HEAD START®

Caring for Children with
Chronic Conditions

Training Guides for the Head Start Learning Community

Table of Contents | Preface | Introduction | Module 1 | Module 2 | Module 3
| Continuing Professional Development | Resources

MODULE 3: Putting It All Together: Caring for Children with Asthma

Module 3 | Activity 1 | Activity 2 | Activity 3 | Next Steps

Outcomes

After completing this module, participants will apply the essential principles to plan the care of a child with a chronic health condition. This module demonstrates the example of caring for children with asthma.

Key Concepts

Head Start staff must work with the family and health care providers to ensure that the care of the child with asthma is...

• Family-Centered
  
  – Recognize families as primary caregivers and key participants in developing the child's health plan.
  
  – Provide emotional support and assistance in advocacy for the child and family.
  
  
• Individualized
  
  – Get all of the information needed about the severity of the child's asthma, the triggers, signs and symptoms, medications, and emergency response.
  
  – Develop an Individualized Health Plan for each child which includes accommodations needed in the child's and staff's daily activities to:
  
  

  – prevent asthma triggers
  
  – recognize and respond to asthma episodes
  
  – administer medications and emergency care
  

• Safe and Legal
  • Provide staff with protocols, training, equipment, supplies, supervision, and support to care for the child.
    
  • Ensure confidentiality of sensitive medical information.

Background Information

A. Understanding Asthma As A Chronic Condition

Asthma is a chronic respiratory condition. It is the most common cause of children's absence from school and hospitalization. Current estimates are that 5-10% of children have asthma. The prevalence of asthma has been increasing dramatically over the past decade, and it is anticipated that it will continue to increase in the near future.

Asthma is a condition in which the airways in the lungs are more "reactive" than normal. It can be caused by hereditary factors associated with allergies, and other family members often also have asthma and/or allergies; and it can be caused by lung damage, for example from premature birth or pneumonia.

Increased reactivity of the airways means that certain things in the environment can set off an asthma attack or episode. The environmental factors that bring on asthma episodes are known as "triggers." They include respiratory illnesses, cigarette smoke, air pollution, dust, pollen, animals, exercise, cold air, cockroaches, and emotions.

In an asthma attack, the airways react to the triggers by constricting the airway muscles, swelling the lining of the airways, and producing increased mucus. These result in a narrowing of the airways and the signs and symptoms of an asthma episode which include coughing, wheezing, and difficulty breathing.

Asthma can be successfully controlled and treated. Families, Head Start programs, and health care providers must work together to prevent asthma episodes, recognize early signs, and promptly treat asthma episodes. With effective management, children with asthma should be able to lead active and healthy lives. They should be able to sleep through the night, attend school, engage in normal activities and exercise, and avoid hospitalization.

Asthma is a varied disease. The underlying causes of the condition, the triggers of asthma episodes, the signs and symptoms, the severity of the disease, the medications used, and the responses needed are different for different children. The degree to which asthma affects children's lives is also varied. Some children need daily medications and daily modification of their activities, while others only need medications and modifications during asthma episodes. While children's asthma is commonly characterized as "mild," "moderate", or "severe," it can remain constant in severity or it can come and go or change over time.

Asthma is not contagious. Although one of the symptoms of asthma is coughing, which can also be a symptom of a communicable disease, the asthma itself–the underlying increased reactivity of airways–cannot spread from one person to another.

B. What Head Start Programs Should Do?

Head Start programs must work with families and health professionals to provide proper care for children with asthma.

• Provide family-centered care:
  
  Children and families' success in managing asthma depends on a complex interaction between the child's stage of development, the characteristics and course of the illness, the family's strengths and challenges, and the availability of medical, social, and emotional support.
  
  Head Start programs can support family strengths by recognizing that parents know a great deal about their child and can educate staff about how to best care for their child. For example, staff need to rely on parents for details such as, "When Jamal scratches at his throat, that's his first sign of an asthma attack," and "Veronica takes her inhaled medicine best while I'm reading her a book."
  
  Head Start staff can help provide emotional support and assistance in advocating for the child and family, depending on their particular needs. For example, if a family needs assistance navigating the health care system, Head Start staff can offer families guidance and support with asking questions and getting information at health visits.
  
  Through coping with asthma, many families gain valuable knowledge and skills and feel that the experience makes them more informed, closer as a family, and more effective advocates for the needs of their children.
  
  
• Individualize care of the child:
  
  Get all the necessary information on the child's condition. Get complete information from the parents during the initial Child Health History. In addition, make sure that the child receives a full health assessment, diagnosis and treatment plan, and get detailed information from the child's health care provider. The information should include:
  
  – How severe and frequent are the child's asthma attacks?
  
  – What are the child's asthma triggers?
  
  – What are the signs and symptoms of the child's asthma episodes?
  
  – How should staff respond to asthma episodes (e.g., changes in activity, peak flow meter, medications, observations, emergency plans)?
  
  Develop an Individualized Health Plan for each child. The health plan should include the following:
  
  – The specific accommodations needed in the child's daily activities (diet, classroom activities, outdoor activities, field trips, etc.) to prevent and respond promptly to asthma attacks.
  
  – The child's regular and emergency medications: the name, dose, route, schedule or indications for giving it, and possible side effects.
  
  – The signs and symptoms of an asthma attack and appropriate responses (e.g., removal from triggers, use the peak flow meter, medication, observation, emergency plan).
  
  Since the child's medical condition and special needs may change over time, periodic review of the Individualized Health Plan is needed. The frequency of review should depend upon the child's condition, but most medical conditions should be reviewed at least every three to six months. Head Start should also request that parents and health care providers promptly inform the program about any changes in the child's diagnosis and treatment plan so that the health plan can be updated on an ongoing basis.
  
  
• Provide safe and legal care:
  
  Information about the child with asthma must be shared with Head Start staff and volunteers who need to know in order to care for the child. To respect the confidentiality of the child and family, information should only be shared with the consent of the family.
  
  Head Start staff must have the protocols, training, equipment, supplies, supervision, and support to care for a child with asthma. Head Start programs must investigate their state child-care licensing regulations and Nurse Practice Acts in order to determine what procedures may be done and who can do them. If equipment is needed, it must be in working order; if medications are needed, Head Start must have a current supply. After staff is trained in performing the procedures, there must be a plan for supervision, monitoring, and backup in case of questions or problems.
  
  Head Start should also facilitate the transfer of the child's health records and health plan upon transition to another program or school. By maintaining clear documentation (i.e., the child's assessment, diagnosis, treatment, and Individualized Health Plan) and facilitating transfer of the health records to the next program that cares for the child, Head Start can make a significant contribution to promote the child's future health and welfare.
  

Questions for Discussion/Reflection

Since asthma is a common chronic condition among children, most Head Start programs have cared for children with asthma.

• What experience have you had caring for children with asthma in your Head Start program?
  
  
• Have these children received an IEP/IFSP or Individualized Health Plan?
  
  – If yes, how was that process helpful in caring for the child?
  
  – If no, what were the gaps in the care of the child?