CHILD CARE HEALTH AND SAFETY BULLETIN

Transcription

1 N ORTH C AROLINA CHILD CARE HEALTH AND SAFETY BULLETIN NORTH C AROLINA C HILD C ARE HEALTH AND SAFETY RESOURCE CENTER D E C E M B E R V O L U M E 3, I S S U E 6 About The Resource Center The NC Child Care Health and Safety Resource Center is a project of the Department of Maternal and Child Health, School of Public Health, The University of North Carolina at Chapel Hill. Funding for the Resource Center originates with the Maternal and Child Health Title V Block Grant of USDHHS s Health Resources and Services Administration/Maternal and Child Health Bureau, awarded to the University under a contract from the Division of Public Health, NCDHHS. The development, translating, printing, web posting and mailing of the Health and Safety Bulletin are supported by funding from the Child Care and Development Fund Block Grant of the Child Care Bureau, Administration on Children and Families, USDHHS, through a contract between the Division of Child Development, NCDHHS, and the Department of Maternal and Child Health, School of Public Health, The University of North Carolina at Chapel Hill. In This Issue 1 Administering Medication 2 Steps to Giving Medicines 3 Books to Read 4 Policy of Medication Administration 4 SIDS Law 4 Toy Recalls 5-6 Parent Pages 7 My Dolly s Sick! 7 Alternative Gift Giving 8 Ask the Resource Center Administering Medication The NC General Assembly passed four child care laws which will all be in effect by December 1, The NC Division of Child Development sent child care programs a summary of the laws in their September mailing. Three of these laws affect regulated child care programs: House Bill 152, Reducing the Risk of Sudden Infant Death Syndrome (SIDS) in Child Care; House Bill 1063, Information for Parents, and Senate Bill 226; Unauthorized Medication Administration in Child Care (Kaitlyn s Law). Kaitlyn s Law has caused many child care providers to worry about administering medications in child care. Child care facilities that currently give medications to children in compliance with NC Child Care Rule.0803, Administering Medication, can continue doing what they have always done. This rule remains the same. If a child care provider follows the steps outlined in this rule, s/he will not be violating Kaitlyn s Law. Kaitlyn s law was passed to protect children from receiving medication without parental permission, for non-medical reasons such as encouraging sleepiness. Child care providers do not have the legal right to give a child a medication without written permission from the parent. Written permission protects the child by providing authorization and instructions for administering medications, and by reducing the risk of receiving a medication that could cause serious injury. It protects the child care provider by giving them legal authority to give prescribed medications and over-thecounter medications requested by parents. Kaitlyn s Law makes it illegal to intentionally give a child a medication without written permission from the parent. The punishment for this illegal action is a Class A1 misdemeanor, which can result in an active sentence. However, if the child is seriously injured as a result of being given the unauthorized medication, the punishment is a Class F felony, which may result in imprisonment. A medical emergency is the only exception to the law. If an emergency occurs, a medical care provider must give instructions for providing a medication. Child care programs are not required to administer medication but there are many situations in which providing that service to families might be the better choice. The Americans with Disabilities Act requires that programs make reasonable accommodations for children with special needs, including special health needs. Children with chronic health conditions like asthma may only be able to attend child care if medication can be given on site. Providing staff training in medication administration procedures and establishing a medication administration policy are two ways a child care program can reassure both parents and staff that the program strives to administer medications safely. Your local child care health consultant can assist with training and policy development. Guidelines for administering medication safely are included in this issue of the Health and Safety Bulletin.

