compliance

Health, safety + security

We developed our health care policy with guidelines from the Department of Early Education and Care (EEC) and Massachusetts Department of Public Health (DPH) to ensure each child in our care is kept as healthy and safe as possible. A complete copy of our Health Care Policy is available in the office.

prevention and wellness

Prevention

Health and safety are our top priority at First Circle. We focus on preventing illness and accidents before they occur.

Training

We have written policies for reducing the risk of infectious disease and provide annual training to all staff in CPR, Five Rights of Medication Administration, and emergency management.

Nut-Free

We keep First Circle nut-free and latex-free (gloves and band-aids).

Healthcare Consultant

We are required by EEC to have a Healthcare Consultant who is available to the program for consultation as needed. Our pediatric Healthcare Consultant approved this policy and approves our annual First Aid training and training in medication administration for staff.

Healthy habits

We encourage habits that promote good health and prevention of disease and practice them ourselves.

Classroom design

Our classrooms are designed to have separate food preparation, toileting, and diaper changing activities, as well as prevent accidents.

Pets in the classroom

From time to time, First Circle has kept small pets in our classrooms, including gerbils and fish. We have the following policy about pets, per EEC regulations:

• Pets must be appropriate for the children in care. Before introducing a pet to the program, we must consider the effect on the children’s health and safety, including possible allergies, and notify parents in advance, or prior to the child’s enrollment.
• Educators must closely supervise all interactions between children and animals and instruct children on safe behavior when close to animals.
• When pets are kept in the program:
  • ensure that animals, regardless of ownership, are free from disease and parasites and are licensed and/or vaccinated as prescribed by law
  • do not allow children to clean the animal’s cage
  • keep litter boxes inaccessible to children
  • ensure that pets are kept in a safe and sanitary manner
  • do not allow children to have physical contact with reptiles. Reptiles in the program must be kept in accordance with Department of Public Health Guidelines.

Safe environment

First Circle promotes a safe learning and working environment for all children, staff, faculty, and visitors. We do not allow smoking on or around the premises. We strictly prohibit any weapons in our building at any time, including firearms, ammunition, and any other object that could reasonably be perceived as a weapon.

Idling

Massachusetts state law prohibits idling of automobiles, so we tell parents to not leave their car idling. Also, we insist they not leave any children unattended in their vehicle, no matter how briefly!

Healthy routines

Coughing/sneezing

We teach children to sneeze and cough into their elbows to prevent the spread of germs.

Sunscreen

We support sun safety measures at First Circle to minimize a child’s chance of getting skin cancer from excessive sun exposure. [see DAILY PROGRAM MANAGEMENT for detailed information].

Toothbrushing

We assist children in brushing their teeth when they are in care for more than 4 hours or consume a meal at school. [First Circle does not offer toothbrushing at this time.]

Handwashing

We follow strict hand-washing guidelines in all classrooms to reduce the spread of germs. [see DAILY PROGRAM MANAGEMENT].

Safe Sleep Policy

First Circle follows the Safe Sleep procedures implemented by EEC [see DAILY PROGRAM MANAGEMENT].

Children’s Health records

Annual Physical/Immunizations

First Circle Administration ensures that each child enrolled in our program has up-to-date immunizations and an annual physical exam on file.

For parents who have religious or medical objections to their child being immunized, we must have a signed statement (from the doctor for a medical reason or from the parent for religious reasons prior to the child’s first day of enrollment).

Special health conditions

At enrollment, and yearly thereafter at re-registration, we ask parents whether their child has a condition that may impact his or her life in school. Such conditions include:

• chronic medical conditions requiring special attention
• developmental, behavioral, or mental health conditions or concerns
• allergies; medications the child takes on a regular basis; special diet
• hearing, visual, or dental conditions
• limitations to physical activity
• any other emergency response needs

If a child has any of these special requirements, we (together with the parents and/or health care provider) will complete a Special Care Plan (a.k.a. Individual Health Care Plan), a confidential school health record maintained in both the classroom and the child’s file. It contains information, guidelines, and standards that promote a student’s health and educational goals. The Plan describes the nature of the condition, symptoms, any medical treatment that may be necessary while the child is at First Circle, the potential side effects of that treatment, and the potential consequences to the child’s health if the treatment is not administered.

