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[IPp] Ill kids face a new risk at day care

Sunday, January 30, 2005

 Ill kids face a new risk at day careLaw restricts giving medicineBy Elizabeth
Poughkeepsie Journal

 Only a handful of area day care providers will be able to dispense medication
-- even in an emergency -- to children in their care come Monday.

 New state regulations require child care providers to undergo training and
submit a health care plan to the state Office of Children and Family Services in
order to administer any medication or even store it on hand.
 Many providers have not completed the process. That could mean more than an
inconvenience for parents.
 It could be a matter of life and death for children who must have EpiPens,
epinephrine auto-injectors used to stop an allergic reaction, or asthmatics who
need an inhaler during the day.
Call for assistance 
 Child-care providers who don't have state approvals can't even store the
medication on hand and would have to call 911 for assistance.
 ''The only course of action is emergency services which is kind of
frightening,'' said Liz Hargraves, a nurse who was hired by the Dutchess child
care council as a health care consultant to providers. ''You're talking
 The problem is statewide, said Sage Ruckterstuhl of the New York State Child
Care Coordinating Council.
 ''Our position for providers is, if they do not have the certificate, ... they
absolutely cannot dispense medication. There are liability and there are
regulatory issues,'' she said.
 Assemblywoman Amy Paulin, D-Scarsdale, who sponsored the initial legislation
requiring the training and certification, said regulators should be lenient.
 ''In an effort to try and make a more healthful environment for our kids, we're
taking away a healthful option,'' she said.
 Parents have to start getting their voices heard, Ruckterstuhl said. ''From a
parent's perspective, this can be a major inconvenience; from a child's
perspective, this can be a serious health issue,'' she said.
 Many parents, who don't have a child with a chronic illness, said they ignored
notices sent from child-care providers. Others said their child-care provider
didn't bring up the issue.
 Staatsburg resident Rebecca Fleet, who has always left work to give her
asthmatic son his medication, said, ''It's easier that way.'' The day-care
center her son goes to is across the street from St. Francis Hospital where she
Lengthy forms need filling 
 Dr. Kimberly Clare, a pediatrician with TLC Pediatrics in Poughkeepsie, has
filled out the lengthy forms for parents.
 Despite the low number of child-care providers who will be able to dispense
medication, Clare said, she has not heard of parents complaining their child
will be unable to get the medications.
 Statewide, only 1,508 of the more than 20,000 licensed child care providers
applied for the new certification. Of those, 740 have been approved, the state
Office of Children and Family Services said.
 In the seven county lower Hudson Valley region, there are 2,190 licensed child
care providers, but only 272 have applied and only 62 have been approved.
 In Dutchess, only 18 of 239 licensed providers received approvals, said Jeanne
Wagner, executive of the Child Care Council of Dutchess. The council declined to
release a list as it did not want to appear to endorse particular providers.
Parents can call to find if their provider is approved.
 ''It's up to the parents to give the medication Monday if the program isn't
authorized to do it,'' Wagner said.
 Dr. Predeep Sharma, an asthma specialist in Poughkeepsie, suggested a grace
period for caregivers.
More harm than good 
 ''Not giving the medication suddenly can do more harm than good,'' said Sharma,
who supports the new training requirements.
 The regulations require doctors to fill out detailed forms for all medications
including prescription drugs, over the counter cough syrups and pain medication,
such as Orajel for teething infants, EpiPens for children who may have an
allergic reaction and inhalers for asthmatic children.
 The training is time consuming and costly for child-care providers, many of
whom have been dispensing medication to the same children for years and often
are the sole employee for the business.
 The state is struggling to process the applications, which have created a
 ''We are working very hard to approve health plans as quickly as we receive
them,'' said Brian Marchetti, spokesman for the state Office of Children and
Family Services. ''Child safety is our main concern. We know how much working
parents rely on quality, safe child care.''
 He said the agency could not issue an extension to allow centers to complete