2 MSteps to Giving Medicines Accepting Medication from Parents When parents request that medicine be given to their child, you will need to make sure you have all the documentation and materials required to legally and safely give the medication. If medication is brought into the center for a child riding a van or bus, the medication must be transferred between responsible adults. Permission to Administer Medication: Check to see if parents have completely filled out the required information on the Permission to Administer Medication form. Parents must provide written permission for prescribed medication and for over-the-counter medication. This meets the requirement for written permission from the parent to give the child a medication. The written permission slip must include: Name of the child Any special instructions, Name of the medication like give with food or milk Dosage Any possible reactions Dates to be given to watch for Times to be given Parent s signature For prescribed medications: Check to see that the medication is in its original container. Be sure the container is properly labeled with the: Name of the child who will be given the medication Name of the medication or prescription number Directions for giving the medication: dose, time, number of days, and the route. (Route refers to the way the medication is given: for instance, by mouth, by eye drops or eardrops, or applied topically to the skin.) Name of the prescribing physician or other health professional Date the prescription was filled Date the medication expires For over-the-counter medications: Check to see that the medication is in its original container, has the child s name written on it and that the directions are visible and understandable. Cough syrup, decongestants, and acetaminophen are examples of over-thecounter medicines. Caregivers can only give the recommended dosage included in the instructions found on the packaging, unless the medication is accompanied by written instructions signed by a physician. Written permission to give an over-thecounter medication is valid for 30 days. It can be voided at any time by written notice from the parent. Blanket permissions for medication administration: Parents can give child care providers permission to administer prescribed or over-the-counter medication for up to six months for chronic medical conditions like seizures and allergic reactions. A parent can give child care providers written authorization for up to 12 months, to apply over-thecounter topical non-medical ointments such as teething ointments, lotions, powders and creams, such as sunscreen. A parent may give a caregiver standing authorization to administer a single weight appropriate dose of acetaminophen to a child with a fever when parents cannot be reached in the case of an extreme emergency. Ongoing medications need to be reviewed at regular intervals to be certain the medications are current and still appropriate for the needs of the child. Medications to be given as needed are only administered under certain conditions. When filling out the Permission to Administer Medication form the parent must specify under what circumstances the medication should be given. For example, if a parent wants a diaper cream applied when their child s bottom is reddened they might write, When the child s bottom is red, apply a dime size amount of the diaper cream to the reddened area of the child s bottom following each diaper change. Always remember to: Check the expiration date on the container. Do not accept medication that has expired. Be sure you understand the instructions for giving the medication. Make sure they are legible so others can read them. 2 HEALTH AND SAFETY BULLETIN DECEMBER 2003

3 Ask if the child began the medication at home and if s/he experienced any side effects. Ask the parents what administration techniques work best for their child. Storing Medication Medications must not be accessible to children. Medications are properly stored when they are put In a locked container, box, cabinet or closet; remember to keep the container or door locked. On a separate shelf; not with other items such as food, hazardous chemicals, or cleaning supplies. In a locked container inside the refrigerator, if the medication requires refrigeration. The refrigerator must be inaccessible to children. Storage of Emergency Medications The exceptions to Sanitation Rule.2820(d) are emergency medications for situations such as a severe allergic reaction, severe asthma attack, or low/high blood sugar in a child with diabetes. In these emergency situations, the medications must be readily available since delaying the administration of medication for just a few minutes could be harmful to the child. Emergency medications may be left unlocked but must be kept out of children s reach. Caution: Check all diaper bags when the parents are still available. If medications are found in the bag return them to the parents. Keep on hand only those medications you will be administering. Child care staff and volunteers often carry medications in their purses or briefcases. These must also be in locked