Children with Chronic Health Conditions

POLICY: The parent/legal guardian will provide the required care plan paperwork and emergency medications for children with chronic health conditions prior to the child’s first day.

PURPOSE: To assure staff have appropriate instructions for care of children with chronic health conditions, including emergency care plans and emergency medications.

To comply with licensing regulations.

To protect the health of the children with chronic health conditions.

PROCEDURE:

1. Enrollment paperwork will identify if children have a chronic health condition such as allergies, asthma, seizures, diabetes, or any other medical condition that requires medication to be given at the childcare center OR that may require specific care, accommodations, or emergency actions by childcare staff. 
2. Prior to a new child starting on their first day, the childcare center will have the parent/legal guardian provide the care plan, medication orders, and the emergency medication completed by the child’s health care provider. 
   1. If an existing child develops a newly diagnosed chronic health condition, the childcare center will obtain the care plan and emergency medications as soon as possible.
   2. The childcare center reserves the right to temporarily suspend services until a care plan completed by a health care provider and emergency medications are provided to the childcare center by the parent/legal guardian.
3. The following is required for each child with a chronic health condition:
   1. A written care plan / emergency action plan that is completed and signed by the child’s healthcare provider, and signed by the parent/guardian consenting to the childcare provider executing the care plan.
      1. The care plan will describe which actions childcare staff should take if the child experiences certain symptoms, including life-threatening symptoms such as an allergic reaction, an asthma attack, a seizure, etc. Templates are provided in section M.
   2. Emergency medication. E.g. epi-pen for allergies, an inhaler for asthma, emergency seizure medication, emergency diabetes medication, or others. 
      1. See section E-25 for details on medication policies. 
      2. All medication must be in its original box, including over-the-counter (OTC) medications and prescriptions. 
      3. Prescription medication must have the original pharmacy label on it with the child’s name, health care provider’s name, instructions for use, dose, frequency, and expiration date.
      4. The parent/guardian must provide the emergency medication to the childcare provider and have their own emergency medication to be kept at home.  They may need to remind their healthcare provider of the need for a second prescription.
      5. All expired or unused medications should be returned to the parent/guardian for disposal. If the medication cannot be returned to the parent/guardian, it should be disposed of safely. See Medication Disposal in San Francisco for a list of drop off locations or how to send them by mail for disposal though the SF Environment Department. You can also visit How to Safely Dispose of Old Medicines - HealthyChildren.org for more information.
   3. Medication administration instructions in writing from the health care provider. School staff is not authorized to determine when an "as needed" medication is to be given. Specific instructions are necessary. Templates are provided in section M.
      1. OTC medications without a prescription must also have specific instructions in writing from the parent/guardian. Use form LIC 9221.
   4. Parent consent to administer medications, including all OTC medications.  Templates are provided in section M, or use LIC 9221.
4. It is a licensing requirement to the have this paperwork in the child’s medical file. As a best practice, it is highly recommended to also keep an extra copy with the medications in the classroom, and a copy in the go-bag for evacuations.
   1. Emergency medications and care plans are required to be taken with you during any evacuation or field trip. 
5. Food allergies and substitute foods shall be posted where only staff can view it (ex: inside of cabinet).  
6. In case of contact with an allergen or other medical emergency, the center will assure that emergency care to the child can be administered by childcare personnel. Episodes are documented on injury log and reported per licensing requirements.
7. Allergy episodes will be avoided or appropriately handled by center. Each episode will be investigated by the childcare staff for cause and prevention, appropriate emergency care of the child and follow-up response by staff.  The Nurse Consultant may be notified of each allergy episode while the child is in childcare.
8. All unusual incidents and 911 calls should be reported to licensing.