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 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—e.g., peanuts, gluten.)
• 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 (4th ed., 2019)

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:

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. You can read more on these rights of medication administration by reviewing the resource Information from the American Academy of Pediatrics on Medication Administration located below in the Learn Activities section.

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 medical emergency kit or 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?

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.