Emergency response plan

For any child with a condition requiring emergency management, an Emergency Response Plan will be completed and on file, in conjunction with a Special Care Plan. The Emergency Response Plan details the health condition, any prescribed medications, triggering events, symptoms/signs to watch for, and action. All educators in a classroom with a child with an Emergency Response Plan will receive training to handle an emergency effectively.

Bloodborne pathogens

Childcare providers may be exposed to bloodborne pathogens when diapering, toileting, feeding, or cleaning up the vomit of children in their care, breaking up fights between children, or if bitten by a child. To protect yourself from bloodborne illnesses, you must follow the steps outlined in DAILY PROGRAM MANAGEMENT.

safety

Supervision

Our highest priority as educators of young children is to keep them safe. This requires effective and consistent supervision. The 6 basic principles of supervision:

1. Prepare

• Make sure the height and arrangement of furniture and equipment allow effective monitoring and supervision.
• Scan for potential safety hazards.
• Ensure equipment is organized for play.
• Teach children appropriate and safe use of each piece of equipment. (For example, using a slide correctly – feet first only – and teaching why climbing up a slide can cause injury.)
• Have clear and simple rules for children. (Example: walking feet inside.)
• Know and follow the daily schedule.
• Know and maintain staff/child ratio.

2. Position

• Place yourself so you can see and hear all the children.
• Make sure there are always clear paths to where children are playing, sleeping, and eating so you can react quickly.
• Stay close to children who may need additional support.

3. Communicate

• Listen closely to children to identify signs of potential danger. Specific sounds or the absence of them may signify reason for concern.
• Pay attention to the sounds of the environment.
• Maintain communication both inside and outside the facility.
• Inform a new teacher/assistant entering the classroom of the headcount and any medical restrictions or safety concerns.

4. Scan and count

Maintaining accurate head counts of the children in our care is critical to preparedness. Conducting frequent head counts allows us to identify a missing child and take immediate action. No child should ever be outside the classroom without adult supervision.

• Know the number and names of children present. Identify children by name to face before and after transitioning from one area or activity to another.
• Continuously scan the entire environment so you know where each child is and what they are doing.
• Keep the WEEKLY SIGN IN AND OUT and EMERGENCY CONTACT SHEETS on the same clipboard.
• Notify any new staff member covering in the classroom (including breaks) of the current count.
• Enter the time on the sign in and out sheet IMMEDIATELY when a child arrives/departs.
• Do a headcount before leaving the room with the entire class, and again upon reentering the classroom.
• If one staff member is taking a small group of children out of the classroom, ensure the remaining educator knows how many and which children are with whom (“I have x number, you have x number”). If necessary, write down the names and cross them off when they return.

5. Anticipate

• Know each child’s abilities and anticipate children’s behavior.
• Know who is in charge.
• Review supervision procedures with facility staff and parents.
• Be sure you know First Circle’s emergency preparedness plan.

6. Engage and redirect

• Provide individualized, responsive caregiving and intervene when children are unable to problem-solve on their own.
• Focus on the positive to teach what is safe for the child and other children.
• Assist or redirect according to each individual child’s needs.

Classroom safety

We expect you to use common sense and good judgment when performing your duties. Follow these basic safety rules:

Prohibited objects

• We do not allow latex balloons, glass/ceramic objects, or pushpins in the classrooms.
• Toys in the classroom must be developmentally appropriate and not a choking hazard.

Keep out of reach at all times

• educators’ belongings, including backpacks, and pocketbooks
• scissors, pens, and pencils
• sanitizer bottles and cleaning materials
• sunscreen, ointments, and medications
• hot items (above 110° F), including coffee (Hot liquids must be kept in a travel thermos on the microwave or on top of the cubbies. Do not walk around the classroom with hot liquids.)
• electrical cords

Safety practices

• Conduct daily safety checks and remove hazardous or dangerous objects.
• Wipe up liquid, sand, or other spills from floors immediately.
• Keep a First Aid kit and a CPR mask in the classroom.
• Lift heavy objects or children properly by bending your knees.
• Use a stepstool, not a chair when reaching for overhead items.
• Wear gloves on both hands when diapering or helping children with toileting or first aid.
• Know and follow evacuation procedures (a copy of our evacuation routes is posted in each classroom) and assist the children in a safe and comforting manner.
• Take care handling equipment, cribs, or other cumbersome items.
• Be wary of strangers in the building and feel comfortable asking strangers their business.

