The guide and process for medication administration in a child care setting

The Guide and Process for Medication Administration in a Child Care Setting
Before assuming the responsibility for the administration of medication, child care providers
must have clear and accurate information, clear instruction and when necessary, medical
confirmation regarding the child’s need to know that all medications – including over the counter
(OTC) medications – are powerful and must be administered safely.
It is the department’s intent to help supply that information through the content of this pamphlet.
Medicine as defined in MCA 37-7-101 means a remedial agent that has the property of curing,
preventing, treating, or mitigating diseases or which is used for this purpose.
Day care providers must have written consent from a parent or legal guardian prior to
administering medicine to a child in their care. As a provider you want to do what is best for the
child and you may tend to want to give the child something to make them feel better. However,
after looking at the definition of medicine most things a provider would give to a child such as
Tylenol can no longer be given unless there is written consent.
PRESCRIPTION MEDICATIONS
Must be ordered by a doctor. If the child needs a prescription medication, it is very important
that you understand the pediatrician’s and pharmacist’s instructions.
Antibiotics
Used for bacterial infections like strep throat, some types of ear infections, some sinus infections,
urinary tract infections and some skin infections. Antibiotics are very safe but can have some
side effects including skin rash, loose stools, stomach upset, staining of urine or even mild to
severe allergic reactions. If any of these symptoms occur be sure to tell the parent so they may
discuss with their pediatrician.
Antibiotics (such as penicillin, amoxicillin, sulfas and many others) should be used only for the
specific bacterial infections for which they are prescribed. Viral infections like colds and flu are
not treated with antibiotics. New strains of bacteria have become resistant to some antibiotics
because antibiotics have been overused. When a child is sick, antibiotics are not always the
answer. The child’s pediatrician will let the parent know if an antibiotic would help their child.
Ear Drops (otic)
Commonly used for inflammation and infections of the ear canal. They may cause side effects
such as itching, a sense of canal fullness or “popping.”
Eye Drops or Ointment (ophthalmic)
Commonly used for eye infections (such as “pink eye”), allergies or vision problems. Some
children may get puffy eyes from using these medications and complain of “stinging” when the
drops are applied.
Skin Preparations
Often prescribed for skin infections, burns, parasites/mites (such as lice and scabies), rashes and
acne. When used as prescribed, these products are generally save; however, they can cause
irritation of the skin. If applied for too long a period, skin preparations that contain steroids may
cause serious side effects, so it is important to know the length of time these products should be
used. Use medications for lice and scabies only as prescribed or recommended by a health care
provider to avoid toxic side effects.

