1. Administration of Medication
in the Child Care Setting
Catholic Charities-Diocese of Joliet
ECSD Pre-service Conference
August 29, 2014
Deborah Fears, LPN BA
Linda Paschall, LPN BHA
Health Consultants

2. Introduction and Goals
Dispensing medicine properly to children is very
important in the child care setting. Given
incorrectly, medications may be ineffective or
harmful to the child.
Administering medication requires knowledge of
proper dosage, attention to time, and careful
observation of the child for the effects of the
medication after it is given.
Goals:
1. Staff are trained and designated to safely receive,
store, handle, administer, and document
medication use in the child care setting
2. Staff will be familiar with and demonstrate use of
dosing devices, medication measurement, and
common medications given in the child care
setting. 2

3. Objectives and Agenda:
Staff will be able to:
1. Implement policies and procedures for the
administration of medication in the child care
setting.
2. State the “5 Rights” that must be identified
before giving medication to a child.
3. Demonstrate correct use of different dosing
devices and correct measurement of
medications.
4. Observe for signs of anaphylaxis, adverse
reactions or life threatening conditions
5. Correctly complete the agencies written
documentation for receiving and giving
medicines. 3

4. When medicine is given in the
child care setting:
 All staff members designated to
administer medication must receive
training by a health care professional
annually.
 Staff designated to administer
medications are familiar with the
actions of medications, their
administration, dosages,
measurement, documentation and
specific policies and procedures of the
program. 4

5. When medicine is given in the
child care setting:
 Medicines are given for acute(sudden
or short term) conditions like antibiotic
therapy or
 for chronic (ongoing) conditions like
asthma.
 Medications given at the child care
setting must be prescribed by a
physician or
 OTC (over the counter) medication
given by permission of the parent with
prior approval of the physician.
5

6. When medicine is given in the
child care setting:
 The Americans with Disabilities Act
(ADA) requires child care programs to
make “reasonable accommodations” for
people with disabilities and special
medical needs. Giving medicine is an
accommodation made in the child care
setting.
 When talking with the parent or
prescribing health provider, determine if
the medication can be given before or
after the child is at the program,
eliminating the need for giving
medication at the child care setting. 6

7. When medicine is given in the
child care setting: Written
Authorization
 Staff must have a written authorization
signed by the parent/guardian for
medication prescribed by the child’s
health care provider.
 Staff must have a written authorization
signed by the parent/guardian for OTC
(over the counter) medication and
prior approval (standing order) by a
health care provider designating the
intended use of the medication.
7

8. When medicine is given in the
child care setting: Receiving
Medications
 Both prescription and OTC medication
shall be accepted only in its original
container
 Prescription medications shall be labeled
with the full pharmacy label and clearly
readable.
 OTC medication shall be clearly labeled
with the child’s name. The container
must be in a condition that the name of
the medication and the directions can be
read.
8

9. When medicine is given in the child care
setting: Protect the safety of the child.
 A designated, trained staff person shall
administer and document giving the
medication.
 Prescription medication shall require a signed
authorization by the health care provider and
the parent and shall be kept on file and
updated regularly.
 OTC medications may be dispensed in
accordance with the manufactures'
instructions with written permission by the
parent. However, a standing order for the
medication should be obtained from the
health care provider.
9

10. How to give medicine in the child
care setting: Receiving
Medications
Check the label of the original container
before accepting the medication from
the parent/guardian.
 Always use the right technique:
◦ Note the expiration date. (Do not accept
and/or discard expired medications.)
◦ Make sure the medication is in a child-proof
container.
◦ Make sure the administration of medication
consent is completed properly, is current and
on file.
10

11. How to give medicine in the child care
setting: The “5 Rights”
1. Right child (Child’s first and last name).
2. Right medicine (generic or brand name).
3. Right dose (teaspoons: tsp, cubic
centimeters: cc)
4. Right route (mouth, nose, eye, ear
drops).
5. Right time (before meals, after meals)
and frequency (per day) or intervals (every
4 hours)
11

12. How to give medicine in the child
care setting: Follow-up
1. Administer medication and document
immediately!
2. Observe child and monitor
periodically for side effects and
allergic reactions.
3. Observe for the most dangerous type
of allergic reaction, Anaphylaxis.
4. An emergency care plan is posted in
each classroom and someone
trained in first aid and CPR should
be on duty.
12