Safety rules for children

• Children may not climb stairs with toys, stuffed animals, etc. in their hands.
• Children must sit when eating or drinking.

Playground safety

Teaching teams should work with the children in your class to establish cooperative play and safety “rules” for the playground. The rules you create and communicate to the children should include the following:

Prohibited objects

• Blankets, pacifiers, stuffed animals, and inside toys are not allowed outside.
• Children may not wear jewelry or clothing with strings or laces that could become entangled or wedged in playground equipment and present a strangulation hazard. If worn, you must tie or remove them, or have the child change their clothes.

Supplies

• Have emergency phone information and the attendance list with you on the playground.
• Bring water outside for children every day—remember to bring it in when you come in.
• Bring basic first aid items outside, including gauze pads, band aids, and tissues for runny noses.
• Bring outside the child’s EpiPen for any child requiring an EpiPen for insect bites.

Safety practices

• Be sure children’s clothes are weather appropriate; if not, borrow from the extra clothing located above the kids’ sinks.
• Confirm safety mats remain in each fall zone.
• Supervise and “spot” children when they are on climbing structures.
• Stay close when the children are on the swings; they can easily fall off.
• Circulate and monitor all areas of the playground.
• Notify another staff member if you are taking a bathroom break, bringing in a child for first aid or to the bathroom.
• Follow established cleaning guidelines for the playground.

Safety rules for children

• No crashing bikes into the gates, doors, or each other.
• No kicking or throwing balls toward the building or fences.
• No standing on the swings.
• No climbing with anything in children’s hands.
• No playing near the doors or gates on the playground.
• Identify which objects (man-made and natural) stay on the ground, and which can be thrown or tossed

Field trip safety

Prior to departure for each field trip, the Director confirms appropriate preparedness is in place. See APPENDIX for full details.

Supplies

• Take a first aid kit in all vehicles on all field trips, and emergency supplies such as water, snacks, tissues, sunscreen, medicines, emergency consent forms, etc.
• Be sure you have any emergency EpiPens or Benadryl for children with allergies.
• Bring current emergency contacts for all children in attendance including contacts and telephone numbers.
• Have a working cell phone available.

Safety practices

• On each field trip, we have a Transportation Coordinator in charge in case of emergency. The Transportation Coordinator will designate a co-teacher to assist.
• We maintain EEC staff-to-child ratios.
• Each child must wear a distinctive t-shirt to immediately identify them as a child with a First Circle field trip.
• Each child must wear a wristband with First Circle’s address and phone number.

Emergency

• If an accident or acute illness occurs while on a field trip, the Transportation Coordinator will take charge of the emergency, assess the situation, and administer first aid as needed, as well as determine the method and urgency of transportation for the child to receive medical treatment, based on the severity of the emergency or illness. If necessary, call 911. The Transportation Coordinator will also make the necessary communications (911, First Circle, parents, etc.).
• The Transportation Coordinator must notify Administration as soon as possible of the nature and extent of the injury and the proposed plan of action.

WORKERS’ COMPENSATION INSURANCE PROCEDURE

If you are injured or ill, you are responsible for letting Administration know if you think the injury or illness may cause you to seek medical attention or lose time from work. The procedure must be followed for your medical bills – if any – to be covered by our Workers’ Compensation (WC) insurance:

