sharing Concerns," and that's really what it's all about. It's about how to use Learn the Signs, Act Early resources to both celebrate milestones and share concerns and why child care providers, in various capacities, are in a perfect position to be able to do so and provide support for doing so in the best way possible, and that provides free CEU. So, please encourage folks to check that out. The "Milestones in Action" is actually a video, an image library.  

So we, over the course of years, have been able to capture an image, a photo, or a video of just about every single milestone from 2 months of age through 5 years. So, these things are—as hard as we tried to make them—to use parent-friendly language, sometimes milestones are just kind of hard to describe with words. And it makes a big difference to be able to see them in a real human baby so you know what you're looking for, and so that's a great resource for child care, as well as parents, and it's something that we pull and integrate into the Milestone Tracker app, which I'll talk about in a second. The "Check Your Developmental Milestones" brochure is really a promotional piece. It gives just a taste of the important milestones to be looking for, what to do when you have concerns, and then of course links off to more information and resources.   

Kim: And I get excited about all your stuff because it's so parent-friendly. It's so easy to read. It's colorful. They really become a nice thing to do with families, and with staff. I've shown some of the videos—talked to some of the staff with some of the videos, and they've done so much child development, they see so many children development, but they still enjoy those videos. So, I think it's very validating, as well. It's always a great resource.   

Katie: Well, thank you. Thank you. And so talking about CDC's milestone checklist, which is really sort of the core of our suite of materials, a few important things to know is that our milestones are adapted from the American Academy of Pediatrics', "Bright Futures," and their, "Caring for Your Baby and Young Child," publications. So, what we did was take those two sources, look very closely, try to match the milestones with just about every well-child visit, and then really examine the language and provide examples of what the milestones may look like in very parent-friendly terms. So, they use plain language, everyday examples. We have them for ages 2, 4, 6, 9, 12, and 18 months, and then of course 2, 3, 4, and 5 years. They are not sort of the average. They are not at the 50th percentile, but you can say that they are milestones that really most children should have should reach by the designated ages. So, that is probably an important distinction that you should be aware of.  

So, they have ... So the milestones, certainly if they are missing milestones, that may be more of a concern. It's not just a 50/50 chance as to whether or not those milestones have been met by that age, but really these are milestones that most children have met by those given ages. And a very important thing to note is that this is, as I said, a parent engagement and a parent education tool. It is not a substitute for validated developmental screening, and so there are a whole host of other validated developmental screening tools that you can learn about on HHS's, "Watch Me Thrive!" site, "Birth to 5: Watch Me Thrive!" but the milestone checklist that I'm talking about and all the Learn the Signs, Act Early materials are really a great complement to those screeners. They are not a replacement for them.   

Kim: And we will be ... With the email that April sent out after the webinar with the link to the evaluation and the PDF of the slides, you'll also receive a PDF from the Learn the Signs, Act Early that explains the difference between the developmental monitoring, the developmental screening, recommends a formal validated screening tool, and again gives you some of those links to the HHS, "Watch Me Thrive!" that Katie was just referring to, because these are great for parents' engaged monitoring, but for programs that conduct a developmental screening, like a Head Start program, these materials support and complement, but as Katie said, they do not replace doing the developmental screening.   

Katie: Exactly, and if you're doing screening and you soon introduce Learn the Signs, Act Early materials as that parent education tool, we'd love to hear from you as to how that may have helped the process of screening along, because it's our thought that they really may help prepare parents for screening and make that process go a little bit more smoothly.  

OK. Now, I'm running out of time, but I want to talk a little bit about the Milestone Tracker app, and if nothing else, I want you all to promise me that you're going to go on your smartphone and take a moment to download it. So, it's available on iPhone and on Android devices in the App Store and Google Play, and you'll search, "CDC's Milestone Tracker app," and since I don't have a whole lot of time to walk you through it, I'd love for you to just poke around yourselves. And what you will see is the opportunity to put a child's name and birth date in and get customized developmental milestone checklists automatically pulled up for the child's age.  

