Back Injury and Stress

Back Injury and Stress
by Maxine Mercer

It is very important for caregivers to care for themselves as well as for the children in their care. Caregivers are no different from staff in many workplaces; they are only able to provide the best of care when they are healthy themselves. Caring for young children in a child care setting is very demanding at the best of times. However, the job becomes extremely challenging if a caregiver is in poor health. Thus, every caregiver's goal needs to be to achieve optimum health so that he/she feels his/her absolute best physically, mentally and socially every day. This is likely to happen in a positive, healthy environment where health and safety practices are promoted, and factors that contribute to illness and disease are reduced or eliminated.

While some child care centres have positive healthy environments, others are fortunate enough to have occupational health service that includes health and safety education, an injury and illness prevention plan, and health counselling services. This tends to be a comprehensive program focusing on the caregiver's physical, social and emotional well-being. Since there are many other centres and settings where such a program does not exist, thought needs to go into how to prevent illness and injury for caregivers as well as children. In this article, I will focus on two of the many issues that require consideration: reducing back injury and managing stress.

Back Injury
Four out of five adults will experience significant low back pain in their lifetime. This back pain is often caused by work related injuries. Back injuries account for nearly 20 per cent of all injuries and illnesses that occur in the workplace. They are common in a variety of fields, from construction work to child care. Back injury is the most common cause of occupational injury for caregivers, creating a great deal of pain, medical expense, loss of work time and inconvenience. A number of child care situations have been identified as contributing to back injury. Here are eight of the most prevalent:
1. Incorrect lifting of children, toys, equipment
2. Inadequate work heights, i.e., child-size tables and chairs
3. Lowering and lifting children in and out of cribs
4. Frequent sitting on the floor with back unsupported
5. Excessive reaching above shoulder height to obtain supplies
6. Frequently lifting children on and off the diaper changing tables
7. Awkward positions and forceful motions to open windows
8. Carrying garbage diaper bags to dumpster.

The most common cause of low back problems comes from stretching muscles, tendons and ligaments leading to inflammation, swelling and pain. The key to minimizing and/or eliminating this pain is prevention. Many back injuries occur in child care when the physical requirements of the job are too demanding and are repetitive in nature. Obvious solutions are to look at ways to adapt the workplace and/or change caregivers' behaviours. Here are ten things to consider:

1. Proper lifting technique. Keep the child as close as possible to the body; avoid any twisting motion; always lower the crib side before lifting the child out. Don't carry toddlers upstairs; encourage them to walk with others.

2. Adult size furniture. Do not use child-size chairs, tables or desks; changing tables should be adult-height; comfortable chairs with good back support should be used for rocking or holding children.

3. Step up stool. Provisions should be made so that children can climb up to changing tables without being lifted.

4. Convenient transport. When going to a nearby park, use a multi-seat carriage rather than carrying children.

5. Healthy, active lifestyle. Lots of sleep, regular exercise and weight control can strengthen the back; maintain proper posture to put the least strain on the back.

6. Footwear. Shoes should be comfortable and nonslip.

7. Efficient kitchen area. Heaviest items should be at waist height with stools available for retrieving high items.

8. Transporting garbage. Reduce size and weight of loads, and use a cart to transport garbage.

9. Education and awareness. The role of child care managers should be to educate and work with staff on back injury prevention. Use accident report forms to determine where and why a back injury occurred.

10. Prolonged bending. Reduce or eliminate bending by getting down to the child's level. Avoid being on the floor in uncomfortable positions for extended periods of time.

Stress
Work-related stress now ranks as the second biggest occupational health problem after back problems, and three in ten employees will experience some kind of mental health problem in any given year. Stress among caregivers not only affects their health, but also the quality of care that they are able to give.

A caregiver who is under too much stress will not be able to offer the praise, nurturing and direction that children need for healthy development. Guidance and other child care issues are easier for the caregiver to handle when feeling calm and in control. When caregivers feel stressed, everything seems more difficult. It is generally believed that some stress, such as positive stress, is okay, but when stress occurs in amounts that cannot be handled, both mental and physical changes may occur.

Causes of stress in child care settings can be categorized into three areas:
1. Job specific. Heavy workload; fast pace; long hours of work; poor physical environment; loud noise; isolation; too much work to do in too little time; high staff/child ratio; immediacy of the needs of the children.

2. Job satisfaction. Poor relationships with co-workers, supervisors or parents; no autonomy; unable to maximize skills and abilities; unclear understanding of job expectations; lack of control over job performance; limited opportunities for career advancement; poor communication with supervisor; low wages.

3. Family and work balance. Trying to find a balance in work and family requires intricate and complex coping strategies because of the emotional demands that are made throughout the workday.

We know that individuals deal with stressful situations differently. Caregivers, however, need to learn to recognize signs of personal stress and develop a plan for handling it in child care settings. Here are some solutions:
1. Job design. Although the design of the job rests primarily with managers, caregivers need to know their rights so they can advocate for better working conditions and for more reasonable job expectations, such as clear and well-defined job descriptions, policy and procedure manuals, and regular performance appraisals. Managers should take the time to notice and offer compassion and understanding.

2. Stress management techniques. Laughing is one of the easiest ways to reduce stress. Learn to relax; take charge of the day by prioritizing and organizing; control stress; know where to get help when needed; keep the enjoyable activities, such as contact with close friends and relatives.

3. Exercise. Exercising is a feel-good experience. It introduces you to new friends, reduces the risk of illness and disease, helps you eat better, helps you lose weight, gets rid of pain such as neck and shoulder pain, which is often the cause of muscle tension.

4. Take inventory. Note in both your personal and work life what your body was feeling and what caused those feelings. Whenever you encounter something that causes job stress, write it down, but defer your reaction until in a quiet place.

5. Take care of yourself. Don't bring work home or home to work.

Health and safety practices in child care settings need to focus on ways of caring for the caregiver as well as the child. Promoting a healthy, active lifestyle is one way in which this can be accomplished. Caregivers, supervisors and parents need to be aware of all the situations that contribute to conditions such as back injury and stress. The goal has to be for all three to work towards the reduction and elimination of contributing factors so that caregivers as well as children are always in a healthy and safe environment.

Maxine Mercer is program director at the YMCA-YWCA of St. John's, Newfoundland, and a sessional lecturer at the College of the North Atlantic, St. John's campus. She is a past president of the Canadian Association for Young Children.