13. How to give medicine in the child
care setting: Anaphylaxis
 This is a severe allergic reaction which
is life-threatening. Anaphylaxis occurs
after the administration of a drug, eating
a particular food, or sting of an insect to
which the person is allergic.
 If you observe or think a child is having
an anaphylactic reaction:
◦ Instruct someone to call 911 STAY WITH
THE CHILD
◦ Administer medication for allergic reaction if
prescribed.
13

14. When medicine is given in the
child care setting: Anaphylaxis
cont’d
Signs and symptoms of anaphylaxis may
include:
 Hives/itching
 Dizziness/weakness
 Nausea/ vomiting
 Abdominal cramps
 Swelling of the face, hands, feet, and mucous
membranes
 Wheezing
 Shortness of breath
 Difficulty breathing
 Sense of impending doom/fear
 Loss of consciousness
14

15. When medicine is given in the
child care setting: Allergic
Reactions
 These reactions are related to the action
of the medication. It is difficult to predict
if someone will be allergic to a particular
drug even if they have taken the
prescribed drug before.
 When an allergic reaction to a drug
occurs, the body’s immune system
reacts to a drug by producing
histamines. Histamines produce
symptoms of an allergic reaction and the
severity of the symptoms can change
quickly.
15

16. When medicine is given in the
child care setting: Allergic
Reactions cont’d
 If you suspect a child is exhibiting
allergic symptoms, withhold the next
scheduled dose.
 Document and report observations
immediately to the parent, inform them
to contact the physician and have
them pick up their child and go the
nearest emergency room.
16

17. When medicine is given in the child
care setting: Allergic Reactions cont’d
 Signs of allergic reactions (not inclusive)
◦ Mouth- itching, swelling of the lips, tongue or
mouth
◦ Throat: itching/sense of tightness in the throat,
hoarseness and hacking cough
◦ Skin: hives, itchy rash, redness and swelling of
the face and extremities
◦ Abdomen: nausea, abdominal cramps, vomiting,
diarrhea
◦ Lungs: shortness of breath, repetitive coughing,
wheezing
◦ Heart: thready pulse, fainting, loss of
consciousness
§§ All above symptoms can potentially
progress to a life threatening situation. 17

18. When medicine is given in the child care
setting: Common Dosing
Instruments
The following are tips for using common
dosing instruments:
 Syringes: Syringes are convenient for
infants who can’t drink from a cup.
◦ Draw up the correct dose at eye level and
squirt the medicine in the back of the child’s
mouth where it is less likely to spill out.
◦ Syringes can be measured out and caped for
later use. However these caps can be a
choking hazard if not removed before
administering the medication.
18

19. When medicine is given in the child care
setting: Common Dosing Instruments
cont’d.
 The cap should be discarded or placed
where the child can not get it.
 There are two kinds of syringes:
◦ Oral syringes for administering medications
by mouth
◦ Hypodermic syringes (for injections), which
can be used for oral medication when the
needle are removed. Parents should remove
the needle from the hypodermic syringe.
 Always remove the cap before
administering by mouth.
19

20. When medicine is given in the child care
setting: Common Dosing Instruments cont’d.
 Droppers: Safe and easy to use for
infants and children. Always measure
at eye level and administer quickly
because dropper tend to drip,
 Cylindrical dosing spoons: The
spoon looks like a test tube with a
spoon at the end. Small children can
hold the handle and the spoon fits
easily into their mouth.
20

21. When medicine is given in the child care
setting: Common Dosing Instruments
cont’d.
 Dosage cups: These are used for
children who can drink from a cup
without spilling. Be sure to check the
measurements on the side of the cups
for the correct number. Measure liquid
doses at eye level.
 Medication pacifiers: These are used
for infants. The medication is measured
and poured into the medication holder
and the infants sucks the medication
through the pacifier. 21

22. When medicine is given in the child care
setting: Common Dosing
Measurements
 Whether they measure teaspoons,
ounces or milliliters, dosing devices must
be used. Regular tableware must never
be used because it is not an accurate
measure. One type of teaspoon may be
twice the size of another.
 If a product comes with a particular
device, it should be used. Do not use a
device from another product.
 Read the measuring instruments
carefully, the numbers on the side are
small and sometimes difficult to read.
22

