Awareness and Prevention of Back Pain and other Musculoskeletal Disorders in the Early Years Workforce

washing hands

Back pain and associated conditions are a common problem in childcare.

82% of UK early years and primary practitioners experience work-related Musculoskeletal Disorders (MSDs) — which include back, hip, shoulder and knee pain —  at least once a week (1).

Health and safety laws apply to work activities in registered childcare premises and schools.

As an employer or duty holder*, you need to protect your workers from the risk of injury and ill health from MSDs. This guidance suggests ways you can do this.

The guidance is aimed at employers and duty holders of the early years and childcare workforce.

Employees, students, volunteers, trainers and the self-employed (such as childminders) who work with children 0-5 years, may find it useful.

*Duty holder. Accountability for health and safety lies with the employer, however this can depend on the type of school and its location in England, Scotland or Wales.


What are MSDs?

Any injury, damage or disorder of the joints and tissues in the upper and lower limbs of the body, back and neck. Back and other MSD pain caused by work-related activities (for example, awkwardly lifting children, sitting on children’s chairs, getting on/off the carpet) can develop quickly or build slowly over time.

However, once developed, MSDs can adversely affect many aspects of life, including work and leisure activities, ability to take care of our mental and physical health, ability to drive and can lead to absence from work.

Symptoms can include back ache, sciatica, knee pain and shoulder discomfort, hip stiffness, painful toe joints and others.

Effective awareness and management of MSDs helps reduce risk and improve wellbeing, no matter what size your organisation is.

Potential benefits may include:

  • Fewer injuries to practitioners
  • Reduced risk of work-related ill health and sickness absence
  • Reduced stress and improved morale
  • Improved staffing levels/attendance
  • Improved professional care to children.

The good news is, the majority of MSDs can be prevented, symptoms eased and fully recovered from with early intervention, suitable treatment and musculoskeletal health management.

Examples of working practices that can increase the risk of MSDs

Sitting in chairExamples of working practices which can increase MSD risk in 0-5 settings include:

  • Repetitive bending and twisting (e.g. over low tables and child-height sinks)
  • Uncomfortable working position, including unsuitable furniture (e.g. sitting on children’s chairs, kneeling at child-height desks)
  • Repetitive or awkward lifting of children and heavy equipment (e.g. when using nappy changing units, at mealtimes, moving sand/water trays and outdoor equipment)
  • Not receiving and acting upon notification of symptoms quickly enough (e.g. niggling pain leading to longer term injury. Prevention of injury is most effective)
  • Psychosocial factors (e.g. high job demands leading to increased anxiety and associated MSD risk)
  • Working too long without a break (e.g. not allowing body to rest and recover)
  • Time pressures (e.g. inadequate time to move and change postures, or to correctly set up and to use equipment appropriately).
The law

As an employer or duty holder*, you have legal duties to assess, control and manage the risks associated with work-related MSDs.

This includes manging the risks to children, visitors and volunteers.

The self-employed have similar responsibilities to third parties.

See Appendix 1 for specific legislation relating to 0-5 early years and childcare workforce.

*Duty holder. Accountability for health and safety lies with the employer. In schools, the employer is determined by the type of school and location in England, Scotland or Wales.

Managing MSD risks for the early years and childcare workforce

leaning over little bikeEarly years working is a physically demanding role.

Risk assessment is about identifying and taking sensible measures to control the risks in your workplace, not about creating huge amounts of paperwork.

You may already be taking steps to protect your employees, but your risk assessment will help you decide whether you should be doing more.

The aim is to make the risk of someone being injured (employee, visitor or child) as low as possible. See the HSE website for more information.

A hazard is something in your setting that can cause harm. A risk is the chance, however large or small, that a hazard could cause harm.

You can delegate the task of risk assessment, but you will need to make sure it is carried out by someone who:

  • Is competent to do so (has the right skills, knowledge and experience)
  • Involves your workers and their representative in the process
  • Understands when specialist help/advice may be needed

Identify the hazards

Look for hazards that may result in harm when working with children aged 0-5 years. Remember to ask your employees, or their representatives, for their views as they will have first-hand experience of what happens in practice.

