hands holding a diabetes awareness ribbon (blue)

Managing Diabetes in Child Care Programs

Diabetes and the Americans with Disabilities Act (ADA)

The ADA is a federal law that protects people with disabilities. The law requires child care programs to care for children with disabilities unless it will create an undue hardship for the provider or a threat to the child.  Children with diabetes are protected by the ADA. A child with diabetes needs special care in child care programs. With careful planning, you can safely care for a child with diabetes.

Incidental Medical Services (IMS) in Licensed Child Care Programs

Child care providers can perform IMS in licensed child care programs in California, including:

  • Testing blood glucose (sugar)
  • Giving insulin
  • Giving glucagon for very low blood sugar (in an emergency)

Provider information notice PIN 22-02-CCP describes what needs to be in place to safely give IMS in licensed Family Child Care Homes (FCCHs) and Child Care Centers (CCC).

Your Program’s IMS Plan

Your IMS Plan describes the kinds IMS you are prepared to give and the steps you will take to do it safely. Your IMS plan is part of your plan of operation.  It needs to be kept up-to-date and submitted to your Regional Licensing Office.  It also needs to be available for staff to read.

When you enroll a child with diabetes in your program, update your IMS Plan to include children with diabetes. This update will list all of the details about how you will keep children with diabetes healthy and safe in your program. Include:

The forms you will use, such as:

How you will store medicines and supplies out of children’s reach. Include how you:

  • Receive
  • Store
  • Return unused and expired medicine

Your staffing plans:

  • One or more trained staff members must be present when a child with diabetes is in care, even on field trips.
  • Find out what kind of training is needed. Ask the child’s health care provider.
  • Keep proof of training on-site.
  • Provide training for new and substitute staff who provide care for a child with diabetes.

Your hygiene and sanitation practices:

  • Use standard precautions when you may have contact with blood: wear gloves, clean and disinfect surfaces, wash hands, dispose of items soiled with blood properly.
  • Store needles and other hazardous waste in special “sharps” containers.
  • Dispose of “sharps” containers according to local hazardous disposal rules.

The records you will keep:

Keep a record of when a staff member gives insulin, tests blood sugar, or notices unusual signs or symptoms.
Share the records with the child’s family.

What to do in an emergency:

Work with the child’s family and health care provider to identify the child’s emergency signs and symptoms and what to do in an emergency. Watch for general signs and symptoms of low blood sugar: sweating, chills, clamminess, dizziness, confusion, blurred vision, weakness, nervousness, hunger, nausea, anger, or irritability. Refer to the child’s special health care plan for what to do when a child has low blood sugar, for example: give the child frosting, candy, juice etc. and/or give emergency glucagon.

Immediately after giving glucagon in an emergency:

  • Call 9-1-1.
  • Notify the family.
  • Fill out an Unusual Incident/Injury Report (LIC 624 for CCCs, LIC 624B for FCCHs). Submit the completed form to your Regional Child Care Licensing Office.
Your Disaster Plan

Update your Disaster Plan. Include how children with diabetes will be cared for, even during an emergency. Make plans to take medication and supplies with you in case of evacuation.

The Child’s Special Health Care Plan

You will also need to develop a special health care plan for a child with diabetes. Work with the family and their health care provider to develop a special health care plan.  Having a detailed plan will help you keep a child with diabetes healthy and safe.

The special health care plan describes the specific needs of a child with diabetes. Work with the child’s family to create a care plan. Include:

•    A statement from the child’s health care provider with the kind of care the child needs and the kind of training child care staff need
•    Written parent consent for each staff member trained to give the care needed
•    The supplies you will need
•    When and how to test blood sugar and target blood sugar levels
•    The plan for giving insulin including who is trained to give insulin
•    The child’s meal and snack times
•    The child’s symptoms of high blood sugar and low blood sugar
•    What to do in an emergency
•    If staff need to be trained to give glucagon in an emergency
•    When and how to contact the child’s family
•    When and how to contact the child’s health care provider

More information:

Diabetes in the Child Care Setting

Call American Diabetes Association 1-800- DIABETES (1-800-342-2383) or email [email protected].

February 2023, UCSF California Childcare Health Program