Child Health 2: Safety, Hygiene and Health Systems

The guidelines say to lay children on their back with the face visible, except when a doctor has recommended sleeping face down for medical reasons. Soft bedding and stuffed toys should not be used, so the option saying soft bedding makes suffocation less likely is wrong. Staff regularly check breathing, body position and sleep state, in line with the number of children and staff, so the option of avoiding breathing checks is wrong. String-like items such as bib strings should not be left near the child, so the option allowing a bib with strings during sleep is wrong. Laying babies on their back until age 1 is also a key point for lowering the risk of SIDS, so the option of laying children under 1 face down is wrong.

The three points are: (1) lay the baby on their back until age 1, (2) breastfeed as far as reasonably possible, and (3) parents and others stop smoking. Avoiding breast milk is the opposite of point 2. SIDS is described as an illness of unknown cause that is different from accidents such as suffocation, so the option saying measures against suffocation alone are enough is wrong. Laying the baby face down is the opposite of point 1.

The guidelines say to separate the person who supervises from the person who teaches, and that the supervisor concentrates only on watching, moving their eyes regularly to cover the whole area. Combining teaching and supervising goes against separating the roles. What staff must find are children who are not moving or are moving unnaturally, so the option of focusing on children who are swimming or making loud noises is wrong. Water play is covered by the same cautions, so the option saying shallow water play needs no assigned supervisor is wrong. When proper supervision cannot be ensured, stopping the activity is one of the options, so the option of going ahead as planned without proper supervision is wrong.

The reference example treats round foods 4.5 cm or less in diameter and non-round foods 3.8 cm or less as dangerous. The option giving 3.8 cm for round foods and 4.5 cm for non-round foods swaps the numbers. Foods larger than 1 cm are also within the danger range, so the option saying only foods 1 cm or less are dangerous is wrong. The example also says that even small items of about 1 cm can be very dangerous depending on how the molars have developed, so the option saying only foods over 3 cm are dangerous is wrong. Size and shape are given as a guide, so the option saying size does not matter is wrong (properties such as elasticity, roundness and stickiness are also reasons for risk).

The accident prevention guidelines say that foods that have caused choking accidents in the past, such as whole cherry tomatoes, should preferably not be used, after explaining this to parents. One of the feeding cautions is to give liquids such as soup, so the option of giving no liquids during meals is wrong. Choking can happen with familiar foods at any age, so the option saying familiar foods carry no risk is wrong. The Consumer Affairs Agency (消費者庁) asks that hard beans and nuts not be given to children aged 5 or under, so the option allowing whole hard beans and nuts after age 3 is wrong. Trying to remove an object with a finger can push it further in, so the option of scooping the object out with a finger is wrong.

The guidelines assume that mistakes can occur at every stage from menu planning to serving, and list measures such as making allergen-free and substitute meals look different, using serving cards, and double- or triple-checking by speaking aloud and pointing. Responses are based on a written instruction grounded in a doctor's diagnosis, so the option allowing removal without a doctor's diagnosis is wrong. Foods never eaten at home are, as a rule, not given, so the option of trying new foods for the first time at the nursery is wrong. The rule is complete removal, so the option of partial removal as a rule is wrong. Clearly assigning responsible staff is one of the measures, so the option of not assigning serving staff is wrong.

Under the guidelines, reports cover deaths and serious accidents involving injury or illness needing 30 days or more of treatment, and facilities and local governments share the understanding that the first report to the national government is in principle made on the day of the accident (at the latest the next day). Injuries and illnesses are covered, so the option covering only deaths is wrong, and there are no "7 days" or "one week" figures, so the "7 days / within a week" option is wrong. Reporting does not depend on parental consent, so the option making reporting depend on parental consent is wrong; analysis of the cause proceeds after reporting, with support from the local government, so the option of waiting until the analysis is finished is wrong.

The guidelines put the child's life and health first and say that if unsure whether to see a doctor, the child should see one. Staff who were present should record the facts as soon as possible on the same day, in ink that cannot be erased, alone and without consulting others. Parents are contacted promptly and told the facts known so far, so the option of holding off contacting the parents is wrong. Writing in pencil and agreeing the wording with others goes against how records should be made, so the option of drafting in pencil and rewriting after discussion is wrong. Unfounded reassurance such as "Everything is fine" should be avoided, so the option of first telling parents "Everything is fine" is wrong.

The handbook says that for infants, back blows and chest thrusts are given alternately, 5 of each (someone else is asked to call 119). Abdominal thrusts are for children aged 1 and over when back blows do not work, so the option of giving abdominal thrusts first is wrong. The accident prevention guidelines warn that trying to remove the object with a finger can push it further in, so the option of scooping the object out with a finger is wrong. While the child can cough, let them cough, so the option of giving water even while the infant is coughing is wrong. CPR should not be done on bedding, so the option of pressing on the chest while the infant lies on a futon is wrong.

The Children and Families Agency handbook says to press hard enough that the chest sinks about one third of its depth, at 100–120 compressions per minute. Sixty per minute is too slow, so the option of about 5 cm at 60 per minute is wrong; half the depth or more is too deep, so the option of pressing until the chest sinks by half is wrong. The accident prevention guidelines say not to spend more than 10 seconds checking breathing, so the option of taking 30 seconds or more is wrong. They also say CPR with rescue breaths is desirable, especially in children's cardiac arrest, so the option of compressions only is wrong.

