Caring for Our Children (CFOC)

Chapter 3: Health Promotion and Protection

3.5 Care Plans and Adaptations

3.5.0 Caring for Children Who Require Medical Procedures

Content in the STANDARD was modified on 02/27/2020.

Any child enrolled in an early care and education program who requires dietary, activity, environmental, or behavioral modifications or medication regularly or for emergencies should receive a written care plan from his or her primary health care provider or pediatric specialist. This is especially important for children with special health care needs who need procedures while in early care and education programs. Medical procedures requiring a written care plan can include, but are not limited to, instructions about1

  • Blood sugar regulations
  • Postural drainage
  • Supplemental oxygen
  • Endotracheal suctioning
  • Catheterization (unless the child requiring catheterization can perform this function on his or her own)
  • Medication administration to control seizure activity
  • Tube feedings
  • Special medical procedures performed routinely or on an urgent basis


Early care and education staff should consider how the procedure aligns with the child’s daily schedule.


The child’s primary care provider, medical home (eg, pediatricians and other specialists), or pediatric specialist should provide all medical information, while parents/guardians are responsible for supplying the required equipment necessary to accommodate the child’s needs. This care plan 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). This care plan should also include instructions for performing the procedure, a description of common and uncommon complications of the procedure, and what to do and who to notify if complications occur.


Caregivers/teachers should not assume care for a child with special health care needs who requires a procedure unless they are comfortable with training they have received and approved for that role by the child care health consultant or consulting primary care provider. Appropriate and sufficient training, consultation, and monitoring of early care and education staff should be provided by a qualified health care professional in accordance with all state practice acts and local, state, and other applicable laws. Facilities should follow state laws where such laws require registered nurses, or licensed practical nurses under supervision of a registered nurse, to perform certain medical procedures. Updated, written medical orders are required for these procedures.


If possible, parents/guardians should be present and take part in any training required for accommodating needs of their child in the early care and education program. Parents/guardians know their child best and should be encouraged to establish a relationship with their child’s caregivers/teachers and communicate information about the child’s tolerance of the procedures, normal reactions, and complications/issues they have encountered.

Communication among parents/guardians, the early care and education program, and the primary care provider (medical home) requires the free exchange of protected medical information.1(p30–31) 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(p23–24)


Special health care needs that require specialized procedures are common among children, with their specific needs varying with age, abilities, and increasing independence.1(p3) Children with special health care needs, and their families, require assistance to maintain health, well-being, and quality of life while in out-of-home care. Another goal of implementing these special health care procedures is to maximize the inclusion of children in all program- or school-related activities.


The 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.

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS First Aid and Cardiopulmonary Resuscitation Training for Staff Child Care Health Consultants Care Plan for Children with Special Health Care Needs
Appendix O: Care Plan for Children with Special Health Care Needs
  1. American Academy of Pediatrics. Managing Chronic Health Needs in Child Care and Schools. Donoghue EA, Kraft CA, eds. 2nd ed. Itasca, IL: American Academy of Pediatrics; 2019


Content in the STANDARD was modified on 02/27/2020.