You'll have the opportunity to go through the checklist and see one by one each milestone, via photo or a video of that particular milestone, and indicate whether or not your child has reached the milestone, not yet, or not sure. Maybe you just haven't looked yet, and so you would have the opportunity to go back. OK, let's see how we can get through here. Of course, add your child.   

Kim: So, don't rush, Katie. This is such a cool resource. I know you're talking about it as a parent would do it. So, it's something great that parents can use, but a teacher or someone else could do it. You're not going to ... You can't violate confidentiality. You have to follow all those rules. But there's so much depth here—if folks can hang on. And then this is getting recorded, so we can put it up. So, in case you have to leave, at least they can go back and hear about it.   

Katie: OK. Super. Yeah, so as a child care provider or person supporting child care or early educator, you can add as many children here as is wished. You can give them fake names. You can give them a whole name. If you have a certain age group, you can choose a birth date where a lot of your children fall around and then pull up sort of general checklists that way. And then indicating the boy and girl, the gender piece, that is just to help to sort of customize the summary of the screener and talk about his or hers.  

OK so, here on the Home screen, you'll see, of course, all the main components of the app, and they are the Milestone Checklists—the When to Act Early—and so you'll be moved right into the When to Act Early as soon as you've completed the checklists, and really those are those red flags or when you know that it is time to reach out to your health care provider and ask for developmental screening, of course, Tips and Activities, Milestone Quick View, so if you don't want to sign in with a particular child, but you want to review the milestones for a particular age under various domains, you can go ahead and use the Milestone Quick View feature for that.  

And then, My Child's Summary, and that takes all the information that you put into the Milestone Checklists and the other sections and compiles it into something that you can email. A parent could email it and share it with a child care provider, or early educator, or with their health care professional, or a partner at home, or a grandmother who has more to say about that. So, this is what the Milestone Checklists look like, and again, you'll see both videos or photos for every single milestone. And there's an area, as well, to write down notes. So, if you make a selection, but there's sort of a caveat that you want to remember to talk with your doctor or your child care provider about, ask them what they're seeing in the classroom, or a note that you want to make to share with a parent.  

So, if you're using this as a child care provider, or support to one. That would be a great place to capture that, and that also gets pulled into the summary. Of course, the When to Act Early, and if you select any of these, you'll get a notification about what are the best next steps. So, completing the checklist, of course, and sharing the summary, making an appointment with the health care provider and talking with others about developmental screening and what to do. And so here's an image of what that notification may look like when you've indicated a concern, and this is the summary page.  

So, you'll be able to view a summary of each child's milestones after all the sections have been completed. You can bring it up right on the screen by selecting, "Show Doctor," and that will pull it up into something really friendly where you could just literally hand over the summary on your phone to a child care provider, or to anyone else that you want to share that information with, or of course you can email the information.  
And so, another great ...  

Kim: I'm sorry. I'm sorry. I was going to say another great thing. A parent ... You don't necessarily have to use all those paper handouts. The parents can do it right on their phone, have all their questions and everything ready to go when they go to their health care provider.  
Katie: Great. OK, and of course, Tips and Activities, and these are by age, so they're age-appropriate, and they just give you some really simple ideas, things that could be done in the classroom during individual time or group time, can help you think about how to individualize the learning experience for each child, but also tips that you can share with parents to be trying at home to make sure that in all aspects of the child's world, their development is being stimulated and supported. Here's the Milestone Quick View that I mentioned, and you'll see the various domains of development and then the milestones by age, and that's a good way to kind of preview, and check in, and remind yourself of what to be looking for.  
Lots of other apps features, including appointment reminders, and that may not be something that you all would use, but may be very helpful and practical for parents. Reminders for when checklists are left incomplete or if you've indicated developmental concern, some added encouragement a couple of days later that says something along the lines of, "You've indicated a potential concern, and it's worth talking about, and asking for developmental screening." And then of course, you'll be notified that your child may be ready for the next age checklist as they're growing up, when they're due and due for developmental screening, when that's recommended.  