Also seek the views of those who only work with children occasionally. The main areas to think about are the working environment and the practitioner. See the ‘Work-Related MSD Questions’ below for some suggestions about what to consider.

Who might be harmed?

Decide who might be harmed and how. This will usually be the practitioner, but it might also include children or visitors. Also consider whether there are any groups who may be particularly at risk, such as: new starters, pregnant workers, employees returning to work, those with pre-existing medical conditions or those working long hours.

Evaluate the risks

Having identified the hazards, decide how likely it is that harm will occur. You are not expected to eliminate all risks, but you must make sure you know about the main risks and how to manage them responsibly. You need to do everything reasonably practicable to protect people from harm. You must carry out an assessment of the risks to the health and safety of your employees, while they are at work, and to other people who may be affected by your organisation’s work activities. The risk assessment should include any specific risks to females of childbearing age who could become pregnant, and any risks to new and expectant mothers.

Record your findings

Record your significant findings – make it simple and focus on controls. See the ‘Work-Related MSD Controls’ for some suggestions.

If you have five or more employees, you are required by law to write it down. If you have fewer than five employees you do not have to write anything down, but it is good practice to keep a record.

An easy way to record your findings is to use HSE’s risk assessment template. This also includes a section for your health and safety policy.

Any record produced should be simple and focused on controls.

Use the findings of risk assessments, accident investigations and consultation with workers to identify what changes to working practice, control measures and changes to the built environment can be made to mitigate the risk of MSDs amongst employees, e.g. trolleys, ergonomically assessed workstations etc.

Regularly review your risk assessment

You should review your MSD risk assessment on a regular basis.

There is no set frequency for carrying out a review, but you need to ensure that the risks to those who work with children aged 0-5 years, and others, are suitably controlled.

For this to be effective you need to know about any MSD cumulative strain and incidents, your practitioners and their working environments.

Changing circumstances may also prompt a review, e.g. increasing number of children on role, changing ratios or reduced number of employees, children with specific moving and handling needs, acquiring new equipment, buildings expansion or redesign. If anything significant changes, check your risk assessment and update it.

Work-Related MSD Questions

nappy changeTo effectively manage MSDs in your setting, you may find it helpful working through the following questions, thinking “Healthier working environment” and “Safer practitioner”.

Healthier working environment

Seating, Furniture and Equipment

  • Do you understand the potential harm to practitioner and volunteers from using inappropriate seating? (e.g. tiny chairs or poor office seating)
  • Is seating, furniture and equipment for employees fit for the purpose for which it is used?
  • Do you ensure seating, furniture and equipment does not exceed its maximum load weight when in use? (e.g. teacher’s chairs, pushchairs for children).
  • When buying new seating, furniture and equipment, do you assess which is most suitable for the health and safety of practitioners?
  • Do you ensure privately owned seating and furniture meets your health, safety and insurance requirements? (e.g. fire regulations, weight limits and maintained in line with manufacturers’ recommendations)?
  • Is seating, furniture and equipment maintained in safe and fit working condition (e.g. are maintenance checks carried out in accordance with manufacturer’s recommendations)?
  • Is manual handling equipment working and used properly as intended?
  • Do you ensure seating, furniture and equipment checks are carried out?
  • Do you have procedures for reporting defects and are they remedied promptly?
  • How do you ensure maintenance and repairs are carried out to an acceptable standard?
  • Do you have a clear policy that unsafe furniture and equipment should not be used?

kneelingStorage

  • Do you have appropriate arrangements for moving, carrying and safely storing goods and equipment in your setting? (e.g. trolleys, wheeled bags for books, mobile storage solutions, adequate and easily accessible storage areas, assistance to put up displays).
  • Do you plan where equipment is stored so children can help safely access and pack away? (e.g. sheds with portable ramps to wheel trikes, organised storage).

