Giving Medication in Childcare

Giving medicine to a child who is not your own is a serious responsibility. A wrong dose, the wrong child or a missed note in a log can make a child sick and put your program's license at risk. Federal childcare funding rules list medication administration as a required topic for staff training, and most states add their own rules on who can give medicine and what training that person needs.

This guide teaches the habits that apply almost everywhere. State rules, your program's written policy and the child's written orders always come first. If you are not trained and authorized in your program, you do not give medication, except where your state rule and training allow it in an emergency. If something does not look right, stop and ask your director, the parent, or the health consultant before you give it.

What You Will Be Able to Do

• Check that you have everything you need before you accept any medicine
• Store medicine safely, and keep emergency medicine within reach of staff
• Use the five rights before every dose
• Document a dose correctly, and respond if something goes wrong
• Respond when a child needs emergency medicine

Before You Accept Any Medicine

Do not take a bottle from a parent at the door and put it on a shelf. Use your program's intake process each time. You should have all of the following:

If something is missing or does not match, do not accept the medicine. Explain what you need, and tell your director. Read the label yourself. Check it against the permission form, and look for differences in the child's name, dose and time. If a parent asks you to give a dose different from what the label says, the parent will need new written instructions from the prescriber.

Pharmacy labels show the child's name, medicine name, dose, how often, the route, the prescriber and the date. A pill bottle with a parent's name, or medicine moved into a plastic bag or a different bottle, is not acceptable.

Over-the-counter products need the same care. Fever reducers, allergy medicine, cough syrup and medicated creams are all medicine. Your rules decide what you need for sunscreen and diaper cream. Most programs ask for at least written parent permission. Do not assume that a product is exempt because it is sold without a prescription.

Storing Medicine Safely

• Keep medicine in its original container.
• Keep all medicine locked and out of children's reach, except emergency medicine.
• Keep medicine that needs cold storage in a locked box inside a refrigerator, separate from food.
• Keep it away from heat and sunlight, following the label.
• Keep each child's medicine apart, so that no one can pick up the wrong bottle.
• Send unused medicine home, or dispose of it as your policy says, when the course ends or it expires.
• Keep staff medicine locked up as well.

The label is the reason for the original-container rule. It carries the name, the dose and the expiration date, which are the facts you need for a safe dose.

Emergency Medicine Is the Exception

Epinephrine, asthma rescue inhalers and seizure medicines must be available right away. They should not sit in a locked cabinet in an office where a key may take minutes to find. Keep them out of children's reach, but where trained staff can get to them in seconds, and take them along on walks, field trips and fire drills. Ask your director where each one is stored in your room, on your first day.

The Five Rights

Check these every time, even for a child who has taken the same medicine for weeks:

Many programs add a sixth check: the right documentation. Some also ask a second adult to look before you give the dose.

Giving a Dose

1. Wash your hands. Clear away distractions, and hand your duties to another adult. Do not give medicine while watching a group alone.
2. Read the log to see when the last dose was given.
3. Read the label and form, and check the five rights.
4. Measure the dose at eye level on a flat surface, using the device supplied. Shake liquids if the label says to.
5. Give the medicine, and stay with the child until it is finished. Be calm and honest. Never call medicine candy.
6. Wash your hands, clean the device and put the medicine away.
7. Record the dose right away.

Write down the child's name, the medicine, the dose, the time, the route, and your name or initials. Also note anything you saw, such as a spit-up dose or a refusal. Do not write it in advance, and do not rely on memory.

If a child refuses or spits out a dose, do not force it, and do not give a second dose on your own. Record it and call the family or your health contact for advice.

Watch the child afterward. Some medicine causes sleepiness, upset stomach or a rash. Report changes to your lead teacher and the family. A rash, swelling or trouble breathing after a dose may be an allergic reaction.

When a Medication Error Happens

An error can mean a wrong dose, wrong child, wrong time or missed dose. Honest reporting keeps children safe, and hiding an error is what makes it dangerous.

1. Check on the child right away. If the child has trouble breathing, is hard to wake, has a seizure or collapses, call 911.
2. Call Poison Help at 1-800-222-1222 for advice. It is free and open at all hours. Have the medicine label and the child's weight handy.
3. Tell your director.
4. Tell the parent or guardian right away.
5. Write an incident report that states what happened, when, and what you did.
6. Your director handles any report to licensing. Your state may require one.

Emergency Medicine

Some children have a written care plan for asthma, seizures, diabetes or severe allergies. Read each plan for the children in your room before you care for them, and ask questions. Plans tell you which signs to look for, what to give and when to call for help.

Severe allergic reactions can turn deadly within minutes. Signs can include hives, swelling of the face or tongue, trouble breathing, repeated vomiting, dizziness and collapse. When a child with a plan shows these signs:

1. Give epinephrine right away, as the plan says. Do not wait to see if it gets worse.
2. Call 911, even if the child seems better. Epinephrine buys time, but it is not a cure, and symptoms can come back.
3. Lay the child flat with legs raised, unless they are vomiting or having trouble breathing, in which case let them sit up or lie on their side.
4. Stay with the child, follow the plan on a second dose, and call the family.
5. Give the used device to emergency crews, and write up what happened.

Epinephrine comes as auto-injectors, including EpiPen and other brands. A nasal spray has also been approved by the FDA, including a lower dose for children age 4 and older who weigh at least about 33 pounds. Use the device in the child's plan, and practice with a trainer device, not a real one.

Warning: Giving epinephrine by injection or nasal spray needs hands-on training. Reading about it is not enough. Ask your director when your next practice session is.

Special Situations

• Field trips. Bring emergency medicine, plans and the log. One named adult carries them.
• Long-term medicine. Daily medicine, such as for seizures or ADHD, follows the same steps. Ask how long the permission lasts, as many states require new forms each year or when a dose changes.
• Children with disabilities. Disability laws such as the Americans with Disabilities Act can require a program to give medicine or care a child needs. If you are asked to do something new, talk to your director rather than saying no.
• Vitamins and home remedies. Treat them like medicine, and follow your policy. Many programs do not give them.
• Medicine from one family for another child. Never. A prescription is only for the person named on it.

Common Mistakes

Check Your Understanding

1. A mother hands you a bottle of children's pain reliever and says, "Just give her some at lunch if she seems fussy." What do you do?

Do not accept it that way. You need the original container, a signed form with the exact dose and time, and any provider instructions your state requires. "If she seems fussy" is not a clear order, so ask your director.

2. You are about to give a child his 12:00 dose and see the log already has a 12:00 entry from your coworker. What do you do?

Stop. Do not give another dose. Speak with your coworker, and tell your director if there is any doubt.

3. You give a child the wrong child's allergy syrup. He seems fine. What do you do?

Check on him, call Poison Help for advice, then tell your director and the parents right away. Write an incident report. Do not wait to see if something happens.

4. A child with a peanut allergy has hives and is coughing after snack. Her auto-injector is in a locked office, and you are not sure who has the key. How do you fix this before it happens?

In the moment, shout for help and get the device to the child at once. Call 911 as you do. Afterward, the device has to move to a place trained staff can reach in seconds, and all staff should know where that is.

Key Takeaways

• Never give a dose without written permission, the original container and clear instructions
• Lock up all medicine except emergency medicine, which must be reachable in seconds
• Use the five rights every time, and check the log first
• Record each dose right away
• Report any error at once, and use Poison Help at 1-800-222-1222
• Give epinephrine first, call 911, then call the family