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    Objectives
    • Deepen your understanding of individual health care needs and the importance of administering medication correctly.
    • Suggest management practices to ensure that staff meet the individual health needs of children and youth in your program.
    • Present opportunities to apply the content of this lesson to ensure greater oversight and accountability to administer medication correctly, thereby meeting the individual health needs of children and youth.

    Learn

    Learn

    Know

    As a manager, you must strive to meet the needs of the children and families enrolled in your program. Children and youth may need additional support for health needs such as food allergies or asthma. Health needs should be identified at the time of enrollment so you can work with your staff to make the classroom and program safe for all children prior to their first day. However, if health needs present after a child is enrolled (e.g., the family of a toddler in your program discovers that their daughter has a severe allergy to peanuts), you must work with families and staff to update the appropriate documentation and ensure training and the environment are updated to meet the child's new special health care needs.

    Health needs should be addressed using your health care plan to ensure that there is a system in place that addresses all facets of a child's health care needs. If a health care need arises after a child is enrolled, the care plan needs to be written as soon as you and your staff are informed. Medical and physical care plans should be completed for children and youth with special needs or health conditions in accordance with your requirements. As the manager, you should be aware of your program's policies on serving children with special needs and also how to support staff to ensure all needs are met.

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

    According to Caring for Our Children (3rd ed.), a care plan typically includes information like:

    • The child's diagnosis or diagnoses
    • Contact information for the primary care provider (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 and your team might need to work with the child

    It may be helpful in some cases for you or your program to communicate with the family and the child's primary care provider. Remember, 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 sure that you and your staff are familiar with these regulations; refer to your program's guidelines and policies regarding who should talk with the child's primary care provider. A health care consultant can be a good resource.

    Common Health Care Needs

    Some of the most common health care needs among children and youth are allergies and asthma. The following information provides an overview of each health care need, what to watch for, and ways to support children with these needs.

    Allergies

    Allergies are one of 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 manager, ensure that staff members are aware of allergens that children or youth in their care have, their common symptoms and reactions to these allergens, and what they can do to make their classroom or program spaces allergy-friendly.

    Allergies can be difficult to diagnose and can develop at any age. A child may not have any allergy symptoms at age 3, but by age 5 they could develop a severe allergy. This is why it is important for staff to monitor the health of the children in their care. Staff should also feel comfortable approaching you if they have concerns that child in their care may have an allergy.

    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 U.S. (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 classrooms and care environments have become peanut free zones in an effort to prevent any serious allergic reactions.

    Although some children and youth may be aware of their own food allergies and the precautions they must take, not all children will fully understand what it means, or what foods they can and cannot eat. It is therefore essential that staff know whether any children or youth in their care have food allergies. A list of documented allergies should be posted in each classroom or program.  Stay vigilant at mealtimes to ensure children are not exposed to foods that contain known allergens. If there is a child in your program with a severe allergy, you, the staff members who directly care for the child, and perhaps the staff's trainer or coach, and the nurse or health aid, 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. Staff should know that if a child is having an allergic reaction that is severe or out of the ordinary, they should 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.

    Review each child's enrollment application to ensure that sections are filled out completely for:

    • Medical history
    • Overall health
    • Allergies or dietary considerations

    Your staff need to communicate openly with families about food items that children might be allergic to. They need to read ingredient lists and know the different versions and types of allergens. For example, nut products and byproducts are included in a variety of foods you might not expect; potato chips fried it peanut oil for example. If there is any doubt concerning a food or product, families need to be consulted. Quality assurances need to be established as formal standardized practices for the program to ensure that every child is screened accordingly and does not slip through the monitoring aspect of keeping children safe. If you do not already have one in place, establish a system to monitor allergies to eliminate risk.

    You can read much more about caring for children and youth with food allergies in childcare settings by visiting the Food Allergy Research & Education (FARE) website: https://www.foodallergy.org/education-awareness/community-resources/resources-for-child-care-facilities. You can also refer to the Centers for Disease Control and Prevention's Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs located below in the Learn Activities section.

    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)

    Asthma

    According to the Centers for Disease Control and Prevention, more than 26 million Americans suffer from asthma--more than 6 million of whom are under the age of 18 (CDC, 2018). As the number of people with asthma continues to rise, 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, 2013). The American Association of Pediatricians 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 who is diagnosed with asthma will probably be taught strategies to cope with an attack and may be prescribed an inhaler. It is important that staff members know how to respond to an asthma attack and how to comfort a scared child. Make sure staff follow the child's care plan in the event of an asthma attack. If a child has their first asthma attack while in your program, staff will want to seek emergency medical attention immediately. They should also do their best to keep the child calm by encouraging them to take slow breaths.

    Caring for Less Common Health Needs: Medical Procedures

    Sometimes 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 staff are expected to perform the procedures (and if this is acceptable under state law), the plan must include guidelines for training staff in the procedure. Be sure to support staff to get any training they may need.