• Staff member (or witness) reports injury to member of Administration.
• We complete a FORM 101 (Employer’s First Report of Injury or Fatality), including as much detail of the injury as possible, within 5 days of the injury.
• We give the injured employee the following information to be provided to the health care provider: Our insurance carrier’s name, phone number, and policy number as well as the newly assigned case number. Any additional questions should be referred to the Business Manager.
• If the injury results in just medical bills, or fewer than 5 full or partial calendar days of disability, we will report it to our WC carrier, supplying them with all pertinent information from the form and receiving an assigned case number.
• If the injury results in 5 or more full or partial calendar days of disability, we will report the injury to the DIA (Department of Industrial Accidents) as well as our WC carrier within 7 days of the injury.
• All initial medical bills will be covered through our Worker’s Comp Insurance.
• The employee will be paid only for hours worked, and the day of the injury is considered the first calendar day of disability.
• The insurance company has 14 calendar days from the date they receive the Employer’s First Report of Injury or Fatality – Form 101 to either:
  • mail a check and the Insurer’s Notification of Payment – Form 103 to the employee;
  • or contest the claim, by sending a certified letter denying compensation via an Insurer’s of Denial – Form 104.
• The caseworker assigned to the claim will contact the injured employee and all subsequent reasonable and necessary medical treatment needs will be approved.
• You should start getting a check (60% of total gross average weekly wage) within 3 to 4 weeks after your injury or illness. You will receive compensation for lost wages for any days you are disabled after the first 5 full or partial calendar days. (You are not compensated for the first 5 calendar days of incapacity unless you are disabled for 21 calendar days or more.)

security

Communication

Each classroom has its own phone so you can communicate directly with parents during the day. First Circle does not allow the use of personal cell phones to communicate with parents unless it is an emergency.

• Emergency phone numbers are posted by every phone.
• We use Procare Engage to rapidly communicate with parents in the case of an emergency.
• If we must evacuate, Admin will bring cell phones for any communication with authorities.
• Educators must have an emergency contact information sheet for each child in their classroom.

Safe Access

All our facilities are locked. We keep to a minimum the number of families that have access to the code or biometric fingerprint system, which uses fingerprints to unlock the door. The biometric ID pad is not just a security measure; it also allows us to track a child’s attendance in the program. EEC requires us to keep records of the arrival and departure times of all children in our care. Each time the pad reads an associated person’s fingerprint, a child(ren) will be automatically logged into or out of First Circle’s attendance record.

Safe release

It is crucial that you make sure each child is picked up by an authorized person. All employees must know this policy thoroughly and follow it without exception [see DAILY PROGRAM MANAGEMENT for full policy].

illness and communicable conditions

Overview

Preventing the spread of communicable disease is a high priority. We follow all requirements and recommendations of the DPH and EEC.

As a childcare center, we must balance the health of the children and staff with sensitivity to the pressures of families’ work commitments. We try to be as flexible as possible within the EEC and DPH guidelines, but are conservative to protect the health of other children in our care.

We ask parents to use good judgment in deciding whether their child is well enough to attend school. We cannot provide care for a child with a diagnosed communicable disease, nor one who is not well enough to participate in a normal active school day. A child who is too sick to go outside or who cannot participate in the group’s activities is usually too sick to be with other children.

Symptoms

First Circle cannot accept a child who has exhibited symptoms of an infectious disease (flu, chicken pox, measles, mumps, hepatitis, conjunctivitis, infectious rash, strep infection) within the previous 24 hours. If a child develops or displays any of the symptoms below while at school, contact the parents and advise them they must come pick up their child. [see the Exclusions from Care chart hung in each classroom].

• FEVER ABOVE 100.5^o on the forehead (measured twice, 15 minutes apart)
• diarrhea more than once in a short period of time (unless caused by antibiotics)
• one bout of vomiting
• pink or red eyes with yellow discharge from the eye or tearing
• rash with a fever or behavior change
• difficulty breathing
• mouth sores, unless the child’s healthcare provider states that the child is non-infectious
• signs of an ear infection (discomfort, pulling on ear), unless the child is fever-free and able to participate in school activities
• blisters or rash consistent with chicken pox
• head lice
• any other symptom of communicable disease, especially if there is another confirmed case within First Circle

Mild illness

If a child is mildly ill, has no fever, seems unusually irritable, lethargic, or generally “not themselves,” but shows no other symptoms, consult with Admin. If you inform the parents, you must tell them your plans to accommodate the child’s needs. If they can participate in the daily program, including outside time, they may remain in school.

