Before a child is enrolled or returns to a preschool or childcare program, the family looks forward to new experiences, new friends, and the caring support of early childhood professionals and other staff. But certain children and their parents have many more issues to consider. Such is the case for children with asthma, diabetes, spina bifida, muscular dystrophy, or other chronic health problems. Planning ahead by parents and caregivers can be the key to assuring that children with chronic conditions receive the best care possible. Here are some ideas that may help.
Caregivers and parents should share information about the child. Parents and caregivers should discuss the child's care before the child begins a new childcare routine and regularly throughout the year. Schedule at least 30 minutes and pick a place where you can talk without interruptions. Parents can share practical suggestions regarding medication or treatments and provide the caregiver with a better understanding of the child's condition. Throughout the year, the caregiver may provide the parent with unique insight into the child's progress or be able to share new ideas or concerns regarding the child. Open communication is essential to proper management of the child's condition whether they are at home or in the childcare program. Being unaware can result in improper management of the condition, leading to complications or even an unnecessary hospitalization for the child.
Get information about the chronic condition. As the person who provides care for the child for a significant portion of the day, it is your responsibility to find out all you can about the chronic condition and how to provide optimal care in the childcare setting. Call your local or regional Children's Hospital (see Resources) for brochures, videotapes, models, or books on the specific condition. Let parents know you are interested in learning more about their child and ask them to bring you additional information about the condition or treatment. The better the information, the more likely the child will receive appropriate and timely care.
Work with the family to make the proper arrangements for the child. Encourage parents to take their child to the doctor well before they begin or change a childcare program or caregiver. That way, if the child's medication, equipment, or type of therapy needs to be changed in order to accommodate the childcare environment or schedule, they can arrange a trial period at home, while the child is still with a caregiver who is familiar with his or her condition. Parents or someone familiar with the child are more likely to notice any side effects, as well as favorable outcomes, of the new treatment.
Ask parents to write down everything about the child's medicine, treatment, or care. Discuss it with the parents and be sure you understand the instructions. Make copies for the child's file and for each caregiver who will interact with the child.
Establish a connection to the child's primary medical care provider to complete the "triangle." Many pediatricians and other health professionals who care for children are happy to work with childcare providers to help accommodate the needs of their patients. In addition, they benefit from the perspective that the childcare provider offers on the child's growth and development. When parents, caregivers, and health professionals work together and communicate, children receive the best care possible at all times.
Know what to do in an emergency. In addition to knowing medication or emergency treatment, be sure you know who to call. Keep a current list of names, addresses, and phone numbers of persons who can make decisions about the child's care in the event of an emergency. Include names and phone numbers of physicians, clinics, and/or hospitals. Take a copy with you on field trips or when transporting the child.
Help the child feel comfortable with others about their condition. Talk with the parents about letting the child share information about their condition with other children. Use words that are easy to understand such as, "I think my blood has too much sugar" (diabetes) or "sometimes it is hard to breathe" (asthma). Many Children's Hospitals provide educational programs for young children, such as the "Kids on the Block" puppet shows that teach children about various conditions, disabilities, and other physical differences such as wearing glasses or using crutches. Encourage other children to ask questions which either you, the parent, or the child can answer.
Be sensitive to the child's feelings when giving medication or treatments. Children do not want to be recognized as "different." If you tell the child "time to take your medicine" in front of the other children, the child may refuse or say he does not need to take it now. This applies to all medications for all children, including "temporary" medications, such as antibiotics, or daily medications such as Ritalin.
Encourage participation in activities. Almost all children can participate in some form of class activity ranging from music, rhythm, or art, to outdoor play. Ask parents to provide a note from the child's doctor stating what activities are best for the child. Support groups can help you identify innovative ways to involve children in as many normal childhood experiences as possible.
By Lois Alexander, RN, Director, Patient Education, The Children's Hospital of Birmingham, Alabama
National Association of Children's Hospitals and Related Institutions, (NACHRI), 401 Wythe St. Alexandria, VA 22314; 703-684-1355; www.nachri.org/aboutn/list_members
Family Voices (parent organization for families of children with disabilities), PO Box 769, Algodones, NM 87001; 888-835-5669; www.familyvoices.org
National Information Center for Children & Youth with Disabilities (NICHCY); PO Box 1492; Washington, DC 20013; 800-695-0285; www.nichcy.org