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    Objectives
    • Recognize the need for planning for children with special health care needs, such as asthma and allergies.
    • Describe your program’s policies regarding medication and individual care plans or inclusion support plans.
    • Provide a healthy environment for all children by following procedures related to allergies, medication, and care plans.

    Learn

    Learn

    Know

    Children will enter your care with a variety of needs. All programs must be prepared to serve children with allergies, asthma, diabetes, health impairments, physical disabilities, and more. This lesson will help you follow a plan for meeting these children’s needs. It also includes strategies for addressing common health concerns.

    Each child who enters the program with an identified health care need should have an individual care plan or inclusion support plans in place. This care plan is developed by a primary health care provider and the family. It will give you information about how to care for the child and signs or symptoms to watch for. It is your job to work with the family to put the plan in place.

    According to Caring for Our Children, a care plan typically includes information like:

    • The child’s diagnosis or diagnoses
    • Contact information for the primary care provider (usually a doctor)
    • Medications along with the schedule in which the medicine should be given 
    • Medications to be given on an as-needed basis along with clear instructions about signs and symptoms that warrant giving the medication
    • Procedures for administering medications
    • Allergies
    • Modifications necessary for the child (diet, activity, environment, behavioral, what to avoid--for example, peanuts, etc.)
    • Symptoms to look for
    • Emergency response plan
    • Special training you might need to work with the child

    It may be helpful in some cases for you to communicate with the family and the child’s primary care provider. Any communication and information gained is confidential and protected by the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act (HIPAA). Be familiar with these regulations and ask for help if you need it; refer to your licensing agency’s guidelines and policies regarding who should talk with the child’s primary health care provider. A health care consultant can be a good resource.

    Common Health-Care Needs

    Among the most common health-care needs among children are allergies and asthma. The following information will provide you an overview of each health care need, what to watch for, and ways to support children with these needs.

    Allergies

    Allergies are among the most common health care needs in children. Allergies can cause a wide variety of symptoms and include an even wider set of causes. According to the American Academy of Pediatrics (AAP), allergies are “reactions that are usually caused by an overactive immune system. These reactions can occur in a variety of organs in the body, resulting in diseases such as asthma, hay fever and eczema. During an allergic reaction, the immune system overreacts and goes into action against a normally harmless substance, such as pollen or animal dander. These allergy-provoking substances are called allergens. As a family child care provider, you should be aware of allergens that children in your care have, their common symptoms and reactions, and what you can do to make your home allergy-friendly.

    Allergies can be difficult to diagnose and can develop at any age. A child may not have any allergy symptoms at age 1, but by age 3, or even 5 years they could develop a severe allergy. Infants and toddlers are often exposed to new foods and materials, and these exposures can identify allergies that the child, family, and caregivers were previously unaware of. These allergies may first be apparent while the child is in your care. This is why it is important to monitor the health of the children in your care. If you have concerns that a child may have an allergy, bring it to the attention of the child’s family or guardian immediately.

    Food Allergies

    Food allergies are on the rise (Centers for Disease Control and Prevention, 2013). According to the American Academy of Pediatrics, 8 percent of children under the age of 18 have a food allergy or multiple food allergies. That is roughly 6 million children in the United States (AAP, 2011). Various proteins, harmless to people without allergies, can trigger serious reactions in people with food allergies. The reactions can range from mild to severe, including death. Allergic reactions usually happen shortly after the food is eaten.

    Recent scientific and medical advances have provided the technology to diagnose food allergies more easily and precisely. We now know that many children suffer from food allergies, some of which can be severe, even life-threatening. For example, we have seen an increase in children with peanut allergies, so much so that entire child care programs have become peanut-free zones in an effort to prevent any serious allergic reactions.

    Although some children may be aware of their own food allergies and the precautions they must take, not all children will. In most cases, especially the youngest you care for, children will not fully understand what it means or what foods they can and cannot eat. Therefore, it is of utmost importance for you to know if any children in your care have food allergies. A list of documented allergies should be posted in your program, but covered to protect children’s privacy. Stay vigilant at mealtimes to ensure children are not exposed to foods that contain known allergens. If there is a child with a severe allergy in your care, you should meet with the family to discuss any medications or emergency plans.