paperwork because that would require an act of the state Legislature.
Approval is long in coming 
 While some providers decided to apply at the last minute, others who had their
paperwork in months ago were still rushing at deadline time to get approvals.
 ''It's upsetting to them that in the last week they are scrambling and may not
be ready and not through any fault of their own,'' said Hargraves, the Dutchess
 Judy Robbins, owner of Hull Homestead Day Nursery in Hopewell Junction,
submitted her paperwork in November. Only last week, it was returned with
corrections needed.
 ''I am going through the many, many hoops required for this,'' Robbins said.
''I've been running a day care for 31 years and administered medication to kids.
Now they say 'prove that you can do it.' ''
 She won't be able to give out medication Monday. ''What I worry about is the
child who has asthma,'' she said. ''I would have to say 'I'm sorry I can't
help.' ''
 Community Family Development only got its approval last week, Executive
Director Linda Simmons said. About 10 percent of the center's 120 children are
routinely on medication.
 Simmons had been preparing a back-up plan, in case the paperwork didn't come
 ''We couldn't have administered medication starting Monday,'' she said. ''Our
hands would have been tied. There wasn't anything that we could do.''
 Yolande Dennis, owner of Yo's-Land Day Care, still is waiting for her
approvals, despite sending in her paperwork in September.
Thankfully, she said, she does not have any children with chronic illnesses. 
 ''It's hard for parents to be leaving their work to be giving kids
medication,'' she said.
Opted for training 
 Doretha Oliver, owner of Happy Faces Family Day Care in the City of
Poughkeepsie, said she decided to go through the training because she wouldn't
be able to live with herself if she couldn't help a child in need.
 ''If we go to the park and one of these children got stung by a bee, I wouldn't
be able to use an EpiPen,'' she said, adding for her, the process went smoothly.
 Astor Early Childhood centers have nurses on staff who will be able to
administer medications, but it does not have the certifications yet, so teachers
and directors will not be able to give doses, assistant executive director
Elizabeth Colkin said.
 Astor, which has administered fluoride to its children, will stop that practice
because it was too costly and time consuming to have all staff trained.
 ''We had to make a really hard decision,'' Colkin said. ''It was a painful
decision because we do work with a very vulnerable population.''
Elizabeth Lynch can be reached at email @ redacted 
Where to Call 
To find out if a day care is approved to dispense medication, call: 
- Child Care Council of Dutchess: 845-473-4141. 
- Family of Woodstock: 845-331-7080. 
- Putnam County Child Care Council: 845-621-5619. 
- The state Office of Children and Family Services tip line: 1-800-732-5207. 
Do's and don'ts 
 Day care providers may not dispense medication starting Monday unless they have
undergone the required Medication Administration Training and had their health
care plans approved by the state.
 Medications covered by the new regulations include both over the counter
medications as well as prescription medications such as:
- Tylenol. 
- Motrin. 
- Robitussin. 
- Dimetapp. 
- Orajel. 
- Mylicon drops. 
- Fluoride. 
- Eye drops. 
 - All prescriptions are covered, including EpiPens for those with allergies and
nebulizers and inhalers for asthmatics.
 - To administer insulin injections to diabetics, additional training is
 - Providers who have not undergone the basic training may still administer
first aid, such as cleaning cuts and scrapes.
 - They also may apply topical ointments, such as diaper cream, sunscreen,
insect repellent and Neosporin if they have written permission from the parent.
The ointments should be labeled with the child's name.
Parental reponsibilities 
 - Parents should ask their child care provider if they have received the
appropriate training and if they have had their health plans approved by the
 - If not, parents should talk with their provider about what options may be
available to them to ensure their child gets needed medications.
 - Check with a health care provider about alternative medications that can be
administered once a day, before or after the child attends day care.
 - Relatives can give medications if the child-care provider is not certified
and if the parent is unavailable.
 - Make sure you explain the issue to your employer, if you have to leave work
to administer the medication.

Rachel - email @ redacted/jracheln

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