Antipyretics/Analgesics
Antipyretics are used to relieve fever and Analgesics are used to relieve pain. Analgesics can
have many side effects, including stomach upset, ringing in the ears, dizziness, irritability,
nervousness and allergic reactions. Because young children cannot always tell you if they are
feeling these symptoms, tell the parent if their child behaves abnormally after taking these
medications.
Fever Reducer or Pain Reliever (ie, acetaminophen, ibuprofen)
If a child has a mild fever but is playing, drinking fluids and generally acting well, there is no
reason to treat the fever. However, if the child complains of headaches, body aches or seems
irritable, there are fever reducers such as acetaminophen and ibuprofen that may help him/her
feel better. Acetaminophen and ibuprofen also can help relieve minor pain from bangs and
bumps, or tenderness from an immunization. Given in the correct dosage, acetaminophen and
ibuprofen have few side effects and are quite safe. They come in drops for infants, liquid
(“elixir”) for toddlers, and chewable tablets for older children.
Remember the infant drops are stronger than the liquid elixir for toddlers. Some parents make
the mistake of giving higher doses of the infant drops to a toddler thinking the drops are not as
strong. Ibuprofen tends to be more effective than acetaminophen in treating high fevers (103
degrees Fahrenheit or higher). However, ibuprofen should only be given to children older than 6
months. Never give it to a child who is dehydrated or vomiting continuously. If the child has a
kidney disease, asthma, an ulcer or other chronic illness, the parent should ask their pediatrician
if it is safe for their child to take ibuprofen.
Do not use ibuprofen or acetaminophen with any other pain reliever or fever reducer, unless
directed by a doctor. Remember, some cold remedies contain these in combination with other
medications.
Inhalers
These are used to treat asthma and other lung conditions. Inhalers should be used with a
“spacer” so that more of the medicine gets into the lungs. Make sure the parent tells you how to
use inhalers the right way.
Nasal Sprays or Nasal Inhalers
Typically used to treat allergies. It is important to use these and all medications only as directed.
OVER-THE-COUNTER MEDICATIONS (OTC)
Over-the-counter (OTC) medications can be bought at your local drug store or grocery store
without a doctor’s order, although it is recommended parents should check with their doctor
before giving any OTC to their child. This does not mean that OTCs are harmless. OTCs are
medicines used to treat or lessen the symptom of an illness, not to cure, prevent or treat the cause
of the illness. Like prescription medications, OTCs can be very dangerous to a child if taken
incorrectly. The provider needs to read and understand the instructions before giving OTCs to a
child.
Common OTCs for Children
The following list describes some common OTCs for children. The parent needs to talk to their
pediatrician before giving any medications to their child. Like any other medication, the parent
needs to give the provider written authorization before giving the OTC.
Antihistamines
Antihistamines (such as Claritin, Benadryl, Chlortrimeton) can relieve runny noses, itchy eyes
and sneezing due to allergies (but not colds). They also relieve itching from chickenpox or
insect bites and may even control hives or other allergic reactions. Some types can make
children sleepy. In other children they may cause irritability and nervousness, making it difficult
for them to rest. For that reason, antihistamines should not be give before a child sleeps.
Decongestants
Decongestants (such as Pseudophedrine) can relieve stuffiness due to allergies or colds.
However, decongestants taken by mouth can have a number of side effects. Children taking
these medications may act “hyper,” feel anxious, have a racing hear or find it difficult to sleep.
These medications should be used very sparingly.
Nose Drops (decongestant)
Decongestant nose drops can temporarily shrink the membranes in the nose and make breathing
easier. However, they should never be given to an infant because too much of the medication
can be absorbed through the membranes of the nose. Also, the more they are used, the less
effective they become and symptoms can return or even get worse. Do not give a child
decongestant nose drops for more than two to three days unless pediatrician advises to continue
this treatment.
Nose Drops (saltwater/saline)
Infants and toddlers cannot blow their nose. If a child is sleeping well and eating happily, there
is no need to treat the stuffy nose. But if the child is unable to sleep or eat because of thick
mucus, saltwater nose can help clear the nose. Put a drop or two into a nostril at a time. Using a
bulb syringe, squeeze the bulb first, put the tip gently in the child’s nostril, then let go. This will
suction out the drops, along with the mucus. Be careful, overuse of a bulb syringe can be
irritating to a child’s nose.
Cough Syrups
Coughing helps the lungs clear out germs. A cough is “productive” if it sounds like mucus is
being brought up. You can best relieve it by humidifying the air in the room to loosen mucus.
Be sure to clean the humidifier frequently to prevent mold and bacteria buildup. Some cough
medicines, called expectorants, also may help loosen mucus.
Cold Remedies
Combinations of antihistamines and decongestants can have side effects such as hyperactivity,
sleeplessness and irritability. Giving a child more than one cold medicine to treat different
symptoms can be dangerous. Many cold medicines contain acetaminophen or ibuprofen in
addition to the cold medicine, this can lead to overdose. Read labels carefully. Have the parent
check with their pediatrician before giving their child any cold medicines.
Mild Cortisone Cream
Insect bites, mild skin rashes, poison ivy or small patches of eczema usually respond to cortisone
cream. Never use it for chickenpox, burns, infections, open wounds or broken skin. If a product
is requested for extended use, the parent should get a medical statement.
Medications Used for Common Gastrointestinal Problems
There are many OTCs for heartburn, gas, constipation and diarrhea. Most of these conditions
usually go away by themselves or are relieved by a temporary change in diet. Before
administering any medicine for constipation or diarrhea, parent need to talk with their
pediatrician and a recommendation from the pediatrician should be made. Repeated bouts of
diarrhea or chronic constipation can be caused by serious underlying problems.
Common over the counter medications used in day care facilities:
9 Diaper Rash Cream Ointments
9 Insect Repellent
9 Sunscreen
9 Cortisone/Anti-Itch Creams/Ointments
9 Medicated Lip Treatments
9 OTC Antibiotic Creams/Ointments
9 Teething Tablets/Ointments
9 Burn Creams/Sprays

These medications must be brought to the facility by the parent in the original container with a
legible label, expiration date of the medication and the child’s name on the container.
Liquid Medicines
Many children’s medicines come in liquid form because they are easier to swallow than pills.
But they must be used correctly. Too often the directions are misread, giving children several
times the recommended dosage. This can be very dangerous, especially if given over a period of
several days. Read the instructions carefully. When giving a child liquid medication, do not use
standard tableware tablespoons and teaspoons because they are usually not accurate. Instead, use
one of the measuring devices listed below (many children’s medications come with one and it is
best to use the device which accompanies the product). These can help you give the right
amount of medicine to the child.
Syringes and oral droppers
These can be very helpful when giving medicine to an infant. Simply squirt the medicine
between the child’s tongue and the side of her/her mouth. This makes it easier for
him/her to swallow. Avoid squirting the medicine into the back of the child’s throat,
he/she is more likely to gag and spit the medicine out. If you have a syringe that has a
plastic cap, throw the cap into the trash so that it does not fall off in the child’s mouth
causing a choking hazard. The syringe does not need to be recapped.
Dosing spoons
These can be useful for older children who will open their mouths and “drink” from the
spoon.
Medicine cups
These often come as caps on liquid cold and flu medicines.