Workplace Design Considerations

  • Do you ensure “adult height sinks” are available to practitioners for handwashing and cleaning resources?
  • Toilets and washing facilities for staff should be adult-height and separate from those provided for pupils, except where they are designed for use by those who are disabled.
  • Do you take account of ergonomic considerations (e.g. working position when sitting at child height at tables, planning and preparation tasks, group activities on the floor, working 1:1, when hanging learning resources, nappy changing, during outdoor learning and at meal/snack times)?
  • Are floors even, unobstructed and well-lit and are doorways kept clear and accessible?
  • Have you considered steps to reduce the frequency of practitioners to lifting and carrying children? (e.g. children independently moving in/out of their own seat at tables, on/off sleeping mats, accessing/tidying away own resources and equipment).
  • Do you plan timetables in consultation with practitioners or their representatives, taking account of, for example, the need for rest breaks to change position, hydrate and access toilets?
  • Are work schedules realistic to give time for children to assist practitioners (as their independence allows) with physical tasks e.g. toddlers climbing down from play equipment rather than being lifted.
  • Do you involve practitioners in decisions about their seating and workstation set up?
  • Do new setting design and build consultations include the workplace health and safety needs of practitioners?

Safer Practitioner

Training

  • Are your practitioners properly trained in health and safety (including manual handling of children, display screen equipment use and postural awareness) to carry out their duties safely in a 0-5 working environment?
  • Is priority given to those at highest risk, e.g. those working with non-ambulant children, pregnant workers and new mothers, young workers and those new to the job, or those receiving treatment for MSDs?
  • Have practitioners been trained to correctly lift, carry and move a child in their care under a range of scenarios? E.g. a heavy, non-ambulant child, a child throwing themselves backwards or forwards, for therapeutic positioning and developmental play).
  • Do you assess training needs periodically, including the requirement for refresher training?
  • Do you ensure your training providers are competent to deliver the training you need?

Knowledge

  • Are your practitioners competent and capable of doing their work in a way that is safe for them and other people?
  • Do practitioners know how to carry out routine safety checks, such as on wheels of mobile equipment (pushchairs, trikes and storage equipment), cot side mechanisms and nappy changing unit fixings and report any faults?
  • How are your employees made aware of your setting’s work-related MSD risks and what is expected of them?
  • Do practitioners know how to carry out their own workstation ergonomics checks (in the classroom, outdoor learning and at a computer?).
  • Have you considered practitioner health when encouraging communication with children at their level?
  • Do you know your duties under health and safety law when employing supply cover and agency staff?
  • Do practitioners know how to recognise and report early symptoms of MSD ill health?

Employees: For back pain and MSD awareness and prevention to be most effective, practitioners should understand their setting’s risks and procedures, working in conjunction with their employer/duty holder (for example notifying of potential MSD risks, early reporting of symptoms and using equipment provided).

Work-related MSD controls

blocksThe following suggestions offer further guidance on how you can reduce MSD risks in your registered premises.

Healthier working environment

Seating, Furniture and Equipment

  • A range of safe, appropriate seating is offered to meet the needs of our 0-5 workforce
  • When choosing new seating, furniture and equipment practitioner health and safety (ergonomics) is considered
  • Seating, furniture and equipment is in good working order and meets health and safety requirements
  • Seating, furniture and equipment is inspected and maintained at regular intervals, in line with manufacturer’s recommendations and our maintenance schedules
  • Manual handling equipment is provided and used appropriately by our employees
  • Unsafe equipment is removed immediately from service and reported to a named contact.

