Health and Illness Care

National Quality Standard (NQS) Quality Area 2 – Children's Health and Safety covers several specific areas related to this topic:

• Element 2.1.2 - ‘Health practices and procedures’ requires that ‘effective illness and injury management and hygiene practices are promoted and implemented’.
• Element 2.2.2 - ‘Incident and emergency management’ requires that ‘plans to effectively manage incidents and emergencies are developed in consultation with relevant authorities, practised and implemented’.

The Education and Care Services National Regulations 2011 are highly relevant to this topic, particularly the following regulations:

• Regulation 85 Incident, injury, trauma and illness policies and procedures
• Regulation 86 Notification to parents of incident, injury, trauma and illness
• Regulation 87 Incident, injury, trauma and illness record
• Regulation 88 Infectious diseases
• Regulation 89 First aid kits
• Regulation 90 Medical conditions policy
• Regulation 91 Medical conditions policy to be provided to parents
• Regulation 92 Medication record
• Regulation 93 Administration of medication
• Regulation 94 Exception to authorisation requirement—anaphylaxis or asthma emergency
• Regulation 95 Procedure for administration of medication
• Regulation 96 Self-administration of medication

This section outlines the health information and data that is required by the Education and Care Services National Law Act 2010 (Cth) and the Education and Care Services National Regulations to be collected from families for each child on enrolment and before they commence care into the service, and when this information changes during the child’s care within the service.

Purpose of collecting children’s health and medical records

Maintaining accurate health records is essential to providing quality care and protecting the health and safety of children who attend the service. It provides the service with relevant information about each child’s medical history and current level of health and professional medical advice on how best to care and provide for the health needs of each individual child.

This information helps you:

• Identify preventative health needs such as immunization or dental care
• Prepare a special care plan for children with chronic health issues or special needs such as asthma
• Determine whether or not to exclude a child from activities for health reasons

Privacy and confidentiality

A service has an obligation to ensure any medical information or health data collected from families is received, implemented and stored with the highest level of privacy and confidentiality.

Health information and records should be shared only with employees and educators that are responsible for providing care to the child.

Outside of sharing information to meet the child’s care and health needs, information should not be shared or spoken about with others. This includes other employees, families, friends, community groups or visitors in or out of the service.

Health information and data, including enrolment records, must be kept in safe storage. This will commonly be in a personal file in a locked filing cabinet, with a key under the supervision of the management team in the office area.

Where appropriate, medical information related to medical action plans, such as for anaphylaxis and allergies, may be displayed in the kitchen, staffroom and the child’s rooms. The display of this information should always be implemented with the consent of the parents/guardians.

Types of health data collected

The National Law and Regulations specify the types of health data that must be collected. The data may be collected in paper format or through online software.

Health data is initially collected through the enrolment form, and the child is unable to commence care with the service until the required information has been supplied. This is to ensure the service has all the relevant information in order to prepare and provide high-quality care for the child.

Use the checklist to read the specific types of health data that should be collected. The Education and Care Services National Regulations (specifically Regulation 162 – Health information to be kept in enrolment record) specify the exact health data that must be collected about a child from the family.

General health information that must be collected includes:

• The child’s name, address and date of birth
• The child’s current general practitioner (GP) and other medical practitioner information
• Any current medical conditions, such as allergies
• Any medical management plans in place for the child
• Immunisations records outlining the child’s status
• Authorisation to administer medical care and medication
• Authorisation to call an ambulance and transport the child to hospital.

Collecting immunisation information

Immunisation information is a key part of a child's health record, and in early childhood services, this information often requires updating. Having accurate, up-to-date records is critical, and directors are required to seek medical documentation and update children's records every six months or as the child moves through the immunisation requirements.

There are three (3) immunisation schedules in Australia to cover the requirements of all families and children. Access the Department of Health website and review the information for each schedule:

• Immunisation Program Schedule for All Aboriginal and Torres Strait Islander People: ACT, NSW, Tas, VIC and for NT, QLD, SA and WA
• National Immunisation Program Schedule.

