Illness, medication and what a centre must report

Almost every parent question about daycare health policy comes down to one of four things: what happens if my child gets sick here, who is allowed to give medicine, what will they be fed, and what will I be told if something goes wrong.

All four are answered in the regulation, and the answers are more specific than most centre handbooks make them sound.

When a child becomes ill during the day

If a child becomes ill while in care, the centre must do two things.

It must provide a quiet and clean resting area within the facility for that child, and it must ensure the child is under the close supervision of a responsible adult.

Separately, it must immediately notify a parent or the emergency contact when a child becomes ill or is injured while under its care or supervision.

The regulation does not set exclusion rules by illness, which is why sick-child policies vary between centres. What it does require is that the centre can reach you. A licensee may not provide care to a child unless it has first ensured that the child's parent or emergency contact can be readily contacted while the child is in care.

Medication

The rules here are precise, and they exist because medication is one of the most common sources of serious error in group care.

Where a centre has agreed with a parent to give medication, whether prescribed by a medical practitioner or supplied by the parent, it must be administered in the amount and at the times specified by the parent or set out in the child's record or care plan, and it must be readily accessible to employees.

Medication must not be accessible to any child. The one exception: a child may have access to their own medication where the parent has instructed the centre to allow it and the nature of the medication is such that the child's health would be significantly at risk without immediate access. That is the provision that lets a child carry an inhaler.

An employee competent to administer the medication, or to supervise a child self-administering it, must be available at all times.

Everything gets written down. The child's record must show any medication given, including the amount and the time. Where an employee supervises self-administration, that goes in the care plan.

Child-minding programs are treated differently: they must not agree to give medication at all, and may only do so where it is immediately necessary to address a significant risk to the child's health.

Food and drink

The nutrition section is short and unusually direct.

Each child must have healthy food and drink according to Canada's Food Guide, and the centre must promote healthy eating and nutritional habits. The food must be sufficient in quantity and quality for the child's development, having regard to their age, the number of hours they are in care, and their food preferences and cultural background.

Then a list of prohibitions:

• no feeding by propped bottle
• no forcing a child to consume any food or drink
• no leaving a child unsupervised while eating or drinking
• no using food or drink as a reward or a punishment

Safe drinking water must be available. Information about the food and drink given to children must be made available to parents.

Where a child's record or care plan contains instructions about food and drink, those instructions override the general Canada's Food Guide requirement to the extent they differ, and the centre must follow them. That is the provision that covers allergies, medical diets and religious or cultural requirements.

Behavioural guidance

The centre must have a written policy on behavioural guidance and give it to both employees and parents. Guidance must be appropriate to the age and development of the child receiving it.

The prohibitions in section 52 are worth reading in full, because they set the floor for how a child may be treated:

• no shoving, hitting or shaking by an employee or another child
• no confinement or physical restraint by another child, and none by an employee except as authorised in a care plan
• no harsh, belittling or degrading treatment, verbal, emotional or physical, that could humiliate a child or undermine their self respect
• no spanking or any other form of corporal punishment
• no separation from other children without supervision by a responsible adult
• no deprivation of meals, snacks, rest or necessary use of a toilet as punishment

Abuse and neglect, as defined in Schedule H, are separately prohibited.

Parental access, and who may collect your child

Two provisions sit alongside the health rules and matter just as much.

A licensee must ensure that a parent has reasonable access to their child while the child is in the facility. A centre that makes seeing your own child difficult is not applying a policy the regulation supports.

Separately, where a person has been identified in the child's record as someone not permitted access to that child, the licensee must take reasonable steps to prevent that person from reaching them. That is why the child record includes a field for it, and why a written consent to release the child to someone other than a parent must be held on site.

Reportable incidents

Schedule H lists the incidents a centre must report. The list is long and specific:

death; a fall serious enough to require emergency care or hospital transfer; any other injury requiring emergency care or hospital transfer; choking requiring first aid, emergency care or hospital transfer; poisoning; food poisoning requiring emergency care or hospital transfer; a medication error that adversely affects a child or requires emergency intervention; unexpected illness serious enough to require emergency care or hospital transfer; a missing or wandering child; a disease outbreak or occurrence above the level normally expected; emergency restraint not approved in a care plan; attempted suicide; aggressive or unusual behaviour by a child that has not been appropriately assessed in their care plan; a motor vehicle injury during transit; a service delivery problem affecting the centre's ability to provide care; and emotional, financial, physical or sexual abuse, or neglect.

The timing. A parent or emergency contact must be notified immediately. The medical health officer must be notified within 24 hours of a child being involved, or possibly involved, in a reportable incident.

Note "may have been involved". The duty to report does not wait for certainty.

The log of minor events

Separately from reportable incidents, the centre must keep a log of minor accidents, illnesses and unexpected events that did not require medical attention and were not reportable under Schedule H.

That log is a facility record, and a licensing officer can review it. A centre that keeps it well has a clear picture of the small things, which is often where a pattern shows up first.

What is in your child's record

The regulation requires a current record for each child showing: name, sex, date of birth, medical insurance plan number and immunization status; date of enrolment; a daily attendance record with arrival and departure times; the name and telephone number of a parent, medical practitioner and emergency contact; any illness, allergy or medical disability disclosed; any medication given, with amount and time; any notification made to a parent, emergency contact or medical health officer; any written special instruction the centre has agreed to; a photograph or digital image and other information to identify the child in an emergency; a record of any person not permitted access to the child; and the date the child stops attending.

Two written consents must be held on site: consent to call a medical practitioner or ambulance in an emergency if you cannot be reached, and consent to release the child to someone other than you.

Where a child requires extra support, a care plan is required, reviewed with a parent at least once each year.

What to ask

Ask what the centre's threshold is for sending a child home, since the regulation does not set one. Ask who holds the current first aid certificate and whether someone with it is always on site. Ask how medication is stored and logged. Ask to see the behavioural guidance policy, which you are entitled to as a parent. Ask what happened the last time they had to make a 24 hour report, and what changed afterwards.

Next, inspections and how to read a report.