storage. Administering Medication Before giving medication: Wash your hands before giving or applying medication to each child. Check that the parent has signed and provided all the required information on the Permission to Administer Medication form. Take the medication out of the locked storage area or container. Relock. Prepare the dose. Avoid touching the medication with your hands. Use an appropriately labeled medicine dropper, cup, or spoon for accurate measuring of liquid medications. Do not use tableware such as spoons for measuring, as they are not accurate. Double check the time, the amount of the dose and the route of administration on the container label and on the permission slip. Remember: Never give a medication you do not have written permission from the parent to give. Never give a medication that has expired. Never give a medication someone else prepares. Never give medication by a route you are not comfortable with or for which have not received enough training. Administer medication: Give the exact dose to the child, by the route specified. Follow any special instructions, such as giving the medication with food or on an empty stomach. Wash your hands. Return the medication to the locked storage area or container. Relock. Document that you have given the medication by completing the required information on the Permission to Administer Medication form (date, time, dose, route, signature). After medication is given: If an error is made administering the medication, be sure to document what was given and inform the parents and director of the error. Additional documentation may be needed. Observe the child s response to the medication and report any side effects or reactions to the parent, the child care health consultant or physician if necessary. If an allergic reaction occurs, the parent should be notified immediately. If a life threatening reaction occurs, dial 911 immediately and: - Follow the emergency action plan for your facility. - If the child has special health needs, follow the instructions on the child s individual health plan. - Complete the required incident report. Keep a copy in the child s folder, send a copy to DCD, and give the parents a copy. Record the incident in the incident log. Return unused medication to the parents after the last authorized dose has been given to the child. Return expired medications to parents or dispose of them if the parents do not want the expired medications. Books to read: Froggy Goes to the Doctor by Jonathan London, 2002 How Do Dinosaurs Get Well Soon? by Jane Yolen, 2003 Kevin and the School Nurse by Martine Davison, 1992 Miss Polly Has a Dolly by Pamela Duncan Edwards, 2003 DECEMBER 2003 HEALTH AND SAFETY BULLETIN 3

4 Policy on Medication Administration When considering whether or not to provide medication at child care consider the needs of your families and the staff s ability to properly administer medications. Child care may be the ideal place for medication to be given. For children with special health care needs, receiving medication may be the only way they will be able to attend child care. Parents and staff can work together to meet the child s needs. A policy might include: In which situations medications will be given. Who will give the medications. Where the medications will be stored, including emergency medications. Under what circumstances the parents will be called to administer a medication. How the center will meet the needs of children with special health care needs. Remember the ADA law may come into effect when considering the needs of children with special health care needs. What procedures the program will follow for medication administration. What documentation will be required. What parents responsibilities will be. What staff responsibilities will be. What training the staff will receive on medication administration. Special training should be provided for administering medication that must be given in a specialized way, such as a nebulizer for asthma medication, and for giving controlled substances such as Phenobarbitol for a seizure disorder. Pharmacy Law requires specific documentation of controlled substances. How staff and parents will be informed about the policy and its procedures. Following the clear procedures established in a policy reassures everyone involved with the program that the child care facility is dedicated to dealing with medication administration safely North Carolina Child Care Health & Safety Resource Center Providing Training, Consultation & Resources for North Carolina s Child Care Community SIDS Law Child care providers are required to position infants, 12 months or younger, on their backs for sleeping unless a written waiver for another position is provided. For infants less than 6 months, a physician must provide a waiver stating that the infant has a medical condition requiring a different sleep position. A parent or physician waiver can be provided for an infant from 6-12 months. Related to this law, NC Child Care Rules for the mandatory safe sleep policies and staff training are being developed by the Child Care Commission. For