Successful coordination starts with parents who do their homework and apprise a caregiver of the child's needs before that child sets foot in the care-giving environment. But you also need to observe if a child care program has proper support to help your child keep his asthma under control and to make the transition from home as seamless, safe, and healthy as possible for your child.

The Asthma-Friendly Checklist

A good place to start is by inquiring what a child care program already has in place. The National Heart, Lung, and Blood Institute of the National Institutes of Health has developed a checklist with targeted questions that you can use to determine how prepared a child care setting is to assist the asthmatic child. They include:

• Is a medical or nursing consultant available to help child care staff write policy and guidelines for managing medications in the child care setting, reducing allergens and irritants, promoting safe physical activities, and planning field trips or outside activities for children with asthma?

• Have child care staffers been instructed on how to give medications prescribed by each child's health care provider and authorized by each child's parent?

• Is someone available to supervise an older child while taking asthma medicines and to monitor correct inhaler use?

• Do you have written emergency plans prepared for each child in case of a severe asthma episode? And, does the plan make clear what action to take, whom should be called, and when to call?

• Does a nurse, respiratory therapist, or other knowledgeable person teach child care staff about asthma, asthma action plans, reducing allergens and irritants, and asthma medicines?

• Is someone available to teach the child's classmates about asthma and how to help a classmate who has asthma?

• Does the child care provider help children with asthma participate safely in physical activities?

If an answer to any of the checklist questions is “no,” you need to realize that the child with asthma in the child care setting could face barriers that may impact a child's attendance and participation in the program.

Provider Special Care Plan

You should ask the child care program if they use a written special care plan that the program — and the child's health care provider — will have on file for a child with asthma. This care plan can list the usual information such as your phone numbers, and your primary care provider's and asthma specialist's numbers. But it also should list day-to-day points that providers can evaluate when taking care of the child such as:

• Known triggers for your child's asthma, such as colds, mold, exercise, strong odors, animals, or weather changes.

• Outdoor activities for which your child may need special attention, such as running hard, going outside on cold or windy days, jumping in leaves, or playing near freshly cut grass.

• Indoor activities for which your child may need special attention such as sitting on rugs or carpets, being exposed to chalk dust or glues, or providing pet care.

• Typical signs and symptoms of your child's asthma episodes such as fatigue, wheezing, quicker breathing, panting, or difficulty with playing, eating, or drinking.

• Recording of peak flow meter results by your child (if old enough).

• Information on how often the child has needed urgent care from a health care provider for an asthma attack in the past three months and past twelve months.

• Medications for routine and emergency treatment of asthma.

A sample of a special care plan form that can be used by child care providers may be viewed at the National Resource Center for Health and Safety in Child Care Web site at nrc.uchsc.edu.