    Food allergies can affect many parts of the body. Common symptoms include:

    • Hives, skin rashes, and swelling
    • Sneezing, wheezing, and throat tightness
    • Nausea, vomiting, and diarrhea
    • Lightheadedness, and loss of consciousness

    If the symptoms are severe or if several areas of the body are affected, the reaction could be life-threatening. If the child has an itchy rash, swelling of the throat, and low blood pressure, they likely have anaphylaxis and requires immediate medical attention. If you notice that a child is having an allergic reaction that is severe or out of the ordinary, seek immediate emergency medical attention.

    While there are more than 160 types of foods that can cause an allergic response in sensitive individuals, these eight foods account for 90 percent of food allergy reactions:

    • Milk
    • Eggs
    • Fish
    • Crustacean shellfish (e.g. crab, lobster, shrimp)
    • Tree nuts (e.g., almonds, walnuts, pecans)
    • Peanuts
    • Wheat
    • Soybeans

    This topic is explored in greater detail in Lesson Seven of the Essentials in Child Care Food Service course.

    Non-Food Allergies

    There are many other allergens (manmade and natural) that can cause allergic symptoms, like runny nose or sneezing, coughing, wheezing, chest tightness, skin rashes, itchy, and watery or red eyes. Common non-food-related allergens include:

    • Dust mites
    • Animals or animal dander
    • Mold
    • Pollen (trees, grasses, weeds, flowers)

    If you suspect that a child in your care may have an undiagnosed allergy, talk with the child’s family to discuss the symptoms you notice. If the child has an allergic reaction to an environmental allergen that is specific to your home, the symptoms may not be as noticeable at their home.

    Be aware that some children may have animal allergies. Certain family pets may be harmful to such children. All children should wash their hands before and after handling an animal.

    Asthma

    According to the Centers for Disease Control and Prevention (CDC), more than 26 million Americans suffer from asthma, and over one-quarter of them are under the age of 18 (CDC, 2018). As the number of people with asthma continues to rise, so do more accurate methods are available to diagnose and treat the disease. Asthma can begin at any age; however, most children with asthma develop symptoms by age 5 (Cleveland Clinic, 2019). The AAP defines asthma as a chronic respiratory disease of the tubes that carry air to the lungs. These air passages become narrow and their linings become swollen, irritated, and inflamed, making breathing difficult (AAP, 2015). 

    Asthma can be difficult to diagnose. Although the airways are always irritated and inflamed, the symptoms are not always present, but are usually sporadic: sometimes they occur often, but at other times there may be long periods between symptoms. Asthma is often mistaken for other health problems, such as respiratory infection, pneumonia, bronchitis, or a chronic cough. For these reasons, it is important that families and caregivers be alert to the possibility of asthma and seek help if they see any of the following symptoms:

    • Wheezing
    • Regular coughing
    • Tight feeling in chest
    • Shortness of breath
    Asthma Attacks

    Asthma attacks are a scary experience for anyone, but they are particularly frightening for children. A child diagnosed with asthma will probably be taught strategies to cope with an attack and may be prescribed an inhaler. It is important that you know how to respond to an asthma attack and how to comfort a scared child. Make sure you know and follow the child’s care plan or inclusion support plans in the event of an asthma attack. If a child has their first asthma attack while in your care, seek emergency medical attention immediately. Do your best to keep the child calm, and encourage them to take slow breaths.

    See

    Specific policies for caring for children with health needs will vary from child to child. This video provides general information about what you might encounter in different family child care programs.

    Special Health Care Needs

    Each child is different, but it is important to prepare yourself for all health needs you might encounter

    Do

    Allergies to Pets or Food

    Children may come into your program with previously-identified allergies, or allergies may be identified after they start care with you. Either way, it’s essential that you talk with a child’s family to understand their child’s individual health care needs. Do not assume children with similar allergies are treated the same way. Children’s allergies are unique; the same allergy may present different symptoms in different children. As with all special health needs, allergies require a care plan for a child. This plan should include written information about the foods or animals the child is allergic to, a written treatment plan, a training plan for providers, and a plan for storing any medicine. You, and any back-up care providers must know how to appropriately administer and store any medication. The child’s allergies should be clearly and prominently posted in your program.

    If an allergic reaction occurs while the child is in your program, be sure to:

    • follow the child’s individual care plan or inclusion support plan, specifically following the guidance of what to do in the event of exposure to the allergen and/or display of allergic reaction
    • if the plan states, administer the prescribed medicine right away
    • contact the family, contact emergency medical services if appropriate, and encourage the family to contact the primary health care provider.

    Be sure to take a copy of the plan, any medication, and a cell phone with you whenever you and the child leave your home, such as on a field trip or walk to the park.

