Diabetic 3yo

[QueenBee]

A child in my daycare has been diagnosed with type 1 diabetes. I have to accommodate her as it falls under ADA so I took the MAT and diabetes trainings. While I'm waiting for approval from doh to give medication, dad has been stopping by at lunch time to give insulin. We have to monitor child/device throughout the day. We text dad when sugar level is low and he texts back what snack (that they pack in specific carb quantities) to give her. My assistant and I are nervous about managing this and have been a bit overwhelmed with the level of monitoring that has to take place along with the caring for the other children in our care.


Anyone had this situation? Any pearls of wisdom to offer? What should I be aware of? What should be my responsibility vs I do vs the parents?

[Alwaysgreener]

I had a child that fell under the ADA. I called the ADA and they suggested repeatedly that I inform the parents that they needed to pay for an assistant to focus just on their child. (When she told me that, I was mad because that's not the answer I was looking for and I didn't want the parents picking out assistant to be in my home but when I let the parents know this is what the ADA said, they pulled their child because they were not willing to pay an assistant and me.)

In school my daughter's class there is a para por that takes care of a child with diabetes. So if a fifth grade grown up child has a dedicated adult to take care of them, then a three year old should have a dedicated adult taking care of them.

(For the record I was trying to get to ADA help me find a way to work with the child and that was the only thing she was suggesting)

So my advice is to calm ADA.

(800) 514-0301

[QueenBee]

I called ADA when parent told me diagnosis. The rep directed me to their website which has a page for child care centers/provider and specifically a section on diabetic children. They told me that unless I have to 'fundamentally alter' my program, I cannot exclude for needing one-on-one attention. I have to accommodate child and integrate the responsibility into my program.

Parents applied for a para and was told that most likely, they would not get one for my family daycare. Had child been in public school, they would've been assigned a para.

SO, no additional help and must continue to provide care to avoid a lawsuit. I feel unequipped to deal with this...

[Alwaysgreener]

Let me see if I can find my emails/notes from Tom Copeland.

[Michael]

Here are some archived posts for diabetes: Type 1 Diabetes - Daycare.com Forum

https://www.daycare.com/forum/tags.php?tag=diabetes

https://www.daycare.com/forum/tags.p...+in+child+care

[QueenBee]

Thank you Michael. I did a search after my post and began to read some of them.

[GirlMomma]

It sounds like the ADA is telling you the same thing they told AG. The child needs one-on-one attention (from my understanding per the ADA’s website) so therefore, the parents are responsible for hiring an assistant. Whether they’re denied or not - the ADA believes they’re responsible for paying for one.

Alwaysgreener is that what you’re understanding? Am I misunderstanding this?

[Alwaysgreener]

Yes basically, the ADA can not come right out and say term because they are there to protect the child not you.

In my case no matter what I said, the ADA keep giving the same advice, have the parents pay an assistant. Which my reaction was, that would be weird to have them pay an assistant and I don't want someone else in my home. But after I got off the phone, I realized she gave me an out because the parents are not going to pay me and an assistant. And her advice worked.

QueenBee in your case you have already made some of an effort to accommodate the child and you have an assistant, so you may have to see it out, at least for a while until you can prove that you have done everything possible to accommodate.

Tom's advice to me is below.

[Springvalley]

We had a child that had a feeding tube and it was easy to care for, give meds & make sure it wasn't dirty, Dad was a nurse so he came the first day & showed us what to do. Crazy thing was, it was the exact same feeding tube I had when I was a child (I had one from the time I was 3 until I was 12).

[Blackcat31]

My DH is a type 1 diabetic.
I’m happy to answer any questions/concerns you might have.
You’re welcome to PM me or ask within the thread, whichever works best
Its hard….I won’t lie.
Manageable under most circumstances but it’s definitely serious…as in life/death serious.

