Caring for a child with diabetes can be a challenge. Families and early care and education staff need to know what to do. Diabetes affects 7% of the population. About one in 500 children has diabetes. Children with diabetes do not make enough insulin. The body needs insulin to use sugar in food for energy and growth. Insulin is a hormone that must be produced naturally by cells in the pancreas or be given as a medicine at proper times and in the right amounts.
Infants and toddlers in diapers often get rashes-everything from tiny red bumps to more irritated tender areas.
Why do babies get rashes? One or more conditions can cause a diaper rash. The enzymes that help digest food can be irritating when they come out with feces (poop) into the diaper. Wet diapers can cause irritation where they are in contact with the skin. This is more likely to occur where the diaper rubs the creases of the upper thighs. Yeast growing in the warm, wet diaper areas can be another cause of diaper rash.
Some tips to help prevent diaper rashes are:
Change diapers often. Changing a diaper before it gets very wet and as soon after a child has a bowel movement helps. Prolonged contact of the skin with moisture from pee and/or feces irritates the skin.
Avoid irritating soaps and wipes. Use unscented and alcohol-free diaper wipes or just water rather than other skin cleaning products. Scented soaps and wipes that have alcohol in them can irritate a baby's bottom. The ingredients in many soaps remove the skin's natural oils. Without these normal oils on the skin, skin irritation is more likely.
If the diaper area is red and irritated, clean the skin by patting it with a diaper wipe, with cotton balls soaked in warm water or with freshly laundered, well-rinsed, soft, washcloths wet with water. Avoid rubbing the skin. Always use a fresh wipe, or different wet wash cloth each time you swipe. Once soiled, store reusable cloths in a washable, plastic-lined, tightly covered receptacle until they can be laundered.
Consider use of a barrier product . Ask the family to discuss with the child's health care professional the use of a barrier product if an infant has ongoing difficulty with diaper rash. Barrier diaper creams or ointments can help protect the skin from irritation caused by rubbing on the moist and/or soiled surface of a diaper. They are over-the-counter products that contain petroleum or zinc oxide. If the child has had a problem with diaper rash that requires use of a barrier medication, the program should have instructions from the child's health care provider and permission from the child's parent to use it. The product's container should have the child's name and instructions for use too. Put 2 or 3 tablespoons of the barrier cream on a facial tissue and bring it that way to the diaper changing surface. (Do not bring any of the containers of supplies to the diapering surface. Everything on the diapering surface will need to be disinfected after the diaper change.)
Apply the barrier in a thick layer, spreading it gently and smoothly across the diaper area. Be sure to cover the creases of the upper thighs under the edge of the diaper. When cleaning the child, remove only the soiled barrier product. Rubbing to remove the unsoiled lower layer of barrier product will irritate the skin.
The recommended medication administration and diaper changing procedures are in Caring for Our Children, (CFOC3) Standards 18.104.22.168 and 22.214.171.124 for medication administration and Standard 126.96.36.199 for the diaper changing procedure. Access these standards at www.nrckids.org.
Follow the instructions from the child's health care provider and the CFOC3 recommended procedures when using any diaper cream. Some diaper creams contain active ingredients that are not for prolonged use. Documentation of the product applications can be as simple as having a check mark in a diaper cream column on a diaper change log sheet. Note the date and time of the diaper changes there. This lets families know about the frequency of diaper changes and use of recommended medication.
If a diaper rash is bleeding, seems very sore to the child, or lasts more than a few days, be sure to seek guidance from the child's health care provider and check the procedures being used by anyone who is changing the child's diaper.
Contributed by Sarah Macdonald, MD, FAAP, CHOP Care Network High Point
The attached ECELS Health and Safety Checklist includes references. It was updated December 2011 as Version 1.4. This tool guides the user to the appropriate national health and safety standard(s) and other related references for each item. Each item is cross-referenced with corresponding topics from: Caring for Our Children: National Health and Safety Performance Standards, 3rd Edition, 2011 (CFOC) , the Environmental Rating Scales (ITERS-R, Infant/Toddler Environment Rating Scale - Revised Edition; ECERS-R, Early Childhood Environment Rating Scale - Revised Edition); and the Pennsylvania Child Care Facility Licensing Regulations. Reviewed and reaffirmed 6/2018.
The widely-used Emergency Information Form on the website of the American Academy of Pediatrics (AAP) records key health information for children with special health care needs. It should be completed and kept up-to-date, ready to give to Emergency Service Personnel who may not be familiar with the child's needs. Early education and before and after school personnel should use the information on the form to prepare for care a child might need in the event of an emergency that involves only the child or the group in the facility. It documents the child's medical history, medications, and treatments. To view and download the form, go to the AAP website at www.aap.org, and then enter "Emergency Information Form" in the search box.
Many children and adults have asthma. Up to 90% of children with asthma have allergies also. Wheezing, irritation of eyes and noses may be an allergic response to substances like pollens, animal dander, or dust mites. Nearly a quarter of children with asthma have food allergies too. Early education and child care providers must be prepared to respond to a situation that involves a severe allergic reaction. Without prompt administration of an appropriate medication, someone with an allergic reaction may die.
This workshop uses the interactive curriculum from the Food Allergy Network. It includes a video and mock epinephrine (EpiPen) demonstration. Participants practice reading food labels to find hidden ingredients that are the same as common food allergens and learn the basics of food allergy and allergen types in foods. The group discusses how to modify the child care setting for a child with a food allergy, and a plan for handling a food allergy response.