From two months to four years of age, children go through up to six immunisation periods. The national immunisation schedule for children is for all nonindigenous people.

Keeping records current

While it is a parent’s and family’s responsibility to provide any changes or updates to their child’s health information, early childhood services need to proactively help.

You can do this by:

• Communicating frequently with parents to stay updated on a child’s health, and make every effort to ensure records are maintained with up-to-date information
• Working proactively with other educators to ensure the sharing of a child’s health information
• Ensuring lines of communication are strong between all the critical caregivers in a child’s life.

Check your understanding

Knowing what to look for and how to swiftly respond to illness and injury in children helps to care for the child, and keep them and those around them safe. The content in this section assumes that educators have a current first-aid certificate. Your first-aid manual is an excellent resource for learning appropriate first-aid practices and techniques.

Short and long-term medical conditions

In a service educators will commonly need to identify, respond to and manage children’s medical needs and illnesses. This is a daily practice, and educators need to be confident in their understanding of the child’s short term medical needs and long-term medical conditions. Common signs and symptoms of an illness can be present in both short-term illness and long-term medical conditions.

Short-term medical needs

Short-term medical needs relate to illness that usually lasts between one and seven days. This kind of illness can typically be treated with general home care, such as rest, hydration and medication.

Short-term illness in an early childhood service may include:

• Cold- or flu-like symptoms
• Stomach upsets
• Conjunctivitis
• Headaches.

Long-term medical conditions

Long-term medical conditions refer to medical conditions that have been diagnosed by a medical professional and that last over six months.

Long-term medical conditions in an early childhood service may include:

• Asthma
• Anaphylaxis
• Allergies
• Diabetes
• Epilepsy
• Eczema.

Personal protective equipment

When responding to short-term illness, long-term medical conditions, or injury, you must always protect yourself from harm by using the appropriate personal protective equipment (PPE).

PPE, such as gloves, should be available at all times in the room and also in the outdoor area. Staff are encouraged to put on gloves before administering first aid or caring for an unwell child. A first-aid kit should be available in each room or in a bathroom that is shared by more than one room.

Each room should always have plastic bags available, such as bin bags or large-sized nappy bags, for bloody clothes, and educators should use gloves to remove bloodied clothing and place it in the plastic bag. The bag should then have the child’s name put on it and be given to the family on departure.

Other forms of PPE include:

• Closed-toe shoes
• Clothing covering your shoulders
• Sunglasses
• Sun hat
• Apron
• Hair net.

Identifying and responding to illness

A child may present a variety of signs and symptoms when feeling unwell. These signs and symptoms may be common for either or both short-term illness and long term medical conditions.

Early childhood educators want the best for each child in their care. When a child is unwell, it is vital we ensure they receive care as well as implement practices to ensure we reduce the risk of spreading the illness to other children, staff and families.

Most services have limited ability to care for unwell children and need to be confident to identify, respond to, manage and exclude children where required for the safety of all children and staff.

Health check

Educators should ensure they do a health check of each child when children arrive at the service. This should be done in a subtle manner and without the family and child being aware.

When conducting a health check on a child’s arrival, consider the following:

If you do note any health concerns when a child arrives at the service, you should communicate these concerns with the parent. There may be additional reasons or circumstances for the signs and symptoms. For example, a child may look lethargic and pale due to lack of sleep.

Each educator will need to be guided by the legal requirements and service policies to conclude if the child is well enough to be accepted into the service on that day.

Assessing a child’s wellness

Once a child is in your care, you can still use the health check to monitor the health needs of the child. However, educators will also need to ensure they can respond to a child when they determine a child is unwell.

Common illnesses you need to be able to recognise:

• Temperature
• Vomiting
• Diarrhea
• Rash
• Conjunctivitis
• Head lice
• Common cold
• Hand, foot and mouth
• Chickenpox
• COVID-19

The following table details the signs and symptoms of each of these common illnesses, the exclusion periods and the care you should provide:

Other common indicators of illness:

Responding to signs and symptoms of illness

If you suspect a child may be ill, follow these steps:

While caring for the child, remember the following guidelines to minimise infection spread:

• Remind the child to cough or sneeze into their elbow. Wash their hands if they have coughed or sneezed into their hands.
• If you wipe their nose, dispose of the tissue and wash your hands.
• Wash your hands and have the child wash theirs before touching other children.