more information go to or call Toy Recalls The US Consumer Product Safety Commission regularly issues recalls for toys for children of all ages and for other products that have been found to be unsafe. To check whether a toy is unsafe or to report a toy-related injury, call the Consumer Product Safety Commission at or go to prerel/category/toy.html Don t Forget 2004 National Smart Start Conference January Joseph S. Koury Convention Center Greensboro, North Carolina Keynote Speaker: T. Berry Brazelton Registration: December is National Drunk and Drugged Driving (3D) Prevention Month Safe Toys and Gifts Month Dec. 1 World AIDS Day Dec National Hand Washing Awareness Week January is National Eye Care Month National Birth Defects Prevention Month National Children s Dental Health Month National Volunteer Blood Donor Month Jan Healthy Weight Week 4 HEALTH AND SAFETY BULLETIN DECEMBER 2003

5 g We encourage you to copy page 5 and 6 and distribute them to parents. P a r e n t Medicine in Child Care: What Should You Know? A number of conditions or illnesses may require that a child receive medication during the day. Children may have chronic health conditions such as diabetes and need ongoing, daily medication. They may have a short term illness such as an ear infection that needs a brief course of antibiotics. If medicine needs to be given during child care hours, parents can help providers care for their child by becoming familiar with the program s medication policy. For a child care provider to give a medication it must be in its original container and the parent must give written permission to the child care facility to administer the medication. This written permission makes it legal for the caregiver to give the medication. Medications cannot be given after their expiration date. They cannot be given for a non-medical reason such as encouraging sleep. It is illegal for child care providers, licensed or not, to intentionally give medication to a child without a parent s written authorization. If your child needs medicine while attending child care: Remember to Review the program policy that addresses medication administration Know who will be administering the medication to your child Follow the guidelines required of all child care programs Doctors may write prescriptions for medicines or prescribe over-the-counter medications such as cough syrup, acetaminophen or antibiotic cream. P a e s Prescription medication should come in original pharmacy containers labeled with: The child s name Date the prescription was filled Physician s name Name of the medicine or the prescription number Directions for dosage, or written instructions for dosage Date and signature of prescribing physician or other health professional Date the medication expires Over-the-counter medicines should come in original containers and be administered only with written authorization from the parent or guardian. Caregivers can only give the recommended dosage stated on the package instructions, so make sure your instructions match these. Sometimes a doctor will prescribe a larger dose of medicine than is specified by the product. In these cases, the medicine will be treated similarly to a prescription medication. You must bring in written instructions signed by a physician. Permission to Administer Medication The Permission to Administer Medication form gives child care facilities the legal right to give your child medication in child care. The facility needs to know exactly what to do. The permission should include all of the following information: Child s name Name of the medication Amount (dose) of medication to be given Time to give the medication Dates it is to be given Special instructions, if any Possible side effects to watch for, if any Parent s signature Blanket Permissions: A blanket permission can cover a long period of time. These are given in three situations. 1. Parents can provide a written blanket permission for up to six months to authorize administration of medication for chronic illnesses such as asthma and allergic reactions. 2. Parents can provide a written blanket permission for up to one year to authorize administration of sunscreen and over-the-counter diapering creams. 3. They can also give a blanket permission to administer a one-time, weight appropriate dose of acetaminophen in cases where the child has a fever and the parent cannot be reached. This should only be used in the case of an extreme emergency Parent Pages continued on Page 6 DECEMBER 2003 HEALTH AND SAFETY BULLETIN 5