[JaeB]

So is there a high chance that the child could die while in her care? Even if she follows the plan to a T? Lord its scary just talking about it smh

[Blackcat31]

JaeB Unfortunately yes. One can do everything right and still not have the intended outcome. It's scary. My DH is super conscious about everything he eats and watching his blood sugar and we've still had incidences where I've had to take emergency actions and two incidences where I had to call 911. It's scary and even though I know the ins/outs of what living with diabetes means, I can't say I'd be willing to care for a child that is type 1. I know she's protected under the ADA but if I were the parent, I would never be able to allow my child to be in someone else's care NO MATTER how experienced they were with diabetes management.

[QueenBee]

Thank you BC, for sharing your experience and your offer. Honestly, I don't even know what to ask at this point as I'm still processing the fact that I have no choice in this matter. I understand the ADA is there to prevent discrimination but it needs to make sense as I am not qualified to manage this. The law is putting the child's life and my business at risk!

[Alwaysgreener]

Let me see if I can find my emails/notes from Tom Copeland.

From Tom:

how can you provide appropriate care to meet the needs of this child and all the other children in your care?

Is it possible, and if so, what should be done?

You need a doctor to answer these questions. Ask the parent to allow you to speak to the child’s doctor or nurse to give you an assessment of what this child needs and is it possible for you to provide it. If the parent won’t allow you to hear from a doctor or nurse, and you believe that the child is not receiving the appropriate care it needs, you can terminate care. Without the parent cooperation in determining what this child needs, you can terminate care. Tom

If it’s a safety issue, then the question is how can all the children be kept safe in your program?

Since one of the children has a disability you would need to explore other options, rather than immediately termination. You must provide care for this child unless doing so would create a “significant difficulty or expense.” Tom

[JaeB]

Blackcat31 I'm sitting here thinking right now as we speak as to what I would do especially not having the right to turn them away. And I agree with you 1,000% about why aren't these parents looking for places that are geared towards children who have medical issues such as diabetes type 1. I mean are the parents solely looking at family child care thinking that the groups are small their child will get more attention and that we have the ability to accommodate as opposed to a center I'm really confused as to why a parent will pick anybody not qualified to care for the sickness as well .

[QueenBee]

I told the parents repeatedly that i am not skilled , it is a lot to incorporate and I have concerns. They have deaf ears and are well aware of their rights so I have to be cautious about how I say things to avoid a suit. Well, I'm hoping they come around but so far...? Nope.

[JaeB]

QueenBee oh I see and from the laws that I've read they definitely don't leave you any room to keep yourself free of liability should something happens so this situation is definitely frustrating. But question, how did this family come to find you in the first place ? If you don't mind me asking

[Blackcat31]

QueenBee I private messaged you

[MamaCaf]

I have a bit of a different perspective as a parent of a child who was diagnosed Type 1 at age 8 in 2002. You didn't say how old your daycare child is and that does kinda matter. All bodies react differently to Diabetes also. It was a bit overwhelming when he was diagnosed but we quickly became competent and confident with the challenges. My son has always been able to manage his condition well. I realize not all others do. BUT, I feel strongly that children with medical diagnoses need programs to accommodate them. Finding childcare is hard enough and finding programs to accommodate medical conditions is even harder. Children with diabetes do not require extensive modifications in childcare. Regular blood sugar tests and a diet given to you by parents and a little more diligence as to assessing how they feel should be all that child needs beyond a child without diabetes. I want to encourage you to give it a good try. There have been many advances in care since my son was a child. I didn't worry about him dying when he was in the care of others. The more you know, the less scary it is. The school office staff were initially nervous but with experience they loosened up. Testing the child's blood sugars regularly tells you which way he/she is headed so it's unlikely in my experience that the child would suddenly die under your care. And calling 911 is life-saving if the child is in a bad place but you would be in contact with a parent before that time too. I've had to call 911 for a child with asthma so there are lots of conditions you don't exclude for that may prompt a 911 call. Perhaps the child is on a cgm (continuous glucose meter) and then all you have to do is read it, no finger pokes etc. It sounds like the parents are on top of it and very willing to give you the help you need to care for their child. Ask for all the help, knowledge and training they can give you and call them when you are unsure. I, as a parent would be more than willing to do what needs to be done so you can confidently care for my child. If you make your best efforts and approach this with an open mind and still find that you aren't comfortable then talk to the parents. If they are not willing to give you the help you honestly need then term them. There is no problem with being honest about that as long as your don't just blanketly say no because you're scared.------just my perspective.

