Know

As a Program 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 child has a severe allergy to peanuts), you must work with families and staff to update the appropriate documentation and ensure training and the environment meet the child’s new special health care needs.

Health needs should be addressed using your program’s health care plan to ensure that there is a system in place that addresses children’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 as needed for children and youth with dis/abilities or health conditions in accordance with your program’s policies. As a Program Manager, it is your responsibility to support staff members to ensure all children's needs are being 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 health 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 (4th ed.), a care plan typically includes information like:

• The child’s diagnosis or diagnoses
• Contact information for health care providers
• Medications to be given at child care, including the schedule, dose, procedure for administering, reason prescribed, and possible side effects
• Allergies
• Accommodations necessary for the child (diet or feeding, activity, environment, naptime/sleeping, toileting, outdoor or field trips, transportation, etc.)
• Special equipment or medical supplies
• Emergency response plan
• Special training you and your team might need to work with the child
• Parent notes

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 Program 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 a 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% of children are affected by food allergies, that’s 1 in 13 children (Centers for Disease Control and Prevention). Various proteins, harmless to people without allergies, can trigger serious reactions in people with food allergies. Reactions can range from mild to severe, with some being life-threatening. 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. There are steps you can take to prevent exposures to allergens. For example, we have seen an increase in children with peanut allergies, so many classrooms and care environments have become peanut-free zones in an effort to prevent 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 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, staff members who directly care for the child, 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 require 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 ingredients with allergens in mind to prevent accidental exposure, and understand how allergens can come in a variety of forms. For example, nut products and byproducts are included in a variety of foods you might not expect; such as potato chips fried in peanut oil. 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/resources?_limit=12&_page=1&audience=19. 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.

Non-Food Allergies

There are many other allergens that can cause allergic symptoms like runny nose or sneezing, coughing, wheezing, chest tightness, skin rashes, itchiness, 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 enroll in 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 health care provider and family. 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.

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 or administer an epi pen for a child with severe allergies. 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 program’s policies for posting this information.

It is the family's 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 have cultural significance, 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 to some degree. These individuals have trouble digesting dairy products. In the United States, lactose intolerance is most commonly experienced by 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.

We will define medication as 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:

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 ensure 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 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 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). 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 has occurred.

Policy Implementation

As a Program Manager, you are ultimately responsible for the implementation of your Service’s or program’s policies. The appropriate administration of medication is vital, and care should be taken that staff complete training on 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 administering medicine. 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 a Program Manager, you should ensure systems are in place to meet your medication administration policies. One of the best ways to support staff in their adherence to the Rights of administering medicine is through training and the provision of appropriate tools. Ensure staff have the proper forms on hand to document medication administration. You can also add posters or visual reminders about the Rights, so that staff members remember to follow them each time they administer 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’s 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 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, review your role in supporting individual health care needs in your program, including how to appropriately store and administer medication.

Supervise & Support

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