If the child’s condition worsens or symptoms of contagious illness appear [see Symptoms above], or if the child cannot be cared for by classroom staff, contact the parents to arrange pickup. A child who has been excluded from care may return after a) meeting the requirements below, or b) being evaluated by a healthcare provider and receiving written confirmation that they are not infectious and pose no serious health risk to themself or to other children. Nevertheless, First Circle has the right to make the final decision concerning the inclusion or exclusion of the child from attendance.

Parent pickup

If a child is sick, call the parents as soon as possible, following these guidelines:

• If they don’t answer and you get voicemail, leave a message.
• Tell the parent when they answer or when leaving a message that the child is okay, but not feeling well. List the ailment, tell them they need to be picked up as soon as possible, and that we’re doing everything to keep them comfortable.

Our policy is that parents must pick up their child as quickly as possible (within an hour), unless special circumstances apply (discuss with Admin). If you cannot reach a parent, contact an emergency contact(s) and ask them to pick up the child.

Once you have contacted a parent or their emergency contact:

1. Let Admin know you have contacted parents to pick up the child.
2. Make the child comfortable in a quiet area of the classroom or in the office to rest under the supervision of teacher(s) or Admin. Clean and disinfect any toys, blankets, or mats used by an ill child before use by other children.
3. Complete a Sent Home Sick form and get an administrator’s signature. Ask the person who picks up to sign the Sent Home Sick form. During your conversation with the parent, update them on the child’s condition at pickup, remind them that to prevent the spread of infection, the child must remain out of school until they have been symptom-free for at least 24 hours without medication. Please refer to the Exclusions From Care chart for specifics.
4. If a child exhibits a symptom listed above on a field trip, contact the parents and, depending on logistics, decide with them whether they should meet their child at First Circle after the bus returns, or drive to the field trip site to pick up their child. Either way, make the child comfortable and keep them apart from other children as much as possible.
5. Any questions about or exceptions to First Circle policies can only be decided by Admin.

Sent home sick form

If a parent informs you that their child has contracted a communicable disease or serious illness, report it to Admin immediately. As required by the DPH, children with certain contagious, report-worthy diseases must stay home until all danger of contagion has passed.

For any communicable conditions, we will notify the staff in the classroom directly. We will also notify parents by email in the classroom where it occurs with information about the disease and symptoms to watch for. If a child needs to be excluded due to other non-typical communicable disease or for other health reasons, we will contact our Healthcare Consultant or the local Public Health Department, and you will be notified of any further instructions. The child may return to First Circle when approved by the health care provider or DPH.

Head lice

What are lice?

Head lice are a common condition among children, second only to the common cold. About 80 percent of schools across the country have at least 1 outbreak of head lice per year. Preschool and elementary school aged children are most affected, girls more frequently than boys.

Anyone can get head lice. Lice are not due to poor hygiene; in fact, lice prefer clean heads. Lice carry no diseases. However, getting rid of them requires the parent’s vigilance, using treatment with a lice-killing shampoo and manually removing all nits from the hair.

How are lice transmitted?

Lice crawl quickly but do not jump, hop, or fly. Lice pass from one child to another through head-to-head contact. Current research shows that 99% of cases are spread this way. At school, we work to limit head-to-head contact but can’t prevent every instance.

Lice can also spread by sharing of personal articles like hats, towels, brushes, helmets, hair ties, etc. Although First Circle has very few of these items, during a lice outbreak, articles such as dress-up hats should be removed from the classroom until the outbreak is over.

How lice are not transmitted:

Head lice and nits (eggs) are not viable once off the human scalp. As a result, the chances of transmission through clothing, hats, linens, stuffed animals, and sleeping bags is highly unlikely (the remaining 1% of cases). However, as a precautionary measure, during a lice outbreak at First Circle, classroom staff should remove and bag all stuffed animals, dress-up clothes, dolls, and pillows and expose them to high heat.

How do I identify lice?

Lice are small, wingless insects. Their color varies from whitish brown to reddish-brown. Typically, one only sees the nits (eggs) on the hair shaft, not the adults. Nits may be seen as specks glued to the hair shaft, ranging in color from yellow to gray. It’s difficult to see nits without magnification, but they are typically found within a half-inch of the scalp and near the nape of the neck or over the ears. Nits can be confused with dry skin: to tell if it is a nit, flick it or blow on it. If it moves off the hair shaft, it is not a nit.

