Asthma Isn’t Child’s Play Educational Program

Asthma Isn’t Child’s Play Educational Program

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allergy & asthma

Asthma Isn’t Child’s Play

Educational Program Addresses Deficit in Day Care Safety

An alarming trend began to develop over the past decade in day care centers across the country. Escalating numbers of children were being diagnosed with asthma at a young age. When parents disclosed their children’s condition to day care providers, many were denied entrance. Some parents cried discrimination. Others opted to conceal their children’s asthma, jeopardizing their health.

Day care providers explained their reasons didn’t stem from not wanting to care for these youngsters. Rather, they were afraid to care for them. Bandaging up scraped knees was one thing; giving rescue meds to asthmatics during exacerbations was quite another story.

The Asthma and Allergy Foundation of America (AAFA) learned of the dilemma and offered to hold educational workshops to teach providers how to care for children with asthma and allergies. This year, the national, nonprofit organization plans to expand these training programs to 12 areas, including New England, Florida, Texas, Northern and Southern California, Missouri and Washington.

Cecilia Johnson, who runs an eight-child day care out of her Baltimore home, was among the workshops’ first participants in 1992. Her disinclination to accept asthmatic and allergic children stemmed from memories of her cousin’s asthma exacerbations. “It made me nervous. I knew she couldn’t breathe, and I didn’t know what to do,” she recalls.

Johnson didn’t trust in her ability to care for an asthmatic infant or toddler. And, as a mother, she knew she would want only the most qualified person to care for her children.

Then, Johnson accepted responsibility for Jordan, a 15-month-old who doctors said would outgrow his asthma. When Jordan turned 2, it became clear his condition was not improving, and Johnson realized it was time she received some asthma education. Knowing other day care providers shared her fears, she contacted AAFA’s Maryland-Greater Washington, D.C. Chapter and explained her predicament.

A Growing Problem
The chapter was more than happy to help out. With the growing number of children under the age of 5 attending preschool–13 million–and asthma reaching epidemic proportions among this age group, day care providers are likely to have children with this chronic illness in their classrooms.

“What we know is that in preschool age children, children under the age of 5, asthma has increased 160 percent,” emphasizes Colleen Horn, an AAFA spokeswoman. “And it’s hard for preschool age children to discuss what is going on with them physically.”

Spurred by these statistics, AAFA’s Maryland-Greater Washington, D.C. Chapter formalized the workshops and developed the “Asthma & Allergy Essentials for Child Care Providers” program in 1994. Five years later, through a partnership with the Environmental Protection Agency (EPA), the foundation revised the program and field-tested it with more than 500 Maryland day care providers.

Health care providers taught the day care workers how to institute practical environmental controls, the medications asthmatics need, the importance of taking medications on a regular basis, the signs and symptoms to look out for, and how to handle an emergency situation.

The field test results showed that after the training, greater than 95 percent of participants felt either comfortable or very comfortable about caring for an asthmatic or food allergic child. More than 80 percent were able to identify two or more environmental changes they could implement immediately in their child care setting.

Teaching a Class
This success encouraged the national voluntary health agency to institute asthma education programs for day care providers throughout the country. When AAFA called Fran Ahel, RRT, and Esther Guajardo, RRT, of Harris Methodist H-E-B Hospital in Bedford, Texas, to teach a class in their community, they were delighted.

“A lot of times these folks don’t have the specialized training a school nurse in a school district would have,” Ahel says, which meant the program would require detailed information.

AAFA supplied handouts for educators to give the day care centers, including an environmental checklist called “Asthma Friendly Child Care,” reports Jacqui Vok, manager of AAFA’s child care provider program.

Tips from the environmental checklist include practical ways to reduce children’s exposure to allergens and irritants, such as running the air conditioning when the pollen count is high and eliminating stuffed animals and rugs. Live pets also can be a problem in day care settings. “Bunny rabbits, hamsters … even aquariums can be a source of allergen,” Ahel cautions.

Because their class was held in November 1999 during the peak of autumn’s mold season, it was a perfect time for the Texas RTs to mention outdoor triggers as well. “We told them to not let kids play outside in the wet leaves, which the little ones really like to do.”

Many of the day care providers actually give medications to the children, so another topic Ahel focused on was tools used to treat and control asthma, including portable nebulizers, spacers, inhalers and peak flow meters. “There are so many different (inhalers) out there,” Ahel says, which can confuse the person administering the treatment. She displayed the different brands and types of inhalers and other products for the audience so they could see how to use and clean them correctly.

As asthma is a disease that has unique characteristics and treatments for every patient, AAFA offered program attendees copies of action plans that require the providers to obtain parental and physician input detailing medicines the child takes on a regular basis and what to do if a child’s peak flows aren’t up to par.

These action plans apply to children who have life-threatening food allergies, as well. “Notices are showing up now on food packages, and we made (attendees) aware of the need to be reading labels and asking parents about their children’s allergies to food,” Ahel said. She showed the class how to give an epinephrine injection on a demonstrator model, which everyone practiced, and she stressed the importance of calling 911 after injecting epinephrine.

Another tool AAFA provided was a daily asthma and allergy communication card–one side for messages from day care provider to parent, and the other from parent to provider. “The intent is to communicate quickly, in one succinct page, what is going on with their child that day because we all know the exchange between parent and provider is probably pretty quick at the end of the day,” Vok explains. “And if a child is experiencing signs and symptoms of breathing distress, the parents and providers need to be aware so proper medications are used and triggers are avoided.”

Lessons Learned
Most of the information “never even dawned on me,” Johnson confesses about her workshop experience. “The class really made us think about common, everyday uses and things we had to rearrange in our day care because of our children. It was really simple stuff that we took for granted and didn’t really understand.” She calls the environmental changes she made “minor adjustments,” such as removing some rugs, using bleach to clean after the children have left for the day and avoiding aerosol spray use.

After attending the workshop, Johnson was able to recognize little Jordan’s coughing and wheezing as a severe asthma attack, and she knew to get him to the hospital immediately. Jordan, now 6 years old, has graduated day care and attends kindergarten.

When he left her care, Johnson didn’t breathe a sigh of relief and resume turning asthmatic children away. Two of her current day care attendees have asthma, and she is confident that she can provide them proper care or recognize when they need medical attention.

“If it hadn’t been for AAFA coming in … we would still be in the same boat we were in eight years ago. I don’t think we’d have many providers taking care of children with asthma,” she says. “The whole program was a lifesaver.”

For more information on the program, see the AAFA’s Web site at or call (202) 466-7643, ext. 234.

Tracy Schmierer is associate editor of ADVANCE.

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