The reference example says to use child pads for preschool-age children and to use adult pads instead if there are no child pads. AEDs can be used on children, so the option saying AEDs must not be used on children is wrong, and adult pads can substitute, so the option of not using the AED without child pads is wrong. Child pads must not be used on adults, so the option allowing child pads on adults is wrong. The reference flow for choking says to keep the pads on and the device switched on even after breathing returns, so the option of removing the pads and switching off once breathing returns is wrong.

The handbook says to cool a burn right away for 10 to 20 minutes or more and to see a doctor without breaking blisters. For swallowed objects, as a rule the child is not made to vomit and is taken to a doctor with the same item, so the option of always making the child vomit first is wrong. When hot water spills on clothing, cool it over the clothing without removing it, so the option of taking the clothes off first is wrong. Commercial cooling sheets cannot be used, so the cooling-sheet option is wrong. Button batteries require a prompt doctor visit even without symptoms, so the option of just watching at home after a button battery is swallowed is wrong.

Article 6 of the Standards requires evacuation and fire drills at least once a month. Article 6-3 requires facilities to make a safety plan, inform staff and hold training and drills regularly; nurseries must inform parents about the measures; and the plan must be reviewed regularly. The "twice a year" option confuses this with the number of health checkups; review is required, so the option saying the plan never needs reviewing is wrong; and parents must be informed, so the option saying they need not be is wrong.

The guidelines name the three factors as the source of infection, the route of infection, and a susceptible host. Spreading through a room via droplet nuclei is airborne infection, so the option describing droplet infection that way is wrong (droplet infection mostly occurs within about 1–2 m). Standard precautions treat blood and body fluids as potentially infectious and apply to everyone, so the option limiting standard precautions to diagnosed children is wrong. Infection through mosquito bites is vector-borne infection, while oral infection comes from contaminated food or water, so the option linking oral infection to mosquito bites is wrong. Contact infection occurs by touching a person or via hands that touched contaminated objects, so the option saying contact infection occurs only through the air is wrong.

The MHLW Q&A on norovirus says to wear a disposable gown (apron), mask and gloves, gently wipe up the vomit with paper towels before it dries, and afterwards ventilate well, paying attention to airflow so the virus goes outdoors. The infection control guidelines say vomit must be carefully removed before disinfecting and that chlorine-based disinfectants are used during norovirus outbreaks, so the option of just spraying alcohol without wiping is wrong. It is cleaned before it dries, so the option of vacuuming after it dries is wrong, and ventilation is needed, so the option of keeping the windows shut is wrong. Hands are washed with soap and running water afterwards, so the option of skipping hand washing because gloves were worn is wrong.

The infection control guidelines say to wash hands with soap under running water for 30 seconds or more and never to share towels. The MHLW Q&A on norovirus says alcohol does not replace hand washing with soap and running water, so the option saying alcohol can replace hand washing is wrong. Powdered formula is made up with water at 70°C or higher, so the option of using water at about 50°C is wrong. Free residual chlorine in the pool is kept at 0.4–1.0 mg/L and measured every hour, so the option of measuring once a day in the morning is wrong.

The guidelines say formula left for 2 hours or more after being made up is thrown away. Sandpits can be contaminated by cat droppings, so animals are kept out and the sand is turned over and sun-dried regularly; the option saying the sandpit needs no special care is wrong. Diapers are changed in a set place separate from the eating area, so the option of changing diapers in the eating area is wrong, and frozen breast milk is labelled with the child's name, so the option of not labelling frozen breast milk is wrong. Stool is handled with disposable gloves, followed by hand washing with soap and running water, so the bare-hands option is wrong.

Article 12 of the Standards for Facilities and Operation of Child Welfare Institutions requires checkups on admission, regular checkups at least twice a year, and extra checkups when needed, in line with the School Health and Safety Act. Once a year is not enough, so the once-a-year option is wrong. The Guidelines for Nursery Care say the health plan is made based on the overall plan and that all staff work with its aims and content in mind, so the option saying only the nurse makes the plan is wrong; children's health is checked regularly and continuously, and whenever needed, so the option of checking health only on admission is wrong. When an infection occurs, staff contact the contracted doctor, the municipality, the public health centre and others and follow their instructions, so the option saying telling the parents is enough is wrong.

Article 6 says anyone who finds a child who appears to have been abused must promptly report it to the municipality, a prefectural welfare office or a child guidance centre (or to these via a commissioned child welfare volunteer). Reporting happens at the "appears to" stage, so waiting for firm evidence is wrong. Paragraph 3 of the same article says confidentiality rules must not be interpreted as preventing the duty to report, so the option saying confidentiality prevents telling anyone outside is wrong. Parental consent is not a condition, so the option requiring parental consent is wrong, and the police are not among the bodies named, so the option naming only the police is wrong.

Article 2 defines a child with a developmental disability as a person with a developmental disability who is under 18; under 20 is wrong. Developmental disabilities are brain-function disorders such as pervasive developmental disorders including autism, learning disabilities and attention-deficit/hyperactivity disorder, whose symptoms usually appear at a young age, so the options saying symptoms usually appear in adulthood or that they are a type of physical disability are wrong. Article 7 says that when municipalities provide childcare, they take care that these children develop well through living together with other children, so the option of providing childcare separately is wrong.