Storage

  • Furniture and equipment is safely stored to minimise practitioner lifting, carrying and awkward postures
  • Mobile storage solutions are considered and used where possible

Workplace Design Considerations

  • Employees have access to adult height sinks (or can use a washing up bowl in standing), plus access to an adult height desk and chair for written/computer work
  • Consideration is given to practitioners’ working postures with equipment provided to support “child height” working
  • Nappy changing units have unrestricted access to atleast 2 sides, are set at correct standing height or have steps so children can position themselves with assistance and less lifting.
  • Floors are even, unobstructed, well-lit and doorways (including of storage areas) are accessible.
  • Learning resources, artwork and decorations are hung to ensure clear, unobstructed walkways for workers to move freely, without the need to stoop.
  • Children’s independence is encouraged to access their own resources and equipment, at mealtimes and sleep times to reduce lifting
  • Movement, rest breaks and hydration are encouraged throughout the day
  • Timetabling allows as much time as possible for children to be independent and for practitioners to safely assist children
  • Employees are asked about their seating requirements and workstation/classroom set up.
  • New design and build consultations include workplace health and safety needs of practitioners

nanny and childSafer practitioner

Training

  • Our 0-5 workforce has regular, setting-specific manual handling training (which includes lifting and moving children in a range of situations and postural awareness for employees)
  • Employees and volunteers working regularly on a computer/mobile device (more than an hour a day, most weekdays), complete Display Screen Equipment (DSE) training and assessment

Knowledge

  • Practitioners are aware of MSD risks in our setting and how to reduce their risks (in the classroom, outdoor learning and at a computer)
  • Practitioners know how to carry out routine safely checks on mobile and safely equipment and report any faults
  • Practitioners are competent and capable of doing their work in a way that is safe for them and other people
  • Practitioners know how to recognise and report early symptoms of MSD ill health and there is a clear reporting structure for doing so
Appendix 1 — Background legislation

Below is a summary of the specific legislation and guidance relevant to the 0-5 early years and childcare workforce.

For further advice see: HSE’s Consulting employees on health and safety: A brief guide to the law and HSE’s The law on musculoskeletal disorders at Work

The Health and Safety at Work etc Act 1974 states you must ensure, so far as reasonably practicable, the health and safety of all employees while at work. You must also ensure that others are not put at risk by work activities. This includes safety of visitors and volunteers. The self-employed have similar responsibilities.

‘So far as reasonably practicable’ means balancing the level of risk against the measures needed to control the real risk in terms of money, time or trouble.

The Management of Health and Safety at Work Regulations 1999 require you to manage health and safety effectively. You must carry out an assessment of the risks to the health and safety of your employees, while they are at work, and to other people who may be affected by your organisation’s work activities.

You must consult with your employees and, where applicable, their health and safety representatives, on health and safety issues, including:

  • Risks arising from their work
  • Proposals to manage and/or control these risks
  • The best ways of providing information and training

Manual Handling Operations Regulations 1992 seek to reduce the health and safety risks to employees from handling and lifting loads. They give advice on how to handle and move loads to prevent poor posture or injury.

Health and Safety Display Screen Regulations 1992 apply to workers who use DSE daily, for an hour or more at a time. These set out minimum requirements for workstations.

Workplace (Health, Safety & Welfare) Regulations 1992 gives information on toilet breaks, staff room access, adult height desks and chair access.

The Provision and Use of Work Equipment Regulations 1998 covers information relating to work equipment, pushchairs, trollies and staff bringing in own seating/work equipment.

Equalities Act 2010 covers information factoring pre-existing conditions and MSDs, age of workers, pregnancy, reasonable adjustments.

Seating at Work Guidance 1997 - Very specific guidance on how to ensure workplace seating is safe and suitable for all - including for those with additional needs.


Further reading/references

Back Health in Education: risks in schools: Occupational Health Physiotherapy Journal: Volume 18.3 (2014)

Frequently asked questions – Education: Who is accountable for H&S within a school? (*includes “duty holder” definition)

Sensible health and safety management in schools 

Manual Handling of Children 2nd Edition, National Back Exchange (2020)

Planning Learning Spaces: A Practical Guide for Architects, Designers and School Leaders, M. Hudson and T. White (2020)

MSD Design Awards: Jolly Back and Trent Vale Infant and Nursery School  


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