6 Tips for Parents If your child needs medicine ask your child s doctor or health care provider if a two-dose medication can be given. A two-dose medication will allow you to administer the medication at home. When medication will be given to a child while in child care, ask the pharmacist to divide the medication into separate labeled containers, one for home and one for the child care facility. This way you avoid taking medication back and forth between child care and home. If you are providing a medication to be given to your child as needed, make sure the person administering the medication understands the symptoms you believe indicate a need for medication. For example, every time Larry goes out to play in the sun, put specific sunscreen on any exposed skin. Always provide the necessary Permission to Administer Medication forms, even for sunscreen and diapering creams. Use clear tape when labeling over-the-counter medications so the directions and expiration date are legible and not covered by the label or tape. Never put a medication in a child s diaper bag or carrying bag. Always give medication directly to a responsible adult and make sure instructions for administering the medication are clear. Give the child the morning dose before leaving home to make the job of medication administration easier for the child care provider. Dust of Snow The way a crow Shook down on me The dust of snow From a hemlock tree Has given my heart A change of mood And saved some part Of a day I had rued. -Robert Frost- Seasonal Stress Winter months can be a time when some experience seasonal stress or depression. Some of this may be due to shorter daylight hours, less activity, and less time outdoors. Some may experience stress during holiday times because of financial pressures, over-commercialization, travel for family gatherings, or the pressure of gift giving. Holidays can bring about a feeling of loss for those who may experience their traditional celebrations differently because they are unable to be with family or friends. These feelings of stress or depression can carry over into the months following the holidays. If you find winter months to be stressful, consider ways to relax and bring comfort and joy to the holiday season. The following suggestions from the National Mental Health Association may help you cope with holiday stress and depression. Keep expectations for the holiday season manageable. Try to set realistic goals for yourself. Pace yourself. Organize your time. Make a list and prioritize the important activities. Be realistic about what you can and cannot do. Do not put your entire focus on just one day (i.e., Thanksgiving Day), remember it is a season of holiday sentiment and activities can be spread out (time-wise) to lessen stress and increase enjoyment. Remember the holiday season does not banish reasons for feeling sad or lonely; these feelings may still be present, even if you choose not to express them. Leave yesteryear in the past and look toward the future. Life brings changes. Each season is different and can be enjoyed in its own way. Don t set yourself up by comparing today with the good ol days. Do something for someone else. Try volunteering some time to help others. Enjoy activities that are free, such as driving around to look at holiday decorations; going window shopping without buying; making a snowperson with children. Be aware that excessive drinking will only increase your feelings of depression. Try something new. Celebrate the holidays in a new way. Spend time with supportive and caring people. Reach out and make new friends or contact someone you have not heard from for awhile. Save time for yourself! Recharge your batteries! Let others share responsibility of activities. For your local community mental health center: National Mental Health Assn. Resource Center has a toll free number to call: NMHA(6642) TTY Line Reference: National Mental Health Association, 2003, retrieved 10/27/03 from 6 HEALTH AND SAFETY BULLETIN DECEMBER 2003

7 My Dolly s Sick! Miss Polly had a dolly that was sick, sick, sick So she called for the doctor to come quick, quick, quick. The dolly is sick in dramatic play! Quickly turn the area into a sick room or doctor s office/clinic. Through dramatic play or pretending, children are able to build an understanding of their environment and gain confidence in their ability to participate competently in their world. Imaginative play allows children to develop cognitively, socially and emotionally. Caring for a sick dolly or stuffed animal helps a child interpret and imitate what they see when they re sick. It makes them more comfortable about what happens in their real world. It is also a golden opportunity to help children develop good health and safety practices. Ideas for the Prop Box & Dramatic Play Center: medical bags band-aids stethoscope telephone(s) play thermometer pencils x-rays cap, disposable face mask and shoe covers, apron, etc. for nurse/doctor prescription pads or pads of paper photos of children as doctor/nurse Encourage both boys and girls to role-play as doctors and nurses! posters or signs of doctors, nurses, and parents taking care of sick children empty pill bottles *Children should never be encouraged to think medicine is candy. They should learn to only take medicine from a trusted adult. Other Activity Ideas: Invite a nurse or doctor to come and talk about safe ways to take medicine and what they do when a child is sick. Exploring the tools and equipment a doctor or nurse uses is always fascinating to a child. Create picture cards with simple words for how to give medicine. 