OK. So, we kind of think about—when we talk about the Milestone Tracker app, what do we want parents to know?  

We want them to know that looking for milestones is really important, but there are a lot of important things to be tracking, as we know, and we just heard from Jenny about immunizations, and there's so many things to be keeping track of and various ways to prepare for well-child checks and parent-teacher conferences, and this is just a tool. It's our attempt to make it easier, and maybe a little bit fun. So, we hope that that does it for parents, and it is free. It's available for iPhone and Android, and we're happy to say that the Spanish version for both platforms is coming very soon—by fall.  

And sharing developmental progress with the doctor and your child care provider is really important, and this app makes it easy. And of course, what health care providers should know about the app is that it supports ongoing developmental surveillance, which is recommended by the American Academy of Pediatrics. It may help families communicate a little bit more effectively about their child's development during those very brief visits. And it's a great way to share a child's progress during health—health maintenance visits. And early care and education providers, of course, it can help you track and celebrate each child's developmental milestones, letting parents know that this is important, even when there's not concerns, but it's an important thing to be thinking about and to be celebrating, and then that way you've sort of built up this history of engagement around early development so that when a potential concern is identified, it makes talking about it and bringing it up all that much easier. 

And by sharing these resources with parents, you're giving parents the opportunity to see some of these things for themselves, which always makes things go easier, too. But the bottom line is that it helps you engage families and communicate with parents and other providers about each child's development. So, we really are relying on you all and many of our partners to help spread the word about the Tracker app, and all of our materials. And so we have some tools that you can find on our website to help you do that if you'd like, and please reach out to us if you have ideas or have opportunities to reach out to parents or other child care providers. Reach out to us at ActEarly@cdc.gov. And so please do download the app, and by the way, if you love it, go ahead and give us five stars, and if you see room for improvement, you can send us an email about that, and we would love to have your feedback. Please visit our website to find other helpful resources and do tell a colleague, a director, a teacher, and definitely a parent, too. Thank you so much.   

Kim: Thank you so much, Katie and Jenny. We really appreciate, and I think the value of the information you're sharing is evident by all these wonderful people that are staying on late to hear it. So, I think that's really great. We really don't have time for questions. But please, if you have some, type them all in the box right now because our wonderful colleagues from the CDC have agreed to help us answer the questions and get those answers up for you in the MyPeers online community.  

So, I just want to tell you real quick to join the MyPeers online community. There is a website at the bottom of the page. The MyPeers online community is a collaborative platform for early care and education community, and we have a community just for child care health consultants so that you can talk to each other, ask each other questions, share resources. I put the links to all of our health consultant quarterly webinars series right into MyPeers so you can find them. So, if you'd like to join the community, you can go to this website listed at the bottom. You'll then need to complete a join form, and then most importantly, you're going receive in your email inbox a link to ... An email from ... In the "From" part, it will say, "MangoApps," and they're the folks that run MyPeers. When you receive that MangoApps email, you have to open it up.  

Go ... There's a link with a password, it's a temporary password, but it will bring you into MyPeers where you can change your password and then you can go in and pick whatever communities you want to be part of. There's over 50 communities, so you don't only have to join the Child Care Health Consultant community, but you can join whichever ones are interesting to you. So, I'm just showing you here, that's just a page with a bunch of resources that are related to our last webinar that we had on Feb. 15, so there's also a link to that webinar there, as well. So, we'll be posting a bunch of links from today's webinar. We'll be posting the webinar recording, as well as doing the questions and answers on there, so keep filling them up in that questions box. You guys have that down for sure. And with that, I'm passing it over to you, April.   

April: Thank you, both—thank you all so much. This was such a wealth of information, and that's evident by how many questions we've got—we've got about 40 questions. So, like Kim said, please join MyPeers and we'll continue this conversation. Please stay on and the survey will pop up. If you have trouble with the survey, don't fret, you'll get an email within a couple of hours with the link to the survey just as a backup.  

So, thank you to all our presenters, and thank you to everyone that joined us today, and have a good day. 

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