Taking a temperature

High temperatures can be associated with many signs, symptoms and illnesses. Many children will have mild, low-grade temperatures as a result of vaccinations or teething. While a temperature alone is not a clear indicator of a child being sick, monitoring the temperature of a child who appears unwell or hot is important.

Steps to take a temperature:

1. Wash your hands thoroughly.
2. Use a protective cover for the thermometer if available.
3. Clean and reset the thermometer.
4. If taking a temperature orally, make sure that the child has not had anything hot or cold to eat or drink in the previous 10 minutes.
5. Place the thermometer under the arm, tongue or in the ear, depending on the type of thermometer.
6. Leave in place until it beeps, for up to one minute.
7. Record the temperature, time and method.

Care and hygiene

When caring for an unwell child, always remember to wash your hands and have the child wash theirs thoroughly. Ensure any areas the unwell child has been using, or that may be affected by body fluids, discharge or germs, are cleaned and disinfected to keep yourself and the children safe.

You should wash your and a child’s hands for 20 seconds to ensure good hygiene. You can time 20 seconds by singing the song ‘Happy Birthday’!

WATCH

Watch the following 2-minute video on singing ‘Happy Birthday’ with children when washing their hands:

Identifying and responding to injury

Children, particularly toddlers and children just learning to be mobile, are prone to falling, bumping and bruising. It is also hard for them to describe exactly what happened when an injury happens. This means it is important to be constantly supervising children and providing a safe space for them. However, even with the best supervision, injury is possible—it takes only a few seconds for a child to trip and bump their head or scrape their hands.

When responding to injuries, you may be presented with the following:

• Blood
• Scratches and cuts
• Burns
• Breaks and fractures
• Grazes
• Sprains
• Swelling
• Lumps and bruises

It is advised that educators refer to their first-aid training when deciding how best to respond and manage a child’s injury.

The foundations of First Aid

• Protect yourself. First, ensure you and the other children are not in danger. You cannot help a child if you are not safe. This means removing yourself and others from danger, and using PPE to protect yourself against bodily fluids.
• Assess the child’s needs. Assess the child’s needs and injuries, and action first aid.
• Call for help. If required, call Triple Zero (000), and also ask for assistance from other staff—this could include asking them to remove other children from the area.
• Prioritise injuries. If more than one child is injured, prioritise the most wounded and urgent first.
• Document. Document the injury, incident, accident or trauma on the service’s incident report form.

Incidents involving blood

Children can be injured in a manner that causes bleeding. Common bleeding injuries we see in the early childhood setting are nosebleeds, bites from other children, falls, scrapes and cuts. It is important to treat the child and be diligent in cleaning up the blood and protecting other children from coming into contact with the blood.

In the event of a bleeding injury, follow these guidelines:

• Look after the child. Comfort the child and move them to safety. Avoid contact with the blood—put on gloves if possible. Apply pressure and elevate the wound. Reach out for assistance if needed.
• Dress the wound. Dress the wound with a suitable bandage. Call Triple Zero (000) if the situation is urgent. Remember to remove your gloves and wash your hands after dressing the wound.
• Clean the blood spill. The most effective way to clean small and large blood spills is with warm water and detergent. Large spills will require an absorbing agent or scrapper and may also require disinfection with diluted bleach.

Cleaning up faeces, vomit, urine

• Wear gloves.
• Cover the spill with paper towel and let the spill soak in. Put paper towel in plastic bag.
• Clean the surface with warm water and detergent—let it dry.
• Wash hands thoroughly.

  Example

  View this example illness and accident form approved by ACECQA.

