It is well documented that children pass germs among each other, mainly through the exchange of saliva as it passes from mouth to hands to mouth. So when "cold and flu" season hits, the number of children in the childcare setting with the "sniffles" or worse grows quickly. During the winter months, as many as 40-60 percent of the children in childcare may be on some type of antibiotics or over-the-counter medications to fight their illnesses.

The childcare provider sees two types of medications most often. Antibiotics are issued by prescription and are powerful medications that assist in the destruction of bacteria. Over-the-counter medications are non-prescription products such as cough and cold preparations meant to relieve some symptoms of common illnesses. Over-the-counter medications are not intended to cure the cold or flu virus but to lessen the symptoms.

Are these medications really necessary and effective? Studies show that bacteria may be growing immune to commonly used antibiotics like never before. It has also been shown that cold medications do not shorten the time span of the viral disease, and their effects on a cold's symptoms are debatable. While adults may know the negative side effects that medications like antihistamines have on them, they may not consider these side effects when supplying the medications to preschool children. In many cases, such medications do have benefits, and they can help parents and other caregivers feel confident that they are doing all they can to help their children.

What about bacterial infections or viral infections that turn into bacterial? The so-called "green runny nose" is in fact a color change from the fermentation of the secretions from the nose and by itself, does not necessarily indicate a need for antibiotic treatment. Other infections such as sinusitis, otitis (ear infections) media, and other bacterial infections do require an antibiotic. Antihistamines are for allergic problems only (not viral or bacterial colds) and should be restricted for that use.

What childcare providers should do is learn about medication administration. In larger programs, several different caregivers may be responsible for administering medication, so there is clearly a need for education. Caregivers should learn how to label, store, and administer medication; understand the consequences to the child if medication is not given properly; and realize the liability issues that exist for the caregiver, the childcare program, and the director.

Here are some very basic guidelines on the use of medication in the childcare setting.

Medication should only be administered in the childcare setting when it is absolutely necessary. When antibiotics are required, most are given only once or twice per day. This means that the parent can give the medication before and after childcare. When a child is sick or recovering from an illness, it is important that the child see the parent take part in helping them. Only in special circumstances should a childcare provider need to give a child antibiotics.

All medications should be signed in daily.

All medications should be stored and labeled properly. Each medication should arrive at the childcare program in its original container, and prescription medication should have the correct pharmacy label which includes the pharmacy's phone number. In addition, medication should be labeled with the child's name, the name of the medication, and the time and amount of the dose to be given. The parent should understand that the daily schedule and staffing arrangements may not allow for medication to be dispensed at an exact time, and he or she should be flexible.

The parents, the child's physician, or childcare health consultant should inform the childcare provider of any possible side effects of the medication.

It is important that childcare staff discuss all medications and medication procedures with parents and encourage the parents to discuss medications with their child's physician.

By James M. Poole, MD, FAAP, member Early Childhood, Adoption, Dependent Care Committee of American Academy of Pediatrics

Resources

The April/May 1998 of Healthy Childcare, Vol. 1, Issue 3, included an article entitled Administration of Medication in the Childcare Setting and sample forms to be used by caregivers and parents for the use of medications. For back copies of this issue ($3), call Healthy Childcare toll-free, 877-258-6178.