If we are notified that a child at First Circle has contracted head lice, Administration will notify the classroom(s) and families in the classroom(s) involved via email and provide fact sheets and instructions on how to look for, treat, and remove lice. Once an outbreak occurs, it is common for the other children in the classroom to become infected.

To prevent spreading and re-occurrence, we need you to:

• Follow the same instruction we have provided to families and examine the children in your classroom every few days looking for any additional cases.
• Wear gloves and use craft sticks to separate the hair.

A child or staff member who has contracted lice may return after they have been determined to be nit-free. Daily checking of the child or staff member’s head should occur for 14 days after their return.

AIDS/HIV

First Circle follows the Massachusetts Department of Public Health’s HIV Infection/ Aids Policy.

Epidemic illness

As mandated by the Board of Health, if an epidemic illness has been brought into the school and is spreading rapidly and uncontrollably, First Circle may be forced to close its doors to air out the school. In the event of illness believed to be part of an outbreak or disease cluster, First Circle will consult with the local Board of Health to receive further instructions.

We may need to close our program temporarily without notice in the event of an epidemic or pandemic health crisis. We would consult the local and state agencies responding to the emergency when making the decision.

Staff health

Bi-annual physical

We expect all employees to maintain their physical, mental, and emotional health so they are able to perform their job responsibilities to the fullest and keep the children in their care healthy. As required by licensing, all employees are responsible for providing documentation of a physical exam every 2 years after the start of employment.

Illness

Please keep the director apprised of any changes to your health, including any communicable diseases, injuries, pregnancy, or illnesses. You will be allowed to work if it is medically safe for you to do so and poses no danger to you, your co-workers, or the children.

In keeping with our Health and Safety Policy, and to protect your health and that of your co-workers, staff who have experienced the following symptoms during the previous 24 hours must be excluded:

• fever of 100.5° or over
• diarrhea
• vomiting
• pink or red eyes with discharge from the eye (conjunctivitis)
• rash
• any symptoms of communicable disease including flu, chicken pox, measles, mumps, hepatitis, conjunctivitis, infectious rash, scabies, strep infection, especially when there is another confirmed case within First Circle
• head lice (must be nit-free)

Our policy is to make reasonable accommodations for staff that are occasionally ill. Staff members who are chronically ill should re-evaluate their suitability for working in a field where dependability is crucial. (see Job Performance, Attendance/Absences).

All staff must report accidents and injuries at once, no matter how minor, and complete an Incident Form within 48 hours.

Bloodborne Pathogens

Childcare providers can be exposed to bloodborne pathogens when diapering, toileting, feeding, or cleaning up the vomit of children in their care; breaking up fights between children; or if bitten by a child. It’s important that educators become familiar with bloodborne pathogens (diseases transmitted through exposure to infected blood/body fluids that contain infected blood) and how to protect themselves from becoming infected.

To contract a bloodborne disease, blood (or blood-containing body fluids) from an infected person must be introduced directly into your bloodstream through a needle stick, a cut, an opening in your skin, or through mucous membranes in the eyes, nose, or mouth. To protect yourself from bloodborne illnesses, follow these simple steps:

• Assume everyone, including the children in your care, is infected (practice universal precaution).
• Always wear disposable gloves when coming in contact with blood or other body fluids.
• Remove immediately any garment contaminated by blood and bag up (in diaper bag) for return to family.
• Always wash your hands before putting on and after removing gloves. If you believe you have been exposed to a bloodborne pathogen, immediately wash the affected area with soap and water; report the incident to the appropriate personnel and/or agency and proceed immediately to your physician or nearest emergency room.

allergies

Allergies list

Each classroom has an allergy list that includes all the children in the school with a known allergy or cultural dietary preferences. This list should be posted for easy access in a manner that protects privacy.

Prevention

We take allergies very seriously and collaborate with parents to respond to their child’s needs in the safest and most consistent way possible.