1. Get the medicine 4. Get the medicine ready 2. Wash your hands 5. Give dolly her medicine 3. Look at the directions 6. Put the medicine away Sing and act out the song Miss Polly Has a Dolly. Miss Polly (Make up actions to fit the words.) Miss Polly had a dolly that was sick, sick, sick So she called for the doctor to come quick, quick, quick. The doctor came with her bag and her hat And she knocked on the door with a rat-a-tat-tat. She looked at the dolly and she shook her head. She said, Miss Polly, put her straight to bed! She wrote on a paper for a pill, pill, pill I ll be back in the morning with my bill, bill, bill. Alternative Gift Giving And he puzzled three hours, till his puzzler was sore. Then the Grinch thought of something he hadn t before! Maybe Christmas, he thought, doesn t come from a store. Maybe Christmas perhaps means a little bit more! From How the Grinch Stole Christmas by Dr. Seuss Whether we celebrate Christmas, Hanukkah, or Kwanzaa, or just get caught up in seasonal gift giving for the fun of it, most of us want the midwinter celebrations to mean a little bit more. We want to give something that will express our love and affection. A simple gift from the heart has special significance for both the giver and receiver regardless of age. Children too get caught up in the excitement of the season and want to participate in gift giving. Creative projects that touch members of their local community as well as families are one way to direct children s energy and enthusiasm. Gifts to the community: Make cards for nursing home residents: holiday greetings or friendly hellos. Make paper chains, colorful artwork for local service organizations. Make centerpieces or table decorations by filling containers with pinecones, fir branches, holly and other natural objects. Tuck in herbs and spices for a fragrance. Take a field trip to sing songs and share stories with people in a nursing home. Gifts to family and friends: Give Gift certificates to family and friends for special treats such as lunch or phone call, a hug, and help feeding the dog. Glue shells, leaves or feathers on painted cardboard or a colorful paper plate for hanging. Make small pillows out of felt for the child to fill with stuffing and spices. Tape a child or children singing seasonal songs or telling a favorite story. DECEMBER 2003 HEALTH AND SAFETY BULLETIN 7

8 Ask the Resource Center Child care rules require us to take infants outdoors each day even in the winter. Parents often object, fearing their babies will catch colds or become too chilly. How can we reassure parents? In North Carolina s moderate climate, infants are able to go outside nearly every day. Sometimes it s difficult to judge when weather conditions are safe, especially with infants, whose small bodies lose heat quickly in cold weather. Wind chill factors can make a chilly day even colder. How do you decide when it s safe to take children outside in winter? The Child Care Weather Watch, located at provides guidelines for child care providers regarding temperature that may be dangerous for outdoor play. Call us at to request a copy. Below are general guidelines to follow. When temperatures are at or below 20º F, including wind chill factor, infants should not go outside. When temperatures are between 21-32º F, outdoor time should be limited to minutes. Reassure parents about the benefits of fresh air. Getting outside each day helps keep infants healthy. Infectious disease organisms are less concentrated outdoors so children are less likely to re-breathe the groups germs. Light exposure to the skin helps provide the child s body with vitamin D. Take precautions to make sure infants stay warm. Bundle children in warm layered clothing. Make sure clothing is dry. Check children s hands and feet every 15 minutes in cold weather for color and warmth. Even a short period outdoors will benefit babies and providers, providing a chance to breathe fresh air, feel the cool wind on their faces and get a bit of sunlight on their skin. 8 HEALTH AND SAFETY BULLETIN DECEMBER 2003 NC Child Care Health & Safety Resource Center 1100 Wake Forest Road, Suite 100 Raleigh, NC HEALTH BULLETIN EDITORS: VOL. 3 ISSUE 6 Janet McGinnis, Jacqueline Quirk CONTRIBUTORS: Lucretia Dickson, Jeannie Reardon, Jonathan Kotch, Judy Sowerby Special thank you to Alice Elio and Pat Allingham for their contributions to sections on medication administration. DOWNLOAD: You may download a copy of this publication from our website at: REPRINTING: Articles may be reprinted without permission if credit is given to the bulletin and the material is not reproduced for commercial purposes. This publication is produced by the North Carolina Child Care Health and Safety Resource Center and distributed to licensed child care facilities, CCR&R agencies, DCD child care licensing consultants, and child care health consultants throughout North Carolina. We d like to hear from you Call us at to share your comments and requests for articles or information. 10,000 copies of this document were printed at a cost of $.46 per copy Nonprofit Org US Postage PAID Chapel Hill, NC Permit No. 177 POSTMASTER: Please deliver as soon as possible time dated material enclosed