Documentation

In the case of illness, and injury or incident, documentation of the event is critical. When an injury occurs, the staff member who saw the incident or noticed the injury would be the one to complete an incident, injury, trauma and illness record. A witness will also need to sign the form to confirm the details of the form. A witness, which is anyone else who saw the injury or incident, or was in the room at the time (typically another educator), should sign the form. All incident, injury, trauma and illness records must be signed by the director and the affected child’s parent.

When an illness is identified, the person who noted the illness needs to complete the form in relation to the signs and symptoms, and the continuous care and monitoring that has taken place. This form will need to be completed and then signed by a witness.

Click here to access (and download if you wish) the completed pdf form.

Teaching children about sun safety

It is vital that we use approved practices to protect children from overexposure to the sun. It is also important that we educate children on the how best they can protect themselves and develop agency in this area.

This can be done by:

• Familiarising the children with the UV widget and asking them to check it before going outside
• Setting up a sunscreen-and-hats station with a mirror so children can learn to apply their own sunscreen and protective gear
• Reading stories and singing songs that encourage protection learning
• Collaborating with the children about their sun protection
• Embedding educator-led play to teach the children the cause and effects of sun damage and how to protect themselves
• Encouraging the children to use sunscreen in play, such as putting it on dolls
• Having posters and visuals around the room and door to the outside as reminders.

You can monitor the UV rays throughout the day by using the SunSmart widget, which provides real-time updates about the UV level and protection required throughout the day—you can download the widget at this link.

Medication

Accepting medication

Medications may be purchased off the shelf from pharmacies or be prescribed by a doctor.

Medications purchased off the shelf need to be brought to the service in their original packaging, with full instructions and details, and the child’s full name on the medication.

Prescription medication has to come in its original packaging and must have a label printed by the pharmacy with the doctor’s name, child’s name, and instructions.

Educators are responsible for reading the instructions and ensuring they administer medication only in relevance to the instructions. Medication can only be administered if it is authorised by a registered medical practitioner and/or a parent. Whenever is possible, another educator should check the dosage of the medication to be administered and the identify of the child to whom the medication is to be administered.

When a family member or parent brings in medication, they must have a discussion with the educator about their child’s symptoms and the reason for the medication. The symptoms must be in line with the information on the package.

The parent will need to update their section of the medication record, and an educator should place the medication in a fridge or locked in a high cupboard, out of reach of children.

Administering medication

When children require administration of medication in an early childhood setting, educators need to ensure compliance with the Education and Care Services National Regulations. Medication is addressed in regulation:

• Regulation 92 – Medication record
• Regulation 93 – Administration of medication
• Regulation 95 – Procedure for administration of medication

Medication that is commonly administered includes:

• Pain relief
• Cough medicine
• Antibiotics
• Creams and ointments
• Ear and eye drops.

Check your understanding

Many children have long-term medical conditions that are managed but can still require medical treatment and monitoring, and in some cases, emergency medical attention.

It is important to be up to date on the medical history and conditions of the children in your care. Some conditions may be diagnosed at the time of enrolment, and others may develop or be diagnosed while the child is attending your service.

Three (3) common ongoing conditions are anaphylaxis (a life-threatening allergic reaction), asthma and allergies.

Anaphylaxis

Anaphylaxis is a life-threatening reaction that causes the swelling of a person’s throat, restricting the ability to breathe.

Triggers

Common triggers for anaphylaxis are:

• Food
• Insect bites
• Medicines.

Anaphylaxis: What to look for

• Difficult or noisy breathing
• Swelling of tongue
• Swelling or tightness in throat
• Wheezing or persistent cough
• Difficulty talking or hoarse voice
• Persistent dizziness
• Collapsing
• Pale skin and floppiness (young children)

WATCH

Watch the following 1-minute video to see the use of an EpiPen for an anaphylactic reaction:

Treatment

When a child is having an anaphylactic reaction, you need to follow the treatment instructions on the child’s anaphylaxis management action plan.

