Children with Special Health Care Needs: Tips for Early Care and Education Providers

The following suggestions are intended to help include children with disabilities and other special health care needs in your program. It is important to remember that children are children first and each child is different, regardless of whether or not they have a special health care need. All children are provided with the chance to reach their full potential and have a positive experience. When considering adaptations and modifications, it may be helpful to take into account the severity of the condition, the child’s age and the child’s developmental level. Each child with a special health care need requires an Incidental Medical Services (IMS) “Special Health Care Plan” to identify how you will meet the child’s individual needs in your program. A sample special health care plan is available on the CCHP Web site at [link the plan here]. 

Child care providers partner with families, health care professionals, and other service providers or agencies to complete the plan for care. The plan includes support and training for any staff involved in the child’s care.  

Developmental delays 

• Work closely with other agencies and personnel who provide specialized services (such as early interventionists, therapists and psychologists). These specialists are a great resource for answering questions and brainstorming when problems arise.  
• Teach in small steps. 
• Give clear directions, speaking slowly, clearly and using only a few words. 
• Move the child physically through the task, so she can feel what to do. 
• Stand or sit close to the child so you can help as needed. 
• Help the child organize his world by providing structure and consistency and by labeling things with pictures and words. 
• When moving from one activity to the next, let the child know ahead of time and allow plenty of time for the transition

Speech and language delays 

• Be a good listener and observer. 
• Engage infants and toddlers in back and forth conversations by reading their sound, gestures, facial expressions and body language. 
• Give directions using as few, simple words as possible and in complete sentences. 
• Talk about what you or the child is doing as you do it. 
• Use everyday activities such as singing songs, reading books and dramatic play to encourage language development. 
• Encourage the child to talk about what she or he is doing by asking specific questions. 
• Repeat what the child says and add missing words, or ask the child to repeat what you are saying. 
• Expand the child’s language skills—build on what the child says by adding new information. 
• Praise the child’s efforts at communicating even if he or she doesn’t do it exactly right. 

Visual disabilities 

• Use lots of communication during activities such as dressing and eating to help the child orient to the activity. 
• Think about the physical space of the room: be wary of sharp edges on tables, curled up edges of rugs and other potential hazards. 
• Once you’ve found an arrangement of furniture that works for the room, try not to change it too much as the child may rely on furniture to help navigate the room. 
• Give specific directions and use descriptive language. 
• Call children by their names. Address them directly, not through someone else (“Juan, do you want some banana?” not “Do you think Juan wants some banana?”). 
• Avoid glaring lights. Increase or decrease the room lights gradually and try not to change the light suddenly. 
• Display simple, clear, uncluttered pictures that are easy to see. 
• Avoid standing with your back to windows: the glare may make you look like a silhouette. 
• Encourage hands-on and sensory experiences such as touching, holding, exploring, tasting, smelling and manipulating. 
• Ask first if the child needs assistance—try not to assume you should help. 

Physical/neurological issues 

• Work closely with other agencies and personnel who provide specialized services such as early interventionists and therapists. 
• Consider the physical space: are there any obstacles that prevent the child from moving safely in the area? Are the pathways wide enough to accommodate special equipment such as walkers or wheelchairs? 
• Know the child’s strengths and needs so that independence is realistically encouraged and supported. 
• Assist the child with activities she or he may not be able to do alone, such as kicking a ball. 
• Ask any therapists involved with the child to show you proper positioning techniques and how to use and care for any special equipment. 
• If you are having difficulty with positioning, feeding, etc., consult with the child’s parents or guardians for suggestions they have found helpful at home. 
• Give all staff opportunities to hold and position the child to ensure everyone is comfortable. 
• Help other children understand why “Lauren can’t walk” and emphasize what Lauren can do. 
• Try to experience the disability yourself so that you can better understand the child’s perspective. 
• Ensure that the child’s positioning is similar to what other children in the class are doing whenever possible(such as floor time). 
• If the child is unable to use playground equipment, schedule some other outdoor activities that the child can participate in such as blowing bubbles, flying kites, etc. 

Deaf or hard of hearing children 

• Find out from the parents/guardians the degree of the child’s hearing loss and what that means for the child. 
• Ask the child’s parent or guardian how to use and care for the hearing aid or other special equipment. 
• Support the child socially. 
• Be sure you have the child’s attention before giving instructions. 
• Speak in full sentences, at normal speed, to the child’s face—and smile. 
• Use visual cues such as pictures or gestures as you talk. 
• Encourage the child to let you know when he or she doesn’t understand by using a special signal. 
• If the child doesn’t understand at first, rephrase your comment rather than repeating it. 
• If the child uses sign language, learn some simple sign language symbols. 
• Provide opportunities for the child to talk. 

Social/emotional/behavioral issues 

• Try not to change activities abruptly. Warn the child of any changes in schedule ahead of time. 
• Provide routine and structure for the child. Use cues such as timers, bells and lights. 
• Allow the child time to practice new activities away from the group or allow withdrawn children to watch new activities first. 
• Seat the child close to you. Give occasional physical and verbal reassurances and encouragement. 
• Let the child bring a familiar object when entering new situations or beginning a new activity. 
• Help the child make choices by limiting the number of choices available. 
• Allow the child to have a safe emotional outlet for anger, fear or frustration. 

Techniques for managing behavior 

• Ignore negative behavior when you can. 
• Notice and praise positive behavior as much as possible. Focus on what the child can do and accentuate the positive. 
• Acknowledge the child’s feelings. 
• Children follow your example: model the kind of behavior you want to see in them. 
• Prevent problems when possible by considering how the schedule, structure and physical space support your goals for children. 
• Help children to talk about, act out and understand their strong feelings and behaviors. 
• Follow through with realistic consequences. 
• Be aware of what behaviors are your “hot buttons” and work with other staff to make sure you have the support you need. Seek additional help if the behavior persists or you feel the need for support. 
• Give children reasonable choices. 
• Provide developmentally appropriate activities in a safe, nurturing environment. 
• Give the child enough time to comply with your request. 
• Develop a plan for how you will handle difficult behavior the next time. 
• Try to be consistent with the way the child’s family and culture handles behavioral issues and their social and emotional goals for the child. 
• Remember to have fun with the children! 

Resources 

Donoghue, E.A. and Kraft, C.A. (Editors), Managing Chronic Health Needs in Child Care and Schools, Second Edition. Alkon A and Rose R (Contributors), American Academy of Pediatrics, Elk Grove, IL., 2018