    Supervise & Support

    Keeping Everyone Informed

    It is your responsibility to inform staff of a child's special health needs and to ensure staff are prepared to meet any of the child's individualized needs before their first day in your program. This may include training on such topics as how to administer a breathing treatment for a child with asthma. Staff should also be trained in reading and following individual health plans. Health plans should be updated according to your program's requirements and as needed.

    Information concerning food allergies should be shared with all staff members. A dated handout with a child's name and food allergy should be hung up in the kitchen for the meal-preparation staff and in the classroom for the teaching staff. Many programs post the information on the inside of a cupboard door or cover the names of the children so confidentiality is maintained. Follow your policies for posting this information.

    It is the families' responsibility to inform you at the time of enrollment of any medical, health, or dietary concerns of their children that may affect the care the child or youth receives while in your program. Be sure your intake paperwork contains questions about special health needs, and always ensure your line of communication with staff members and families remains open.

    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 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

    Policies for administering medication should be in your family and staff handbooks. You should discuss your medication policy with families before their children enter the program so policies are clearly understood.

    For the purpose of this discussion, medication includes any medicine or treatment that requires a medical prescription. Over-the-counter medication should only be given if approved by your program, along with written parental or guardian consent.

    Your staff should keep the following general guidelines in mind when administering medication:

    • Always follow the instructions for administering the medication as outlined on the prescription
    • Always have families complete the appropriate forms with signatures of medical practitioners as required
    • Always avoid giving the first dose of medication; if a reaction were to occur, it would likely be with the first dose
    • Always keep medications in their original containers so mix-ups don't occur
    • Always follow the exact directions for giving medication including dosage, duration, and storage

    Seven Rights of Medication

    It is your responsibility to ensure staff follow these specific guidelines when administering medication:

    Seven Rights of Administering Medicine

    1. Right Medication. Staff administering the medication should check it against the signed form to ensure that the name of the medication on the bottle or package matches what's on the form exactly. Each time the medication is administered, this should be checked. The medication should be in its original container.
    2. Right Child. During certain seasons of the year when multiple children may need medication or when the program has several children enrolled who need medication support (such as children with diabetes, asthma, or ADHD), the risk associated with medication administration increases. Forms and medication need to be checked to ensure that the right child is receiving the medication. This is even more crucial if administration is conducted by staff not directly working in the classroom.
    3. Right Dose. Confirmation needs to be made that the right dose has been measured. Use of the medication spoon dispensed with the medication by the pharmacy is an excellent way to ensure the right dose is given. Medication administration is not the time for guesswork. Any questions should be referred back to the family for clarification.
    4. Right Route. Medication can be delivered in a number of ways; usually the medication to be delivered by programs 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.
    5. Right Time. Timing of administering the medication should be clearly written on the medication itself and on the signed form. Staff 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. Likewise, when the child is picked up by the family, staff should provide written documentation of when medication was given.
    6. Right Reason. Each time medication is given, the person administering it should assure that the medication is begin given for the right reason (e.g., Tylenol for teething pain, breathing treatment for asthma attack). Consulting the health care plan for the appropriate symptoms can help ensure that the medication is given for the correct reason(s).
    7. Right Documentation. You should ensure a record is maintained for each child of all medication administered. The staff member who administered the medication should document the administration immediately each and every time after they have provided a dose (after washing hands). This is an incredibly critical step. Without proper documentation, another staff member or the child's family member may not appropriately provide the next dose of medication (e.g., they may provide the next dose too quickly which could cause seriously 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). Make sure your staff, coaches, and trainers know which set of medication administration rights are in use at your program. If any of these Rights have not been met, then a medication error has occurred; it must be documented and the family notified immediately. Make sure staff know what to do in the event an error has occurred or if they suspect an error occurred.

    Policy Implementation

    As a manager, you are ultimately responsible for the implementation of your program's policies. The appropriate administration of medication is vital, and care should be taken that staff have been trained in policies and procedures and on specific medication administration. If the administration of medication is more complex, training should be provided by medical personnel approved by the family or the child's medical practitioner. At the time the training is conducted, back-up staff should also be trained in case the primary staff person is unavailable at the time of administration. Training should be documented according to your program's policy. Limiting the number of staff who administer medication is one of the most effective ways to eliminate medication errors.

    As the program manager, you should ensure systems are in place to meet the medication administration policies. One of the best ways to support staff in their adherence to these seven rights is through training and providing the appropriate tools. Ensure staff have the proper forms on hand to document medication administration. You can also post posters or have visual reminders about the seven rights, so staff members remember to follow them each time they administered medication. With the help of trainers and coaches, work with staff to develop systems within their classroom or programs that help facilitate proper medication administration (e.g., where to store medication, timers for reminding when to administer, place in room where administration should happen, where documentation is filed within the room to respect children and family's privacy). With the help of your trainers and coaches, conduct audits of medication documentation to assess whether or not staff are appropriately completing this part, and address concerns immediately. Commend staff when you see them engage in the seven rights.

