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    Objectives
    • Identify and share resources related to health maintenance and common childhood illnesses.
    • Teach, model, observe, and provide feedback on special health needs.
    • Teach staff about your program’s policies regarding special health needs.

    Learn

    Learn

    Teach

    Children will enter your program with a variety of needs. Programs must be prepared to serve children with allergies, asthma, diabetes, health impairments, and physical disabilities, to name a few. This lesson helps you and staff members develop a plan to meet these children's needs.

    Each child who enters your program with an identified special health care need should have an individual care plan in place. This care plan is developed by a primary medical care provider and the family. It provides staff members with information about how to care for the child and what signs or symptoms to watch for. It is your job to help staff members work with the family to put the care plan in place. You should be familiar with each child's individual care plan.

    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

    Source: Caring for Our Children (3rd ed., 2015)

    One part of caring for children's health needs involves administering medication. A child's individual care plan might include emergency or maintenance medication. Teach staff members your program's specific policies and procedures around storing and administering such medication. Teach staff members to follow the Rights of administering medicine:

    Seven Rights of Administering Medicine

    1. Right Medication. Staff administering the medication should check the medication against the signed form to ensure that the name of the medication on the bottle or package exactly matches that on the signed form. Each time the medication is administered, this should be checked. The medication should be brought 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), there is increased risk of problems with medication administration. Forms and medication need to be checked to ensure that the right child is receiving the medication. If administration is conducted by staff not directly working in the classroom, this is even more crucial.
    3. Right Dose. Confirmation needs to be made that the right dose has been measured. An excellent way to double check this point is to use the medication spoon dispensed with the medication by the pharmacy. Dosage is determined by the documentation on the prescription label. If there is a discrepancy, it should be brought to the attention of the family. Any questions should be referred back to the family for clarification. Clarification needs to come from the medical provider or physician. Medication administration is not the time for guesswork.
    4. Right Route. Medication can be delivered in a number of ways; for young children, medicine is usually delivered by means of oral dispensing or through an inhaler. Older children may take pills. Confirmation of method should be written on the medication itself as well as on the signed form.
    5. Right Time. Timing of the medication should be clearly written on the medication itself and on the signed form. Additionally, staff need to confirm with families when the child arrives as to when the last dose of medication was administered as well as when the next one is due. This information should be documented according to program policy and practice. Likewise, when the child is picked up by the family, staff should provide written documentation of medication administration that has occurred, according to program policy and practice.
    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. Each time a child is administered medication, it should be recorded. The staff member who administered the medication should document the administration immediately each and every time after they have finished administering 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 five rights (right child, right medication, right dose, right time, right route) and some states use seven rights, also known as “5 Rights PLUS” which include the last two rights (right reason and right documentation). Check with your administrator to be sure you know which set of medication administration rights are in use at your program.  If any of these Rights have not been met, then the situation is considered a medication error. It must be documented and the family notified.

    Model

    One of the most important things you can do to create a healthy culture is to welcome children to your program and serve as an advocate for them. As a trainer or coach, you can model an inclusive attitude and a problem-solving approach. Make sure staff members embrace your program's philosophy that all children belong by making sure your program is a safe place for children with allergies, asthma, or other special health needs. Documented allergies and dietary restrictions should be posted in each classroom or program where food is served. Model continuous professional growth related to caring for children: learn what you can about each child's health need, learn how to care for each child, and provide support to staff members at all times as they learn. Monitor compliance with the Rights of administering medication.

    Medication or medical equipment should be safely stored in the classroom, office, or nurse's office. Prescription medications should be in a container labeled by a 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 may go into anaphylactic shock, they will likely be prescribed an epinephrine auto-injector (EpiPen, etc.). Keep the auto-injector available at all times.

    Brainstorm with staff about ways to make sure all children are healthy and included during field trips and special events. Address the use of epi-pens and take the first aid kit with you every time children go outside: during field trips, playground time, fire drills, etc.

    Observe

    You might see staff members with a range of comfort levels regarding special health care needs. Read these examples of problems and possible coaching responses. How would you respond?

    ScenarioPossible Response

    You notice Benji and his team out on the playground without the emergency medical kit. Dante's asthma medication is in the kit.

    Take the kit out to them and say, "Benji, the kids are in real danger without this kit, and I'm worried about Dante being out here without his inhaler. Make sure you bring the kit outside every time."

    Sheridan always avoids helping Breanne with her medical treatment.

    "Sheridan, I feel like you might not feel comfortable doing Breanne's treatment. Tell me how you feel about it."

    Cassidy calls you crying. She and another staff member miscommunicated about medicating a child. The child got two doses of his medication.

    "Cassidy, let's stay calm. Bring me the pill container, so we can gather information. This is a major medication error, so we need to handle this right away."

    You will want to continually observe the child for a reaction to the overdose including any behavioral changes such as a rash, a change in breathing, or sweating. 

    Ask: Is the child showing any concerning reactions?
        If yes, call 911
        If no. call Poison Control and let them know the medicine and amount. Follow Poison Control’s instructions. 

    Contact the family

    Report to licensing agency

    Use the Special Health Needs Best Practices Checklist in the Apply Activities section to focus your observation on this important set of competencies. When you have finished observing, store the forms in staff members' training files as evidence of their competence and progress.

    Explore

    Explore

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

    Apply

    Apply

    Use the Special Health Needs Best Practices Checklist as a focused observation tool to support staff that have completed the Healthy Environments course but may need additional support or follow up on supporting children with special health care needs. This checklist provides an easy way to follow up on goals set around this topic and specific feedback to staff members about what you observed. 

    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. (Medline Plus)
    Care planA plan developed by a child’s doctor and family. It describes the child’s health care needs and how they should be cared for at school
    Special health care needDescribes children 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

    Demonstrate

    Demonstrate
    Assessment

    Q1

    A child in your program was just diagnosed with a serious food allergy. What should you do?

    Q2

    A staff member is scared to provide the breathing treatments a child needs. What should you do?

    Q3

    The Parent Advisory Council is planning to offer breakfast snacks in the lobby for a special event. What health information should you make sure they are aware of?

    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. Also available at http://nrckids.org

    Aronson, S. S., Bradley, S., Louchheim, S., & Mancuso, D. (2002). Model Child Care Health Policies, 4th Ed. Washington, DC: National Association for the Education of Young Children.

    Aronson, S. S., & Spahr, P. M., Eds. (2002). Healthy Young Children: A Manual for Programs. Washington, DC: National Association for the Education of Young Children.

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

    Commonwealth of Massachusetts. (2018). Medication administration training and information for child care. https://www.mass.gov/health-and-safety-in-child-care-settings

    National Association for the Education of Young Children. (2007). Keeping Healthy: Families, Teachers, and Children. (2007). [Brochure]. Washington, DC. 

    North Carolina Child Care Health and Safety Resource Center, (May 2009). Information available by contacting 800-367-2229.

    Ritchie, S. & Willer B. (2008). Health: A Guide to the NAEYC Early Childhood Program Standard and Related Accreditation Criteria. Washington, DC: National Association for the Education of Young Children.

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