The steps required will likely be as follows:

1. Remain calm. Remain calm and call for assistance from other educators.
2. Call for assistance. Lay the child down while ensuring someone is calling Triple Zero (000) and accessing the child’s management plan and EpiPen Jr.®
3. Prepare the EpiPen Jr.® Form a fist around the EpiPen and remove the blue safety release.
4. Prepare the child. Hold the child’s leg still and place the orange end against their mid-thigh.
5. Administer the EpiPen Jr.® Push down using the EpiPen and hold it in the thigh for three to four seconds.
6. Monitor responses. Monitor the child for a response—continue following advice of the emergency services.
7. Notify the parents or family. Contact the child’s parents or family to notify them of the anaphylactic reaction.

Administering an EpiPen®

1. Form fist around EpiPen® and pull off blue safety release
2. Hold leg still and place orange end against outer mid-thigh (with or without clothing)

Push down hard until a click is heard or felt and hold in place for 3 seconds. Remove EpiPen®.

The following graphic demonstrates how to properly administer an EpiPen®:

To learn more about anaphylaxis, including triggers, signs and symptoms, risk factors and treatment, visit Better Health Channel.

Asthma

Asthma is a medical condition that affects the respiratory system of a person, narrowing the airways and filling them with mucus. This results in an inability to breathe properly and clearly, and needs interception of medication.

Children may take two forms of medication:

• Prevention
• Reliever.

Triggers

Common triggers of asthma are:

• Colds and flu
• Physical activity
• Weather
• Irritants in the air.

Signs and symptoms

Asthma: What to look for:

• Gasping, wheezing, coughing, rapid and shallow breathing
• Inability to say more than a few words without pausing to breathe
• Tightness in the chest

Treatment

When a child is having an asthma attack, you need to follow the treatment instructions on the child’s asthma management action plan.

The steps that you will be required to carry out are as follows:

1. Check the environment. Check to see if there is something in the environment that is triggering the attack, and move the child away from the trigger. Access the child’s asthma management action plan and medication.
2. Implement the reliever using the 4x4x4 method. Sit the child down on the floor or a chair. Place the medication into the spacer, and place the spacer in the child’s mouth. Dispense one puff of the medication and ask the child to take four slow breaths— repeat this process three more times. Wait and monitor the child for four minutes.
3. Monitor the child and repeat step 2 if necessary. If the child has not improved after the four minutes, implement the 4x4x4 method with the reliever medication again. If after two attempts you see no improvement, call Triple Zero (000).

WATCH

Watch the following 6-minute video to learn more about asthma, its symptoms, triggers and treatment:

To learn more about asthma, including triggers, signs and symptoms, and causes, visit  the National Asthma Council Australia’s website.

Allergies

Allergic conditions are a common health issue affecting children. Allergies can be triggered by a host of indoor and outdoor allergens, and many children have more than one type of allergy. Known allergies should be discussed at enrolment, and educators must be up to date on knowing each child's record and be aware that allergies can change as children are exposed to new things.

Allergies refer to the body’s immune system’s reaction to the presentation of particular food, pollen or substance. Allergens refer to the particular food, pollen or substance that causes the reaction of the immune system.

Intolerance refers to a substance that the body can consume in a particular amount. Once that amount is exceeded, the body will have a reaction.

Signs and symptoms

Allergies: What to look for

• Coughing
• Sneezing
• Itchy eyes
• Runny nose
• Scratchy throat
• Rashes or hives
• Breathing trouble

Responding to an allergic reaction

Always refer to the child’s allergy management plan to ensure you are actioning the correct treatment, which can include:

• Using antihistamines
• Resting and monitoring the child
• Using a cold pack or cool face washer to relieve swelling, redness or itchiness.

Common allergies in children

WATCH

Watch the following 5-minute video to learn more about how to deal with food allergies in an education and care setting:

To learn more about allergies, including what happens during an allergic reaction, what causes a reaction, and signs and symptoms, visit ASCIA’s website.

Management plans

Medical management plans are documents that have been prepared and signed by a doctor that describe symptoms, causes, clear instructions on action and treatment for the child’s specific medical condition, and include the child’s name and a photograph of the child. An example of this is the Australasian Society of Clinical Immunology and Allergy (ASCIA) Action Plan.