    Caring for Less-Common Health Needs: Medical Procedures

    Occasionally, children with more serious medical needs may enter your program. Their medical needs might include tube feedings, catheterization, suctioning, or checking blood sugars. In these cases, a care plan must be in place from the child’s primary care provider. If providers are expected to perform the procedures (and if this is acceptable under state law), the plan must include guidelines for training providers in the procedure. If you feel that the procedure is beyond your expertise or training, talk to your trainer, coach, or family child care administrator to get the help you need.

    Cultural Considerations

    Meals and mealtimes can have cultural implications from the types of food offered to the style of sharing mealtimes to self-feeding and self-help skills. Food choices can be affected by religious practices or cultural preference. Some individuals who practice Judaism, Islam, and Christianity do not eat pork, and some religious groups restrict meat or fast during religious observances. Most of the world’s adult population is lactose intolerant. These individuals experience difficulty digesting dairy products. In the United States, lactose intolerance is most commonly experienced in adults of Native American, Asian, African and Hispanic descent. Very young children typically do not experience lactose intolerance because most infants are born with enough lactase. However, preterm infants born before 34 weeks’ gestation may have difficulty with dairy because their digestive tract is not fully developed. (NIH, n.d.)

    Whether dietary considerations are health-related, personal, or cultural, families must be informed as far in advance as possible of your family child care program's policies and practices around meals and mealtimes, day-to-day menus, and available substitutions. This way, if families need to request a change for a certain day, they have time to do so.

    Soliciting families' cultural preferences not only keeps children and youth healthy, but also shows respect for the family -- the child's first and most important teacher.

    Administering Medication

    Providing medication to a child is a serious event. You must only do so by following a child’s individual care plan or inclusion of support plans. Follow these Rights to prevent mistakes and accidents:

    Seven Rights of Administering Medicine

    1. Right Medication. Any providers administering the medication should check the medication against the signed form to ensure that the name of the medication on the bottle or package matches that exactly on the signed form. Each time the medication is administered, this should be checked. The medication should be kept in its original container.
    2. Right Child. During certain seasons of the year when multiple children need medication or if your program has several children enrolled who need medication support (such as for diabetes, asthma, or attention deficit hyperactivity disorder), the risk increases for improper medication administration. Forms and medication need to be checked to ensure that the right child is receiving the medication.
    3. Right Dose. Confirmation needs to be made that the right dose has been measured. An excellent way to ensure this is to use the medication spoon dispensed with the medication by the pharmacy. Medication administration is not the place for guesswork. Any questions should be referred back to the family for clarification.
    4. Right Time. Timing of the medication should be clearly written on the medication itself and on the signed form. Additionally, providers need to confirm with families when the child arrives as to when the last dose of medication was administered and when the next one is due. This information should be documented, for example, on the child’s daily sheet or a medication administration form. Work with your coach, or licensing agency to ensure that you have the proper documentation required by your Service or state. Likewise, when the child is picked up by the family, the provider should provide written documentation of medication administration.
    5. Right Route. Medication can be delivered in a number of ways; usually the medication to be delivered by child care providers is through oral dispensing or through an inhaler. Confirmation of method should be written on the medication itself as well as on the signed form.
    6. Right Reason. Each time medication is given, the person administering it should make sure that the medication is being given for the right reason (e.g., Tylenol for teething pain, breathing treatment for asthma attack). Consulting the health-care plan or inclusion support plans for the appropriate symptoms can help ensure that the medication is given for the correct reasons.
    7. Right Documentation. Each administration of medication should be recorded. The provider who gave the medication should document the administration immediately each and every time after they have provided a dose (after washing hands). This is a critical step. Without proper documentation, another adult or the child’s family member may not appropriately provide the next dose of medication, which could have serious health implications for the child.

    Note that some states use the first 5 Rights (right child, right medication, right dose, right time, right route) and some states use 7 Rights, also known as “5 Rights PLUS” which include the last two rights (right reason and right documentation). Check with your coach, trainer, or administrator to be sure you know which set of medication administration rights are in use at your program. Failure to meet any of these Rights is a medication error that must be documented and the family notified. You can read more on these rights of medication administration by reviewing the resource, 7 Rights of Medication Administration, adapted from the American Academy of Pediatrics Information on Medication Administration, located below in the Learn Activities section.

