By Emily Regier and Alexander Wolf

Twitter Summary: @AmDiabetesAssn releases position statement on kids w/ #diabetes in childcare – good first step, but real goal is implementation

The American Diabetes Association (ADA) recently released a position statement providing guidance on how to care for young children (under six years old) with diabetes in the childcare setting (e.g., programs like day care, camps, etc.). This is a key issue, given that children in these programs are entirely dependent on staff, and adding diabetes can pose obvious challenges.

Along with the statement, the ADA website offers several resources for parents and childcare providers, including online training resources for program staff, sample written care plans, and a brochure on legal protections against discrimination by childcare programs.

The position statement provides some recommendations for parents and childcare providers – a few of which are summarized below:

• All childcare staff responsible for the child with diabetes should receive “basic training” for diabetes management, including how to recognize symptoms of hypo- and hyperglycemia and how to identify signs of a medical emergency.

• A small number of childcare staff should receive “advanced training,” including how to perform blood glucose monitoring, insulin and glucagon administration, urine and/or blood ketone checks, and basic carb-counting skills.

• Parents, in collaboration with their health care team, should create a written plan for their child’s diabetes management. This plan should be shared with and explained to the childcare team; a sample plan can be found here.

• Parents should determine specified times for routine blood sugar tests throughout the day, including before meals/snacks, before physical activity, or when a child exhibits symptoms of hypo- or hyperglycemia.

• Parents should be responsible for determining and providing healthy food for their child and should explain the carb content of any provided foods to the childcare staff. If the childcare program provides its own food/snacks the parents and childcare team should work together to decide what foods (and portions) are appropriate for the child.

• Federal and state laws (American with Disabilities Act, the Rehabilitation Act of 1973, and the Individuals with Disabilities Education Act) prohibit discrimination on the basis of disability, including diabetes. Public programs or those receiving federal funds should not deny enrollment to a child on the basis of his/her diabetes. Some state laws, however, dictate whether non-nursing staff can administer medication (such as insulin) in the childcare setting.

While the position statement is a valuable first step, advocates for children with diabetes say the real goal will be having these guidelines enforced. As we understand it, children are too often denied access to childcare facilities because of their diabetes, or parents are expected to perform diabetes management tasks in the childcare setting for their children (instead of the providers or staff). Legally, it is currently unclear when it is considered discrimination for a childcare program to refuse to provide services (e.g., giving insulin). As such, some parents find these programs are reluctant to provide care that their child would clearly have in a public school. This is yet another reminder of how challenging life can be for parents of children with type 1 diabetes and is another one of the “silent” problems that parents face, like being unable to find good babysitters. Parents would of course welcome clearer guidance and stronger enforcement of anti-discrimination laws; we are unsure if that will happen but certainly value ADA’s statement.

Never miss an update by signing up here to receive free updates on future diaTribe articles.