Yes, they are mandated to serve nutritious meals, observe sanitation procedures, minimize health and safety risks and do their best to instill healthy habits to the children in their care.
Beyond that, most child care providers attempt to exceed minimum requirements. For instance, they serve meals that exceed the USDA standards, knowing that they are often a child's only source of a well-balanced nutritious meal. They know that parents may either not be able to afford to feed their children as well, or may regularly zip through a fast food joint on the way home.
Our facilities and homes are safe havens for the children in care, with safety paramount and positive guidance in place. Experience and training help to counter the frustration and unrealistic expectations the children may find elsewhere.
But it goes beyond that.
Many states now require providers to be trained in the signs and symptoms of illness. Being with children constantly, providers learn to read children's behavior and to notice the sometimes subtle signs that something is simply WRONG. Experience, too, develops a database of information from which they can draw upon to understand when something is off with a child in their care.
Families are often rushing through the day with chores, dining, bathing and routines with little time during the week to simply passively observe their children. They also are not seeing their children in relationship to other children of a similar age. Even if a parent believes there may be an issue with their child, they often do not want to confront it. Few things in life are scarier than facing that your child might not be perfect, let alone seriously ill.
Child care providers are in the position of providing exclusive attention to children for extended hours. They have the capacity to objectively observe a child for potential health related issues.
One afternoon I had the television on, which I never do, due to tracking severe weather that had arrived in the area. I wasn't paying it much attention. Oprah was on discussing a child's disease, so it did garner a few glances at the 9" screen in the far corner. She was talking to the "ladybug" girl who had brown spots all over her body. They began to talk about how a few “café au lait” spots were just considered birth marks, but if a child had 5 it was concerning and over 6 such marks, irregular in shape, and larger than a dime, then it was a sign of neurofibromatosis. Usually they show up by around the age of 3.
My attention was caught and I raced over to watch the last of the segment. They continued to talk about how the disease truly begins to develop at puberty and that the severity could be mild to the point that a person may not even know they have it, to extreme deformity or even death.
My heart started racing. The instant the segment finished, I grabbed up a little boy in my care who was about to turn 3, and raced to the changing pad where I stripped him down. I counted. Four were readily apparent around his diaper area. They had been getting larger, so it had caught my attention, because I didn't think a birthmark would grow like that in size. I found one more under his arm where I normally wouldn't be looking. I looked over his body closely. Two more faint areas indicated potential ones. My heart dropped and tears came to my eyes. He didn't REALLY have 6...yet.
How do you bring something like this, a potentially devastating disease, to parents?
I waited. Two weeks later, the other two spots were now vividly apparent. I had researched as much as possible. I brought it up to the parents carefully and respectfully and gave them the information I felt they needed. They were devastated, but they made an appointment with his pediatrician the next day, who confirmed that it did indicate a diagnosis. The doctor hadn't thought twice about the spots at his previous appointment, even though the four were present then. She just wasn't familiar with the disease and the indicators.
Within a week they had appointments with several specialists. While there was nothing to be done, there is no treatment or cure, they were able to determine base line readings to go from. He still gets regular evaluations, but it's just a waiting game now until puberty to determine the severity of his case. I will continue to keep in touch with them.
A year later, I had a toddler with vision problems. His mother's first place to turn for information, was me. What did I see? What did I think? What did I recommend? She looked to me for information, direction, objectiveness she was incapable of obtaining, and a shoulder to cry upon.
I was reminded of this as new information came across today that there is a new recommendation that children get a vision test done at one year now, rather than the three year mark as previously recommended. Often, parents do not even have a vision test performed at three, even though it, too, can detect neurofibromatosis, along with "lazy eye," the most common vision problem in young children, and a host of other problems at a stage when they may be more easily corrected.
That little guy went on to have three eye surgeries before kindergarten and still struggles with vision issues. He arrived in my care at four months old and stayed for over five years. His mother and I have remained good friends and it is heart wrenching to see such a bright, exuberant child deal with a disability.
Child CARE Providers
In my years of care I have dealt with multiple child health issues, including potentially life-threatening ones, and it is never easy or simple. But care providers at the core are just that...CARE providers, to the children, parents, and families of those whose lives we are touching.
I have had parents show up intoxicated and notified them that I WOULD call the police if they took the child from the premises. I have refused to allow a grandparent to leave with a child because they forgot the carseat. Those actions are fairly clear cut and governed by regulations and law. It pays to be informed, to question, to be concerned, to stick your nose in whenever you feel it is in the best interest of the child within legal guidelines. If you aren't sure, then there are plenty of resources for you to tap into.
Beyond regulations and law, however, are a host of other health issues that we often face. A child seems to never have their teeth brushed, they arrive dirty and unkempt, they eat as if starving when in care, they have a suspicious rash, or tic, or trouble paying attention. At what point do you bring it up to the parent? That line is so individual, and few situations allow it to be defined. Experience, information, and a heartfelt concern are all that can help a provider make the decision to proceed, and it is never easy.
Many providers are completely uncomfortable with any type of confrontation. Ways to get around addressing issues and concerns directly are to provide information to ALL parents through:
- Company Facebook or blog posts
- Parent newsletters
- Information handouts
- Holding informational meetings
This is just my experience. There are hundreds of providers, just in our city, with vastly more than I have obtained.
I would love to hear yours.
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Here are some wonderful slideshow presentations from WebMD
Common Childhood Skin Problems [and their associated diseases]
Identifying Bugs and Their Bites
11 Common Causes of Skin Rashes
A Visual Guide to Birthmarks
