An indicator of quality in childcare programs is accurate, thorough, and updated documentation. Documentation provides a detailed record of actions taken related to policies and procedures as well as information that may be needed for reports, inspections, and liability issues.

As all health records are confidential, request information that is helpful in supporting children in childcare. Information and documentation should be shared with staff only on a “need to know” basis.

Health-Related Documentation

Childcare programs should maintain work with families to complete, up-to-date health and safety files for each child. Medical history, a health care provider’s assessment form, and a daily health check provide childcare programs with the documentation needed to ensure a safe, healthy environment.

When children enroll in a childcare program, families should supply a health history, particularly in regards to family chronic illnesses that could impact the child’s health. Enrollment also is the time to collect information about the child’s health care provider, medical home, and other specialized health care professionals, such as therapists, dieticians, and counselors, who may be providing services to the child.

Early childcare settings that provide comprehensive services to children, such as Head Start, may request written consent for the childcare program to communicate with the child’s health care team. In addition to the health history completed by the family at enrollment, each child should have an age-appropriate health assessment completed by their health care provider that includes current immunization status and health screenings.

Daily health checks should be conducted soon after each child’s arrival at childcare.  The health check should include looking for changes in behavior or appearance that would indicate illness or injury; a check of the skin, a temperature check if the child seems sick, and observing the child for other signs or symptoms of illness or injury, such as cuts, pain, or vomiting. Note any concerns that are identified during the daily health check in the child’s file.

Consultation and Service Records

Children may receive therapies and treatments from specialized health professionals, such as audiologists, counselors, or psychologists. Caring for Our Children standards recommend that  childcare programs obtain an individualized care plan, prepared by the child’s health care provider, detailing medications, treatments, therapies, and other relevant information.

Written consent to obtain individual care plans should be sought from the child’s parent and the health care provider, and considered in planning for the child’s safety, development, and learning. These plans may need to be updated periodically. Make sure appropriate staff are familiar with a child’s specific care plans.

Nutrition Documentation

Services related to nutrition also require documentation. Caring for Our Children recommends that menus be prepared a month in advance and posted for families’ review. Dietary or feeding modifications, such as those needed for a food allergy or for a medical need, should be documented with written instructions from the primary health care provider. These instructions should include the child’s special need, dietary restrictions, food omissions and substitutions, and special feeding techniques.

Individualized feeding plans for children with specific nutritional needs should be maintained. Examples include plans for children who are overweight or have iron deficiency anemia. For children with food allergies, documentation should include written instructions about foods the child is allergic to and specifics on how the food is to be avoided, as well as a treatment plan that includes details of medication administration and symptoms of a reaction requiring medication.

Medication Administration Documentation

Childcare programs should have written policies for administration of both prescription and nonprescription medications. Ongoing medication records for each child should include specific, signed consent from the parent or guardian for the childcare provider to administer medication.

The consent form should include the child’s name, the name of the medication, the dates and times that the medication is to be administered, the dose or amount at each administration, the method of administration (oral, topical, etc.), and the period of time that the consent form is valid. A medication administration record provides an up-to-date record of medication administration and promotes constant communication between the child’s parents and the childcare program.

The form should include signed parental consent for you to administer the medication, authorization for administration of the medication from the child’s health care provider that includes details (prescription, medical need, dosage, length of time of that medication should be given), along with information about warnings and side effects.

There also should be written documentation of administration of all medications and any side effects that occurred, and there should be a medication errors log. Documentation of medication administration protects the person who administers the medication because it provides a written record of the process that was followed.

Emergencies, Illness, and Injury

The Caring for Our Children standards recommend that childcare programs have written plans for dealing with incidents that may jeopardize the health and safety of children or staff. The plans should include, at the minimum,

• Policies and procedures for a missing or lost child
• Suspected child abuse or neglect
• Injuries requiring medical care, dental care, hospitalization or emergency care,
• Mental health emergencies
• Serious illness or death of a child or childcare provider, including deaths that occur outside the operation of the childcare facility
• The presence of a threatening person at the childcare facility.

In addition, there should also be written plans for natural disasters and other emergencies (power outages, facility damage, terrorism, etc.) and a plan for the management of seasonal and pandemic influenza. Drills that allow staff and children to practice for various emergencies should be practiced consistently and records maintained of the specifics of the drill.

Keeping up with the needed documentation for each child in your childcare program as well as updating emergency plans and procedures is an important part of keeping each child and the staff healthy and safe.

Marna Holland, EdD
State-licensed Birth-Kindergarten Educator, Asheville, NC

Resources

Caring for Our Children: National Health & Safety Performance Standards Guidelines for Early Care Education Programs, www.nrckids.org

Sample Forms, www.childhealthonline.org/downloadform.html