• First Circle is a nut-free and latex-free (gloves and band-aids) school.
• In the case of severe food allergies, we will eliminate serving that food in a classroom.
• In the case of a known allergy to a chemical or other material, we post this information and eliminate exposure in the classroom environment, if possible.
• All educators are trained annually to handle allergic reaction emergencies.

Management

Allergy action plan

If a child has a known or suspected allergy, you’ll receive a Special Care Plan and Allergy Action Plan. The Allergy Action Plan details the specific allergy, preventative measures to be taken, symptoms of the allergy and expected treatment, and exact details of any medication to be given.

Treatment

Anaphylaxis is a severe allergic reaction that can occur quickly (as fast as a couple of minutes) and may be life threatening. Time is of the essence with an allergic reaction. Familiarize yourself with the symptoms of an allergic reaction, which can include:

• MOUTH: Itching, tingling, or swelling of lips, tongue, mouth
• SKIN: Hives, itchy rash, swelling of the face or extremities
• GUT: Nausea, abdominal cramps, vomiting, diarrhea
• THROAT: Tightening of throat, hoarseness, hacking cough
• LUNG: Shortness of breath, repetitive coughing, wheezing
• HEART: Irregular pulse, fainting, pallor, blueness
• NEURO: Disorientation, dizziness, loss of consciousness

For a child with a known or suspected allergy, notice any symptoms and determine the course of action based on the child’s Special Care Plan:

Antihistamine

If the child’s Special Care Plan indicates antihistamine for symptoms presenting:

• One staff member must stay with the child at all times.
• Give the medication listed on the form.
• Contact parent/guardian.
• Notify Administration.
• Closely monitor for improvement or worsening of symptoms.

Epinephrine

If the child’s Special Care Plan indicates an EpiPen for an allergic reaction,  refer to the Plan and determine whether the presenting symptoms call for use of the EpiPen:

• One staff member must stay with the child at all times.
• Call for help from the office.
• Inject EpiPen [see below]. Note time of injection for EMTs.
• Have another teacher or Admin call 911.
• Contact parent or emergency contact.
• Take used EpiPen unit and child’s file in the ambulance to the hospital.

Directions for using epipen or Jr.

Prepare the EpiPen or EpiPen Jr Auto-Injector For Injection

• Remove the auto-injector from the clear carrier tube.
• Flip open the yellow cap of the EpiPen or the green cap of the EpiPen Jr Auto-Injector carrier tube.
• Tip and slide the auto-injector out of the carrier tube.
• Grasp the auto-injector in your fist with the orange tip pointing downward. With your other hand, remove the blue safety release by pulling straight up without bending or twisting it.

Note: The needle comes out of the orange tip. Never put your thumb, fingers, or hand over the orange tip.

Administer the EpiPen or EpiPen Jr Auto-Injector

• Hold the auto-injector with orange tip near the outer thigh. Swing and firmly push the orange tip against the outer thigh until it ‘clicks.’
• Keep the auto-injector firmly pushed against the thigh at a 90° angle (perpendicular) to the thigh. Hold firmly against the thigh for around 10 seconds to deliver the drug. The injection is now complete.
• Remove the auto-injector from the thigh. The orange tip will extend to cover the needle.
• Massage the injection area for 10 seconds.

asthma

Asthma action plan

For any child with a history of asthma, we require an Asthma Action Plan on file and a Special Care Plan. The plan specifies any known or suspected asthma triggers, any environmental control measures, pre-medications, and/or dietary restrictions that the child needs to prevent triggering an asthma episode, symptom management, and any medication that may be needed. All educators in a classroom with a child with asthma will receive appropriate training to handle emergency asthma episodes.

Treatment

To effectively manage a child’s asthma at First Circle, follow these guidelines, below.

medication

Trained First Circle staff can administer prescription and non-prescription medication with written approval from both the child’s healthcare provider and parent. An Authorization for Medication form signed by the parent and an authorization from the child’s healthcare provider must accompany any medication to be administered to a child during the school day. A prescription label is considered written authorization by the healthcare provider. These consents are valid for one year.

Prescription medication must be in the original container with the original prescription label attached and legible.