23. Four Ways To Help Preschoolers Take
Medicine.
1. Mix it up or Chase it dawn
When approved by the pharmacist or
doctor: mix foul tasting meds with yogurt,
applesauce, chocolate syrup. Or the treat
can be used as a reward and an aftertaste
chaser.
2. The Cold Method
If the child likes frozen treats, have her lick
one before giving her a teaspoon or syringe
of medicine. Use a strong flavor like orange
or grape. The cold also dullest the taste
buds.
23

24. Four Ways To Help Preschoolers Take
Medicine cont’d.
3. Take your medicine first.
Pretend to take your medicine first.
Make a big to-do about it. Have the child
agree to take his medicine too when you
have finished.
4. Give the child choices.
Being forced to swallow something
is disgusting. Let her decide
between a spoon or syringe,
popsicle flavor, etc. Give as much
choice as possible.
24

25. Procedures for giving topical
medications: Skin
Creams/Ointments
 Wash hands, identify child, read medication consent.
 Check expiration date. Remember “5 Rights”.
 Explain the procedure to the child, provide privacy. (If child
needs to undress another caregiver should have clear view of
the adult and child.)
 Put on disposable gloves
 Remove any dressings if necessary. Place in a plastic bag.
 Remove previously applied medication with a gauze pad
using a circular motion from the center to the outside of the
affected area. Discard each pad.
 Change contaminated gloves.
 Apply medication using a clean glove or applicator.
 Apply dressing as instructed.
 Remove gloves, discard equipment in plastic bag and wash
hands.
 Document on medication log that medicine was given.
25

26. Procedures for giving Metered Dose Inhalers:
 Wash hands, identify child, read medication
consent.
 Check expiration date. Remember “5 Rights”.
 Explain the procedure to the child, provide
privacy.
 Have child stand up or sit erect.
 Shake inhaler for about two (2) seconds,
 Hold mouthpiece 1-2 inches from lips (or as
instructed), open mouth wide(if using a spacer,
place mouthpiece in mouth).
 Breathe out normally, open mouth and begin to
inhale slowly, as the canister is squeezed.
 Have child hold his breath for about 10 seconds
to allow medicine to settle into air passages.
 Wait 1 or 2 minutes before the second puff.
 Document and observe child for effects of the
medication.
26

27. Most Frequently Prescribed Medications in Child Care
 Antibiotics(given by mouth) –used to
treat infections.
 Acetaminophen( e.g.Tylenol) Used to
treat fever and pain.
 Antihistamines (e.g. Benadryl)- used
to treat allergic reactions, such as
runny nose or hives.
 Bronchodilators-used to treat asthma
attacks. Special equipment such as
inhalers and nebulizers are needed.
27

28. Most Frequently Prescribed Medications in Child Care
 Decongestants(e.g. Dimetapp) used to
reduce stuffiness in ears, nose, and
chest.
 Eye medication (liquid or ointment
administered directly into/or on the
eye) used to treat eye infections.
 Iron (by mouth) used to treat anemia
 Cough medicine (suppressant for a
dry cough or expectorant for a wet
cough)
 Topical medications-used to treat skin
conditions such as diaper rash,
infections.
28

29. Most Frequently Prescribed Medications in Child Care
 Medications for chronic conditions-used
to treat seizure disorder, cystic
fibrosis, and other chronic illnesses.
 Psychotropic medications: used to
threat ADHD and other mental or
behavioral issues.
29

30. Resources
 Administering Inhaled medicines and
Nebulizers
 Procedures for administering Auto-injectors
(Epi-Pen©)
 www.ucsfchildcarehealth.org
 www.fda.gov/ForConsumers/ConsumerUpdates/ucm164427.
html
Review of Agency Policy
Demonstration: Dosing and
Measurements
Quiz: Administration of Medication
Evaluations 30

31. Agency Policy
The medication will be measured by Staff and, if the child
is able, given to the child who will self-administer
medication (with parental and physician consent) in the
presence of Staff.
The date, time given, dosage, amount of medication
administered, and the signature of the Staff person
giving the medication will be recorded in a log, and kept
in a locked file. The log will be kept with the medication
in the same locked box.
The Teachers and other Staff will be responsible for
routine observations of any child receiving medication
for adverse effects. Any side effects will be shared with
the Site Supervisor or designee. The Site Supervisor or
designee will then contact the child’s parent and the
child’s doctor documenting the observations.
34

32.  Physician’s Signature Physician’s name printed

 Name of Medication


 Date to Begin Medication


 Date to Stop Medication


 Dosage


 Time(s) to Give Medication


37