[MamaCaf]

yep, I missed that. Sorry. It is easier to communicate with a 3 year old than an infant. I would be nervous caring for an infant with type 1 diabetes. A 3 yr old would be doable for me but not as easy as an 8 yr old.

[QueenBee]

It is a challenging situation. Public schools assign a paraprofessional who is under the supervision of a nurse to children with this. I don't have those resources. And, as mentioned already, I cannot term family due to the ADA laws here: https://www.ada.gov/childqanda.htm#:...and%20services

[MamaCaf]

I understand. I had 2 children with medical needs and was able to get their pediatric nurse to provide training (along with the parents) and sign off as a resource contact for me. A paraprofessional is not necessarily smarter nor more capable than you. However, I recognize that she may have more support and protections than you do as a childcare provider. I guess bottom line, in my experience it depends a lot on the relationship you have with the family. It is hard for me to understand a parent who would sue you for not taking their child if you honestly considered it and had open communication. BUT....Parents and societal behavior can be disappointing and we as child care professionals are put in very vulnerable and unfair positions. Good Luck. I hope it gets worked for everyone.

[Alwaysgreener]

From Tom:

how can you provide appropriate care to meet the needs of this child and all the other children in your care?

Is it possible, and if so, what should be done?

You need a doctor to answer these questions. Ask the parent to allow you to speak to the child’s doctor or nurse to give you an assessment of what this child needs and is it possible for you to provide it. If the parent won’t allow you to hear from a doctor or nurse, and you believe that the child is not receiving the appropriate care it needs, you can terminate care. Without the parent cooperation in determining what this child needs, you can terminate care. Tom

If it’s a safety issue, then the question is how can all the children be kept safe in your program?

Since one of the children has a disability you would need to explore other options, rather than immediately termination. You must provide care for this child unless doing so would create a “significant difficulty or expense.” Tom

QueenBee

If you didn't know, Tom Copeland was a child care advocate lawyer that just retired this past spring. The info above is from a conversation we had in February.

Tom nor the ADA can hand you your out, so you have to find your own way.

In my letter to the parents about hiring an assistant to care for their child, I also requested (included a medical form for them to sign) that they allow me to speak directly to the medical doctors about the condition/ medical needs of the child.

I had talked to a local provider that specializes in special needs kids. She told me that changing anything that I'm already doing including purchasing or spending any kind of money that would show that I was willing to make changes for any child. She told me that this child needed special equipment and I was to request the parents to provide that. Which I also included in the letter the list of equipment the child required, including a helmet.

I added a new policy to my handbook that they would easily break. (Something Dcd was doing that annoyed me.) I sent the policy out separately as if I had sent it to everyone.

In my case, dcp was in denial/withholding info on the baby's condition and I had not purchased anything specially for the child's needs. However as you mentioned you have taken steps and dad is working with you, plus they were upfront with his care needs.

The link you posted above was the same link I read when I was dealing with the ADA child and I did not see the light at the end of the tunnel right away. I thought the advice was getting a reading was hopeless but it did work out and when I facebook stalk that baby, she is now wearing a helmet.

I do not know what it is like to have a child with diabetes in my care, however, I do have one with food allergies, it was not easy at first looking at all the packages and explaining when he had to eat something else (sun butter instead of Peanut butter) but I made it work.

You have already attempted to make it work but no matter what you say the ADA will not give you permission to term, you kinda have to see this through, you also have an assistant, which should help.

At this point, we could brian storm what you can do or what changes would have to be made and either in the process find a way for you to be able to work with the child or away for you to let the child go.

Let's force on Fundamental alteration (is a change that is so significant that it alters the essential nature of a job or an academic course or program.) At this point what have you altered for this child, name everything even the daily schedule? And what was the cost of those changes?