Being trained and prepared to handle anaphylaxis, allergies and asthma care is highly important given the often sudden and severe nature of attacks. It is important you ensure your training is up to date and that you know and follow the related policies of your service.

For anaphylaxis, asthma and allergies, the family is required to have a medical action plan approved by a doctor and submitted to the service. These action plans will be displayed in the room the child is currently in, possibly also in the staff room and the kitchen, and need to be updated every 12 months and reviewed by the doctor.

These action management plans will indicate the specific signs and symptoms of the child, and actions to take to provide appropriate medical care for the child.

For more information on asthma care plans and first aid, visit the Asthma Australia website.

Additional common long-term medical conditions

Being trained and prepared to handle anaphylaxis, allergies and asthma care is highly important given the often sudden and severe nature of attacks. It is important you ensure your training is up to date and that you know and follow the related policies of your service.

For anaphylaxis, asthma and allergies, the family is required to have a medical action plan approved by a doctor and submitted to the service. These action plans will be displayed in the room the child is currently in, possibly also in the staff room and the kitchen, and need to be updated every 12 months and reviewed by the doctor.

These action management plans will indicate the specific signs and symptoms of the child, and actions to take to provide appropriate medical care for the child.

Click here to see the completed form and to check the correct answer 

According to Panadol's official website, the mother administered the right dosage of Panadol: children of 1-2 years should receive 1.5-1.8 mL of liquid Panadol. It can be repeated 4-6 hourly if required, maximum 4 times within 24 hours.

Use the following questions to check your knowledge. You can check the correct answer by clicking on the 'Answer' button:

1. What may be included in a child health record?

   Answer

   • Immunisations
   • Medicare and health insurance details
   • Medical history
   • Current medical needs such as illness or injures
   • Asthma, allergies and anaphylaxis information
   • Any medications child needs to take

2. How does a service collect and store information regarding children’s immunisations?

   Answer

   The family will provide a copy of the child’s health record. This could be in the form of a health book. These days it’s usually emailed through the mygov app. A copy is printed and placed in the child file under lock and key in the office and is rechecked every 6–12 months.

3. What is a healthy temperature range for children?

   Answer

   36.2^oC-37.5^oC

4. What illnesses require a child or staff member to be excluded from the service?

   Answer

   For example:

   • measles
   • chickenpox
   • conjunctivitis
   • gastro
   • flu
   • hand, foot and mouth disease
   • rubella

5. List six pieces of information that need to be included in an incident, injury, trauma and illness record.

   Answer

   The Incident, injury, trauma and illness record must include:

   • (a) details of any incident in relation to a child or injury received by a child or trauma to which a child has been subjected while being educated and cared for by the education and care service or the family day care educator, including:
     • (i) the name and age of the child; and
     • (ii) the circumstances leading to the incident, injury or trauma; and
     • (iii) the time and date the incident occurred, the injury was received or the child was subjected to the trauma;
   • (b) details of any illness which becomes apparent while the child is being educated and cared for by the education and care service or the family day care educator including:
     • (i) the name and age of the child; and
     • (ii) the relevant circumstances surrounding the child becoming ill and any apparent symptoms; and
     • (iii) the time and date of the apparent onset of the illness;
   • (c) details of the action taken by the education and care service or family day care educator in relation to any incident, injury, trauma or illness which a child has suffered while being educated and cared for by the education and care service or family day care educator, including:
     • (iv) any medication administered or first aid provided; and
     • (v) any medical personnel contacted;
   • (d) details of any person who witnessed the incident, injury or trauma;
   • (e) the name of any person:
     • (i) whom the education and care service notified or attempted to notify, of any incident, injury, trauma or illness which a child has suffered while being educated and cared for by the education and care service or family day care educator; and
     • (ii) the time and date of the notifications or attempted notifications;
   • (f) the name and signature of the person making an entry in the record, and the time and date that the entry was made.