A child with special health needs is a child who has or is at increased risk for chronic physical, developmental, behavioral or emotional conditions and requires health and related services of a type or amount beyond the one required by most children.

When children with special needs are in group care, the information should be shared by parents/legal guardians and the child’s primary health care provider (PCP) with those who care for him/her.  This called a Special Care Plan. It’s created by using a form to communicate information to childcare practitioners who are non-medical professionals. Childcare professionals must understand the information and obtain any training necessary.  Children with special needs will require the completion of the parts of the Special Care Plan that document their daily or emergency needs. Additional information may be required for some children.

As a general statement. childcare programs serve at least 10% of children who have a special need. Many child care providers enroll children who have a developmental delay. Some receive services from a specialist. Ideally, the specialist shares techniques the adults in the child’s life can use to improve the child’s delay every day. The same should be true for a child with asthma, a seizure disorder or a peanut allergy.

Childcare staff members should have a special care plan for any child who has a chronic medical or developmental condition and must have knowledge of how a Special Care Plan works. Special Care plans should specify daily care, and care for any situations when the child might require special care, including an emergency.

Childcare providers need as much information as possible about the daily and emergency needs of all  children. The center must include a Special Care Plan for Children with Special Needs in Child Care as part of the enrollment/admission packet. This lets parents/legal guardians know what type of information the program needs. The Center administrator must collect from the parent/guardian the completed forms before the child’s first day of school. The care plan guides the procedures for the care of the child, as well as the necessary training and education of the staff members to assist the child.

Every program needs general policies and procedures for medication administration. Each child who needs medication should have the details specified in the care plan as well. Some children need special diets, adjustment of their activities or the environment. Some require an individual plan for medical and facility emergencies.

Every adult involved in the child’s care must know and be able to implement the plan. For some children, the child’s health care provider should complete the care plan. The parent/legal guardian must help the health care provider understand what the child’s program must know, in non-medical terms. For some children, the parent/legal guardian can complete most of the form. Then the health care provider should review and add any needed information. For a child with a complex condition, parents should schedule an office visit with the health care provider to discuss and complete the form. Some children will have more than one health care provider or specialist who will contribute additional medical or educational information (i.e. IFSP, IEP).

Information on the Special Care Plan

The Special Care Plan may be very simple or complex depending upon the child’s needs. Possible
content includes:

• Contact information for families, doctors, specialists, and sub-specialists.
• Medical conditions or behavioral concerns
• Allergies
• Medications
• Medical procedures
• Special diet
• Special instructions for classroom accommodations for play, nap, toileting, outdoor activity or
  transportation
• Special equipment or supplies
• Special training or instruction that the staff may need

A care plan should be updated to note changes in the child’s medical condition or routinely whenever the child has a routine check-up. Every state should have a form to collect information for the child care program at each checkup.

Some elements that a Special Care Plan must include are:

• Parent’s/Guardian’s name: Mark with a (*)  by the person who will be contacted first and
  document the person’s phone number.
• Signature for consent: Parent(s)/guardian should be sure to sign the Special Care Plan. This gives consent for health care providers to communicate with the childcare provider about the care plan.
• Authorization for release of information form completed: Federal law requires that a
  parent/legal guardian sign a HIPAA consent form for medical professionals to share information
  from a child’s medical record, although the release of information to school health personnel is
  sometimes permitted without specific consent. It is best to give the authorization to the health
  care provider rather than depend on an exception to what most health care providers consider
  their routine requirements. This form specifies exactly what portions of the medical record
  parents/legal guardians want to be released.
• Specialty Provider: Children with chronic medical problems may have one or more specialists.
  For example, a child with severe asthma may have an allergist or pulmonary specialist who is
  primarily responsible for medication adjustments, or determining when a visit to the emergency
  room is necessary. A pediatrician, nurse practitioner or family doctor might make these
  decisions without involving a specialist too.
• Emergency Information Form for Children with Special Needs Completed: The
  American College of Emergency Physicians and the American Academy of Pediatrics recommends a summary of the child’s medical history. The child’s health care professional should decide whether a child needs this form and then complete it.
• Specialty Care Plan should document specific information for the child’s health problem, (for example, asthma, food allergies, seizures). Note whether the parent/legal guardian and health care professional prefer that the child care staff members use these care plans.
• Needed Accommodations: Children with some conditions might need special arrangements
  that other children in the program do not require.
  • For example, Anthony, age 3 has milk, nut and hay allergies and asthma. Accommodations Anthony needs include: have his food brought from home and only served to him for all his meals, and special snacks for celebrations set aside for him. With parent consent, the program should post a written list of his allergies everywhere in the facility Anthony might go, perhaps with Anthony’s photo attached so volunteers and visitors can be aware of which child the warning applies. Everyone must be vigilant about handwashing on arrival at the program each morning not only for infection control but also to avoid exposing Anthony inadvertently to milk or nuts from someone else’s breakfast. A nut-free classroom would be best. His teacher should have immediate access to an EpiPen® kept close
    at hand and accessible to the teacher at all times wherever Anthony is. An easy way to make sure the emergency medicine is immediately available is to have whoever is supervising Anthony at any time is required to wear a fanny pack with an Epi-pen® while responsible for him. Everyone who is with Anthony during the day needs to recognize the symptoms of a severe allergic reaction, and how to use an Epi-pen® if necessary. In addition, the program might plan a field trip to somewhere other than to a farm while Anthony is in the class.
• Recommended Treatment: Daily or emergency treatments may be necessary. In our example, Anthony may need to use a nebulizer or an inhaler with a spacer to receive asthma medications. Every teacher/caregiver who is responsible for Anthony needs to know how to properly assist Anthony with these treatments.
• Medications Given at Child Care: Local licensing offices as well as health department and higher child care performance standards require proper documentation of administration of medication for children in child care / school settings. Some of these forms include:
  • An Authorization to Give Medication, to be completed by the parent/legal guardian
  • A Medication Log, to be completed by the childcare provider giving the medication.
• Medications Given at Home: Some children receive medication only at home for chronic
  conditions. In the event of an emergency, childcare providers must be able to tell health care
  providers about all the medications a child receives also at home.

Documentation of children’s needs is a must-have in childcare and school facilities, therefore a Special Care Plan is key to have to cover all the necessary information.

Resources

American Academy of Pediatrics. Fact Sheet ECELS Care Plan for a Child with Special Needs in Child Care Retrieved from file:///C:/Users/user/Downloads/11-16-12_Care_Plan_FACT_SHEET__Form.pdf and accessed on 10/27/2018.

Early Childhood Education Linkage System. Care Plan for Children with Special Needs. Retrieved from http://www.ecels-healthychildcarepa.org/resources.html on 10/27/2018.