Asthma & Childcare

Overview of Laws Protecting Young Children with Asthma

Americans with Disabilities Act: Chronic breathing problems are classified as disabilities, which mean that children with asthma are protected under the Americans with Disabilities Act (ADA). Children with disabilities cannot be excluded from childcare unless their presence would pose a “direct threat” to the health or safety of others or require a fundamental alteration of the program. The ADA also requires childcare programs to make “reasonable modifications” to policies and practices to integrate children with disabilities. For more information on what this means, visit the Federal Department of Justice website at http://www.usdoj.gov/crt/ada/childq%26a.htm.

California Law

While limited, California does have some regulations that have applicability to children with asthma and with which all licensed child care facilities must comply. Exceptions or variations for licensed family/home day care are noted.

Trigger Reduction
• Pest management and pesticide use: 22 CCR 101238(a)(1) states that the licensee shall take measures to keep the center free of flies, other insects and rodents. In 2006, the “parents’ right-to-know” law about pesticide application at school sites (California Education Code Section 17610-17612) was extended to licensed day care facilities. Department of Pesticide Regulations is required to send licensed facilities information on Integrated Pest Management (IPM). Family day care centers are exempt from the reporting requirements, but do receive the IPM information.
o Smoking: Health and Safety (H&S) Code section 1596.795(b) bans smoking anywhere on day care premises. Family day cares are required to prohibit smoking only when children are present.

Treatment, Management, and Staff Training
• Section 1596.798 of the California Health and Safety Codes gives child care staff permission to apply inhaled medications. It also requires any licensee or staff person who obtains or renews a pediatric first aid certificate to complete formal training in how to administer inhaled medication to children with respiratory needs.

Model Asthma Policies and Procedures for Child Care Centers
The American Public Health Association (APHA) and the American Academy of Pediatrics (AAP) published Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs.  This report includes six key recommendations for making child care centers safer for children with asthma that are adapted as follows:

1. Each child with asthma should have a special care plan prepared for the facility by the child’s source of health care, to include:
• Written instructions regarding how to avoid the conditions that are known to trigger asthma symptoms for the child;
• Indications for treatment of the child’s asthma in the child care facility;
• Names, doses, and method of administration of any medications, e.g., inhalers, the child should receive for an acute episode and for ongoing prevention;
• When the next update of the special care plan is due;

2. Based on the child’s special care plan, the child’s caregivers should receive training, demonstrate competence in, and implement measures for:
• Preventing exposure of the asthmatic child to conditions likely to trigger the child’s asthma;
• Recognizing the symptoms of asthma;
• Treating acute episodes;

3. Parents and staff should arrange for the facility to have necessary medications and equipment to manage the child’s asthma while the child is at the child care facility;

4. Properly trained caregivers should promptly and properly administer prescribed medications according to the training provided and in accordance with the special care plan;

5. The facility should notify parents of any change in asthma symptoms when that change occurs.

6. The facility should reduce these common asthma triggers by:
• Encouraging the use of allergen impermeable nap mats or crib/mattress covers;
• Prohibiting pets (particularly furred or feathered pets);
• Prohibiting smoking inside the facility or on the playground;
• Discouraging the use of perfumes, scented cleaning products, and other fumes;
• Quickly fixing leaky plumbing or other sources of excess water;
• Ensuring frequent vacuuming of carpet and upholstered furniture at times when the children are not present;
• Storing all food in airtight containers, cleaning up all food crumbs or spilled liquids, and properly disposing of garbage and trash;
• Using integrated pest management techniques to get rid of pests (using the least hazardous treatments first and progressing to more toxic treatments only as necessary);
• Keeping children indoors when local weather forecasts predict unhealthy ozone levels or high pollen counts.
Source:  http://nrc.uchsc.edu/CFOC/