For a chronic medical condition, the educator must successfully complete training given by the child’s health care practitioner or, with their written consent, given by the child’s parent or First Circle’s health care consultant. The training must specifically address the child’s medical condition, medication, and other treatment needs.

For non-prescription medications, the child’s healthcare provider must provide written and signed instructions including:

• type of medication
• route of administration
• child’s previous experience with the medication
• reason(s) for the medication
• dosing instructions
• indications for when the medication is to be given if prescribed “as needed”
• possible side effects to watch for
• storage instructions

PRESCRIPTION + NON-PRESCRIPTION MEDICATIONS

All teachers at First Circle receive training to recognize common side effects and adverse reactions of various medications. We are strictly regulated by both the DPH and EEC regarding medication. There are absolutely no exceptions to these policies:

Parents must provide all medication

Form

An Authorization for Medication form must be filled out each time a child needs a new medication. It must be dated and clearly indicate the kind of medication, dosage, and if non-prescription, criteria for administration if specified “as needed.”

Container

All prescription medication must be in the original pharmacy container and include the child’s name, the name of the medication, the dosage, the number of times per day, and the number of days the medication is to be administered.

Labeling

Non-prescription medication must be labeled with the child’s full name, the date that medication was authorized by the child’s healthcare provider, the provider’s name, expiration date, period of use, and instructions on how to administer and store it. Use a plastic bag if necessary to fit all the information.

Storage

Parents must hand all medications directly to the teacher. You must store medications in a locked container or cabinet in the classroom or under locked refrigeration storage (if required), located in the staff room or kitchen.

Directions

Medications must be dispensed following the directions on the original container, unless authorized in writing by the child’s licensed health care practitioner. Medications without clear directions on the container must be administered in accordance with a written physician’s order.

First dose

We cannot administer the first dose of any medication to a child, except under extraordinary circumstances and with parental consent. New medication must be administered at home at least one hour prior to bringing the child to First Circle.

Training

For children with Special Care plans, parents with written permission from their child’s health care provider may train teachers to implement their child’s plan.

Physicians

As specified by the State of Massachusetts, healthcare providers cannot prescribe medication for their own children.

Return

Return any unused, discontinued, or outdated medications to the parents for disposal.

Logs

First Circle maintains logs of the administration of any medication (excluding topical ointments and sprays applied to normal skin), as part of the child’s file.

Recording

Each time a medication is administered, you must document in the child’s record the name, dosage, time, and method of administration, and who administered the medication.

Unanticipated

Any unanticipated administration of medication or treatment for a non-life-threatening condition requires that the teacher must make a reasonable attempt to contact the parent(s) prior to administering the medication or beginning treatment. If the parent(s) cannot be reached in advance, they must be contacted as soon as possible after such medication or treatment is given.

As-needed medications

When a child has a chronic condition requiring routine medication administration or conditions requiring EpiPens, the classroom will receive a Special Care Plan as well as an Authorization for Medication for that child.

Nebulizer policy

For children with respiratory conditions that require a nebulizer, we can administer the nebulizer treatments with the following stipulations:

• Parents must complete an Authorization for Medication form stating the dose and times of treatment each day.
• A child requiring multiple nebulizer treatments a day must receive the first treatment prior to arrival at First Circle.
• The nebulizer medication must be in the original prescription box with dosage clearly stated. The doses must be pre-measured and individually wrapped.
• We cannot make the decision about giving children a nebulizer treatment on an “as needed” basis. If we think a child’s breathing needs to be assessed during the day, and the nebulizer has already been administered as indicated on the medication form, you must call the parents and ask them to come in to decide about administering medication an additional time.
• For a child who is wheezing or coughing and has an Asthma Action Plan on file, you must call the parent to verbally authorize additional administration of the nebulizer.

Topical medication

Administration of non-prescription topical ointments and sprays such as diaper creams, petroleum jelly, sunscreen, insect repellent, etc., require a signed Topical Medication Authorization form. The signed form is valid for one year and includes a list of topical non-prescription medications.

To apply topical ointments to wounds, rashes (except diaper rash), or broken skin, you must have an Authorization for Medication form signed by the child’s healthcare provider [see DAILY ROUTINES: Playground, Sunscreen and Insect Repellents]