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Administration of Medication
in the Childcare Setting
Child caregivers may be required to give medicine to a child to help treat an illness or ongoing condition. Having clear policies on giving medicines, whether prescription or over-the-counter, can help the staff deal with these situations safely and effectively. It can also help parents better communicate with caregivers about their child's medication needs.
Prescription medicines with scheduled dosages such as "every six hours" will require administration during an 8-10 hour day of childcare. Children with chronic conditions such as asthma may require medication to prevent or treat an asthma attack. Pain associated with teething or a broken bone may be relieved with the correct dosage of acetaminophen.
However, there are risks in giving medicines in the childcare program. For example, a child may receive either too much or too little medication if a caregiver misreads the dosage instructions, if the parents don't clearly inform the caregiver of the amount and time of the last dose, or if someone forgets to record the time the last dose was last given. Too much medicine can cause serious consequences or even death and too little of the medicine may result in complications from the disease being treated.
The National Health and Safety Performance Standards, National Academy of Early Childhood Programs accreditation criteria, Head Start Performance Standards, and state licensing requirements specifically address administration of medicines in childcare programs. It is essential that every childcare program have a written policy and clear procedures on giving medicines.
Over-the-counter (OTC) medicines
Many childcare programs only give medicines if prescribed or recommended in writing by a physician. If a child needs an over-the-counter (OTC) medicine such as acetaminophen or cough medicine, then the parent should ask the doctor or nurse for a written note indicating the medication dosage and how often it may be given.
This policy can eliminate situations where a parent asks a caregiver to "give my child some cough syrup if he needs it." This request means the caregiver must decide whether a child needs medicine or not. Most caregivers are not trained to make medical decisions such as this and should not be asked to do so.
Obtain Written Authorization
Obtain written authorization from the parent before medication is given. This authorization should be required each time a new medicine is prescribed or brought into the center. The sample authorization form included here shows the information that is necessary for the parents to provide.
It is not safe or appropriate to get "blanket authorization" to administer OTC medications for pain, stomach gas, or teething. Such authorizations can lead to potentially dangerous situations. Pain is the body's signal that something is wrong. It is difficult for a caregiver to know exactly what is causing the pain, so the caregiver should not make the decision to give medicine. If a child has a headache, stomach pain, rash, or other discomfort, the parent/guardian should be notified.
Communicate with Parents
Communicate with parents and require written information on time and dosage of medicines. In addition to the written authorization, there also should be written communication each day medicine is given. When the parent brings the child to the center, a medication form should be completed stating the name of the medicine and the time the last dosage was given. When the parent picks up the child, the caregiver should give the parent a written copy of the time and dosage of medicine given at the center. A sample authorization form for medication is included here.
Storage of medication
Medicines must be stored "in original, labeled containers in locked cabinets inaccessible to children" (National Academy of Early Childhood Programs, accreditation criteria H-20a). This requirement applies to all medicines, including OTC products and medicines requiring refrigeration.
Disposal of medicine
Parents should take home any medicines at the end of the day or end of the week. Let parents know that the medicines are included in the child's back pack or diaper bag. Medicines should not be handed to the child or an older sibling to take home.
Staff Training
There should be designated staff members in each center who are trained and authorized to give medicines. Untrained staff, substitute teachers, or volunteers should not give medicine.
Be Familiar with Types of Medicine
Be familiar with the types of medicines that are often given to children. You may ask a pharmacist or physician to discuss with the caregivers the different types of medicine such as pain relievers (acetaminophen, ibuprofen), antibiotics, or cough medicines. If a parent brings in a medicine with a name the staff doesn't recognize, he/she should question whether this is an antibiotic, a decongestant, etc. Also, if a child regularly takes a specific medicine and the medicine brought in is a different color or the dosage has changed, question it. Parents can make mistakes and might pick up the wrong bottle of medicine at home.
Be familiar with typical dosages
Many liquid medicines for children are given in dosages of less than one teaspoon. When you see a prescription that instructs you to give one tablespoon, you should immediately check with the pharmacist or physician. These professionals also can make mistakes, which can have serious consequences. If the parent brings an OTC medicine such as children's acetaminophen, be sure they bring the box with instructions. There is a great difference in the amount of the actual drug contained in infants drops, children's tablets, and junior-strength tablets of acetaminophen.
Practice measuring dosages
Try measuring the amount of liquid in a teaspoon (eating utensil), a measuring teaspoon, a medicine dropper, and a medicine spoon. The actual amount may differ significantly. Always use a medicine dropper, syringe, or a medicine spoon to measure the correct dosage for liquids. Choose one that allows the child to swallow all the medicine with no medicine left in the dropper/spoon. Be sure the markings are clearly visible on the dropper/spoon.
Practice following instructions
Use role play and "real-life" examples to be sure caregivers know when and how much medicine to give the child. Ask a pharmacist for samples of medicine labels, or use printed labels with directions on OTC medicines. Using the daily medication form, tell the caregiver when the last dose was given at home. Then ask the caregiver when he/she would give the medicine, and how much the dosage should be.
Keep Complete Records
Know how to complete the authorization and daily medication forms. Attention to details such as printing clearly the child's correct name (there might be two children with similar names), and correct use of a.m. and p.m., are essential. Also, be sure that the parent, as well as the caregiver, can read and understand the information. If you are not sure of the parent's reading ability, then you should orally tell them the information as well as giving them the form.
Specialized training
Some children may need medicine that requires special administration. A child with a severe allergic reaction might require epinephrine through injection. A child with asthma may need emergency help with a bronchodilator. If children in your center have medical conditions that might require specialized care, make sure all staff involved with those children are properly trained to deal with not only everyday needs, but emergency situations as well.
In addition to training, center directors should monitor staff when administering medicine to children to help them follow procedures such as:
- checking the dosage and label twice before giving the medication.
- locking up the medicine immediately after use.
- filling out the daily medication form completely and legibly.
Giving medicines in a childcare setting is just one of the many parts of a caregiver's busy day. Knowing how to properly administer medicines and having appropriate policies and training available can make a crucial, even life saving difference for both the caregiver and the child.
To clean the dropper/spoon, wash it in warm soapy water and rinse. You may then spray it or dip it in mild bleach solution (one tablespoon bleach to one quart of water), rinse, and air dry. Do not use boiling water to sterilize!
Check expiration dates on all medicines as most should be thrown away after one year. Liquids such as antibiotics have a shelf life of about 14 days. Check packages for expiration dates on all over-the-counter medicines. If the expiration date is not printed on the package, do not use the medicine.
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