    Storage of Medication

    All medication should be kept out of reach of children in a locked cabinet or container. Medication that needs to be refrigerated should be in a locked container within the refrigerator. Your program's procedures for locking and storing medication should be followed.

    For school-age children who bring in their own medications, such as inhalers, be sure it's accounted for when they arrive at your program. Also, following your state's guidelines, you should have additional documentation on hand stating that the child is able to carry their own medication. Often this documentation requires a health care professional's approval.

    As you watch this video, for a review of your role in supporting individual health care needs in your program, including how to appropriately store and administer medication.

    Supporting Individual Health Care Needs

    Supporting the individual health care needs of children and youth.

    The chart below summarizes your key responsibilities when it comes to ensuring that the individual health care needs of children and youth in your program are met.

    Management Practices That Support Individual Health Care Needs

    Management Practices

     

    Staff Practices

    I should always…

    To ensure

    Staff never…

    Make certain that staff are trained on our program's requirements for meeting the individual health care needs of children and youth; including how to notify program staff of health changes

     
    • Are responsible for a child having an allergic reaction because proper procedures weren't followed for special dietary requirements
    • Ignore the cultural and/or religious food preferences of our families
    • Feel unsure as to what course of action to take if a child experiences an allergic reaction or requires medical treatment

    Audit enrollment applications to ensure medical and health information is complete and accurate

     
    • Fail to meet the health care needs of children and youth because information wasn't provided or complete

    Communicate verbally and in writing (family and staff handbooks) our program's requirements for meeting the individual health care needs of children and youth; including how to notify program staff of health changes

     

     

     
    • Fail to meet the health care needs of children and youth because they weren't kept abreast of health changes

    Make certain that staff are trained on our program's requirements for administering medication

     
    • Give children and youth the wrong medication
    • Give medication to the wrong child or youth
    • Give the wrong dose of medication to children and youth
    • Give children and youth their medication at the wrong time
    • Fail to document administering medicine

    Monitor the administration of medication on a regular basis

     
    • Jeopardize the safety and health of children and youth as a result of not following our program's requirements for the administration of medication

    Communicate verbally and in writing (family and staff handbooks) our policies for administering medication to children and youth

     

     

     
    • Administer medication incorrectly
    • Feel uncomfortable requesting information from families prior to administering medication
    • Fail to immediately notify me if there is a medication error

    Audit medication forms and systems on a regular basis; addressing concerns immediately

     
    • Engage in unsafe practices that put children and youth at risk of harm

    Explore

    Explore

    When a child with special health needs newly begins to attend your program, staff members can feel a little intimidated about how they can best care for the child. Read the Meet Claire activity, and write down your responses. Then compare them with the suggested answers.

      Explore Activities
    • Meet Claire

      MG.Hea_7.SpecialHealthCareNeeds_E1.MeetClaire.pdf

    • Meet Claire Sample

      MG.Hea_7.SpecialHealthCareNeeds_E1.MeetClaireAnswers.pdf

    Apply

    Apply

    One strategy to ensure children and youth are not exposed to foods that could potentially be harmful to them is to conduct a program audit of menus for children with allergies. Use the Menu Audit Activity as you review your files to determine all allergies that exist in your program. Then check classroom practices on how food issues are being handled with regard to allergies.

    You could also conduct a similar audit to see how your program meets families’ religious or cultural food restrictions.

    Glossary

    TermDescription
    AnaphylaxisAn 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. (MedlinePlus)
    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
    Food allergyNegative immune-system reaction to a substance ingested in food
    students with special health care needs“Those 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 gener¬ally” (Caring for Our Children, 2015)

    Demonstrate

    Demonstrate
    Assessment

    Q1

    Darin will be joining your school-age program next week and you are aware that he has asthma. What do you need to do before Darin’s first day?

    Q2

    A care plan…

    Q3

    True or False? If possible, always avoid giving a child the first dose of a new medication.

    References & Resources

    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. Retrieved from http://nrckids.org

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

    Cleveland Clinic. (2013). Asthma in Children. Retrieved from https://my.clevelandclinic.org/health/articles/6776-asthma-in-children

    Dresser, N. (2005). Multicultural Manners: Essential rules of etiquette for the 21st century. New Jersey: John Wiley & Sons.

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

    Oklahoma School Nurse Guidelines. (n.d.) Retrieved from https://www.ok.gov/health2/documents/Oklahoma%20School%20Nurse%20Guidelines%20and%20Example%20IHSP.pdf

    U.S. Department of Health and Human Services. (n.d.). Lactose intolerance. Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/lactose-intolerance

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