    Any medication or medical equipment should be safely stored in your family child care program out of children’s reach. Sometimes, this involves storing the medication in a locked cabinet or container, but check with your coach or licensing agency to make sure you follow the appropriate procedures. Prescription medications should be in a container that has been labeled by the physician or pharmacist. Over-the-counter medication should be stored in its original package. All medications should be stored according to the directions on the containers or as directed by health care professionals. Some may require refrigeration, while others may not. If a child has severe allergies and might go into anaphylactic shock, they may be prescribed an epinephrine auto-injector (EpiPen, etc.). Keep the auto-injector available at all times, including field trips and walks to the park.

    Explore

    Explore

    It is important to identify resources needed to meet children’s special health needs. Read the scenario in the Meet Aiden activity, and write your answers in the space provided. Then talk to your trainer, coach, or family child care administrator about how you would best answer the questions as they pertain to your family child care business. Keep in mind the particular forms and procedures that may be required by your licensing agency. 

    Apply

    Apply

    In this section, you will find two documents you can use as templates for your own work: a Care Plan for Children with Special Health Needs and an Information Exchange Form for Children with Health Concerns. Use these resources as you learn more about the forms required for your family child care program. Talk with your coach or licensing agent to see what is needed to appropriately document and care for children with special health care needs.

    You can compare the attached documents with information or forms that you are already using in your family child care program related to children’s health care needs. You may have a nurse with a Care Plan Template developed and in use. Review this existing paperwork to ensure you have all required information in order to provide appropriate services and accommodations for children with special health needs.

    Glossary

    TermDescription
    Anaphylaxis An extreme, often life-threatening, allergic reaction. The reaction is serious and involves the whole body. Unless treated promptly, anaphylaxis can result in: blocked airway; cardiac arrest (no heartbeat); respiratory arrest (no breathing); or shock.
    Care planA plan developed by a child’s doctor and family. It describes the child’s health-care needs and how those should be cared for at school
    Students with special health care needsThose who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally (Caring for Our Children, 2015)

    Demonstrate

    Demonstrate
    Assessment

    Q1

    Dion is starting in your family child care program on Monday. You know his family, so you are aware he has severe asthma. What information or procedures should be in place by the time he starts?

    Q2

    What is a care plan?

    Q3

    True or false? Allergies are a common childhood health issue and do not require a care plan.

    References & Resources

    American Academy of Pediatrics. (2018). Allergies & Asthma. Retrieved from https://www.healthychildren.org/English/health-issues/conditions/allergies-asthma/Pages/default.aspx

    American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2015). Caring for Our Children: National health and safety performance standards; Guidelines for early care and education programs, 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Also available at http://nrckids.org

    American Academy of Pediatrics. (2003). Guidelines for the Administration of Medication in School. Retrieved from http://pediatrics.aappublications.org/content/112/3/697.full.pdf+html

    Centers for Disease Control and Prevention. (2016). Asthma surveillance data. Retrieved from https://www.cdc.gov/asthma/asthmadata.htm

    Centers for Disease Control and Prevention (n.d.). Food Allergies in Schools. Retrieved 
    from http://www.cdc.gov/healthyschools/foodallergies/index.htm

    Centers for Disease Control and Prevention. (2018). 2016 most recent asthma data. Retrieved from https://www.cdc.gov/asthma/most_recent_data.htm

    Centers for Disease Control and Prevention. (2013). Trends in Allergic Conditions Among Children: United States, 1997-2011. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db121.htm

    Cleveland Clinic. (2019). Asthma in Children. Retrieved from https://my.clevelandclinic.org/health/articles/6776-asthma-in-children

    Food Allergy Research & Education, FARE. (n.d.). Food allergy facts and statistics for the U.S. Retrieved from https://www.foodallergy.org/sites/default/files/migrated-files/file/facts-stats.pdf

    Jackson, K. D., Howie, L. D. & Akinbami. (2013). Centers for Disease Control and Prevention (2013). Trends in Allergic Conditions Among Children: United States, 1997-2011.  Retrieved from http://www.cdc.gov/nchs/data/databriefs/db121.htm 

    National Heart, Lung, and Blood Institute (n.d.) Asthma. Retrieved from https://www.nhlbi.nih.gov/health-topics/asthma

    National Institutes of Health. (2008). How Asthma-Friendly Is Your Child-Care Setting? Retrieved from http://www.nhlbi.nih.gov/files/docs/public/lung/chc_chk.pdf

    U.S. National Library of Medicine. (2018). Food allergy. Retrieved from https://medlineplus.gov/foodallergy.html

    Washington State Fathers Network. (2019). Bothell, WA: Kindering Center. Retrieved from https://www.fathersnetwork.org/