THREE TYPES OF UNDESIRED RESULTS OF MEDICATION
Medications are powerful. They can work together or against each other. Some drugs increase
the effect of other drugs; others can decrease or negate the effects of another drug. Some drugs
work faster when taken with food, other drugs work slower. Some drugs should not be taken
with certain foods. Medications can produce both desired and undesired results. The desired
result is the reason for which the drug was prescribed.
Side effects are natural, expected and predictable actions of the drug that may occur at
the same time as the desired effect. Most side effects are minor. The following are
common side effects of medication: dry mouth, diarrhea, drowsiness, dizziness, sweating,
rashes, nausea, rapid heartbeat.
Adverse reactions are unexpected and potentially harmful. Examples include: double
vision, vomiting, and liver damage. If an adverse reaction is observed, the parent and the
child’s health care provider (person who prescribed or recommended the medication)
should be notified immediately. They may want to examine the child, change the dosage,
or stop the medication.
Allergic reactions are difficult to predict. Allergic reactions may involve many different
types of symptoms. Skin disturbances such as itching, rashes or swelling, are the most
common. If an allergic reaction is observed, notify the parent immediately and request
follow-up with the health care provider. The most dangerous type of allergic reaction is
anaphylaxis. CALL 911

Administering Medicines Safely
You can help prevent overdose or poisoning by following these tips:
9 Always use good light. Giving medicine in the dark increases the risk that you will give the wrong medicine or the wrong dose. 9 Read the parent or doctor’s instructions before you open the bottle, after you remove a dose and again before you give it. This routine can ensure the child’s safety. 9 Always use child-resistant caps and lock all medications away from children. 9 Give the correct dose. Children are not just small adults. Never guess on how much 9 Never play doctor. Do not increase the dose just because the child seems sicker than 9 Always follow the weight and age recommendations on the label. If it says not to
give it to children younger than age 2, don’t.
9 Do not confuse the abbreviations for tablespoon (TBSP or T) and teaspoon (tsp or t). 9 Avoid making conversions. If the label calls for 2 teaspoons and you have a dosing cup labeled only with ounces, do not use it. 9 Supervise the children if they are old enough to take medicine by themselves. Never let young children take medicine by themselves. 9 Before using any medication, always check for signs of tampering. Do not use any medicine form a package that shows cuts, tears, or other imperfections.
It is not always easy to give medicine to a child. You may find the infant or toddler hates the
taste and spits out the medicine or refuses to swallow it. Do not mix medications into a bottle or
any food. The child may only eat part of it or it may settle to the bottom and never get into
his/her mouth. Older children may be more willing to take a chewable tablet over liquid
medicines. Although most children’s medicines are flavored to make them taste better, avoid
calling them candy. It might make the toddler decide to take them on his/her own.
Check the Five Rights before administering medication:
9 Right Child
9 Right Medication
9 Right Dosage
9 Right Time
9 Right Route
Medication Routes
9 Oral: tables, capsules, sprinkles, liquids, syrups/elixirs
9 Inhalants: nasal/oral sprays or medicated steam
9 Topical: eye drops/ointments, ear drops, skin ointments/patches
9 Injectable: specific instruction and demonstration for a specific child must be
provided by the child’s parent and/or health care provider AND must be
accompanied by a Special Health Care Plan.

Storing Medication
Make sure to store medication properly. Store only in a locked box or cabinet to be accessed
only by the person/persons designated to give medicine. If the medication needs to be
refrigerated keep it away from food. The refrigerator should be at 36 to 46 degrees F.
Disposing of Medication
If medicine is left over return to parent for disposal. If you must dispose of the medicine do not
throw in the trash. Either flush it down the toilet or rinse it down the sink.
For more information in regards to Medications: American Academy of Pediatrics Your local County Health Department Department of Health and Human Services Public Health & Safety For questions in regards to policy and procedure in a daycare facility contact: Stephanie Goetz For questions in regards to policy and procedure in a Legally Unregistered Provider (LUP/LUI) setting contact: Early Childhood Services Bureau 406-444-9120 Most of the information contained in this document was obtained from the American Academy of Pediatrics.

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