Q: We're having trouble finding a daycare provider willing to look after our recently diagnosed 4-year-old son. What can we do to convince them to take on the extra responsibility of caring for a child with type 1 diabetes?
A: Every day -- and everywhere -- children with type 1 attend daycare. Though it can feel like a very tough road to find suitable care, there are providers out there who are ready, willing and able to take terrific care of your child. The key to finding one of these providers seems to come down to two things: communication and education.
One of the most common problems that parents run into in their search for childcare is misinformation. Just like well-meaning friends and family who tell you that your child's diabetes will be fine if he just cuts back on sugar, some childcare providers incorrectly assume that type 1 is just like type 2 diabetes, requiring little supervision beyond watching the child's diet. When providers learn that type 1 requires more management, they often begin to avoid the situation and take a hands-off approach in order to sidestep any legal complications due to mismanagement. Other childcare providers may know a great deal about type 1 diabetes, but are still fearful about their ability -- or inability -- to manage a child's blood sugar levels while watching other children in their care.
First, have you tried working with your child's current daycare provider? We ask all families with newly diagnosed children to sit down and have an informal meeting with care providers (and/or school nurses and even the child's teachers, if that applies) to go over what a day in the life of this child is like and where diabetes management duties are needed. Understanding at what points in the day to check sugars, offer snacks and administer insulin can be helpful for the provider to see what little time most tasks associated with type 1 truly take. This is also a good meeting to have with any new or prospective caregivers.
When you run into situations in which the provider (an individual or center) is reluctant because the staff lacks training in diabetes management, make it clear that you, as the parent, can train caregivers or you can set up training through your diabetes clinic. It also helps if you're able to offer the reassurance that you can be on hand to answer questions throughout the day or stop by during meals to help with carb-counting and other medical management, especially in the first few days and weeks after starting care.
Be aware that under the Americans With Disabilities Act, children with type 1 diabetes cannot be excluded from public and private daycare centers based on their condition. However, limited staffing and different state and local rules governing things like administering medicines (i.e., insulin) in daycare still lead some providers to do so anyway. If you feel that your child is being discriminated against based on his medical condition, you can contact the American Diabetes Association's Safe at School program for more info on your state's laws and your legal rights.
The bottom line here is that the daycare that's best for your child is the one that meets all of his various needs. Type 1 management is one of them, but so are things like positive social interaction with his peers and a stimulating learning environment. That daycare is out there, and though it may require knocking on a few doors, you will find it.
--Kelle Dawn Overand, M.S., R.N., A.P.N., C.C.N.S.-P., C.P.N., is a pediatric clinical nurse specialist and certified diabetes educator at Harold Hamm Diabetes Center at the University of Oklahoma.
How Other Parents Deal
"When I told our daycare provider (a mom with a home-run center) about our son's diagnosis, she actually volunteered to get trained -- I didn't even have to ask! Later, when my son left daycare to start kindergarten, I let a mom at our clinic know, and now her daughter is taking my son's place. Ask your clinic for recommendations and find out where other parents are sending their kids -- these providers are already trained!"
--Kristen, mom of Tyler
Disclaimer: The information in these articles is not intended as medical advice. Families should check with their healthcare professionals regarding individual care.
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