Chapter 3: Health Promotion and Protection
3.5 Care Plans and Adaptations
184.108.40.206: Caring for Children Who Require Medical Procedures
A facility that enrolls children who require the following medical procedures: tube feedings, endotracheal suctioning, supplemental oxygen, postural drainage, or catheterization daily (unless the child requiring catheterization can perform this function on his/her own), checking blood sugars or any other special medical procedures performed routinely, or who might require special procedures on an urgent basis, should receive a written plan of care from the primary care provider who prescribed the special treatment (such as a urologist for catheterization). Often, the child’s primary care provider may be able to provide this information. This plan of care should address any special preparation to perform routine and/or urgent procedures (other than those that might be required in an emergency for any typical child, such as cardiopulmonary resuscitation [CPR]). This plan of care should include instructions for how to receive training in performing the procedure, performing the procedure, a description of common and uncommon complications of the procedure, and what to do and who to notify if complications occur. Specific/relevant training for the child care staff should be provided by a qualified health care professional in accordance with state practice acts. Facilities should follow state laws where such laws require RN’s or LPN’s under RN supervision to perform certain medical procedures. Updated, written medical orders are required for nursing procedures.
RATIONALEThe specialized skills required to implement these procedures are not traditionally taught to early childhood caregivers/teachers, or educational assistants as part of their academic or practical experience. Skilled nursing care may be necessary in some circumstances.
COMMENTSParents/guardians are responsible for supplying the required equipment. The facility should offer staff training and allow sufficient staff time to carry out the necessary procedures. Caring for children who require intermittent catheterization or maintaining supplemental oxygen is not as demanding as it first sounds, but the implication of this standard is that facilities serving children who have complex medical problems need special training, consultation, and monitoring.
Before enrolling a child who will need this type of care, caregivers/teachers can request and review fact sheets, instructions, and training by an appropriate health care professional that includes a return demonstration of competence of the caregivers/teachers for handling specific procedures. Often, the child’s parents/guardians or clinicians have these materials and know where training is available. If possible, parents/guardians should be present and take part in the training. The primary care provider is responsible for providing the health care plan for the child; the plan can be communicated to the caregiver/teacher by the parent/guardian with the help of the child care health consultant who can then assist in training the staff. When the specifics are known, caregivers/teachers can make a more responsible decision about what would be required to serve the child. A caregiver/teacher should not assume care for a child with special medical needs unless comfortable with training received and approved for that role by the child care health consultant or consulting primary care provider.
Communication between parents/guardians, the child care program and the primary care provider (medical home) requires the free exchange of protected medical information (1). Confidentiality should be maintained at each step in compliance with any laws or regulations that are pertinent to all parties such as the Family Educational Rights and Privacy Act (commonly known as FERPA) and/or the Health Insurance Portability and Accountability Act (commonly known as HIPAA) (1).
TYPE OF FACILITYCenter, Large Family Child Care Home
RELATED STANDARDS220.127.116.11 First Aid and Cardiopulmonary Resuscitation Training for Staff
18.104.22.168 Child Care Health Consultants
22.214.171.124 Care Plan for Children with Special Health Care Needs
- Donoghue, E. A., C. A. Kraft, eds. 2010. Managing chronic health needs in child care and schools: A quick reference guide. Elk Grove Village, IL: American Academy of Pediatrics.