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Revised 2011

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ManagingAsthmainConnecticutChild

CareFacilities

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1. Purpose/Acknowledgments 2

 CaringforaChildwithAsthma:Checklist 3

3. AsthmaFacts 4

a. WhatisAsthma? 4

b. WhatCausesAsthma? 4

c. HowisAsthmaDiagnosedinYoungChildren? 5

d. SignsandSymptomsofAsthma 5

i. EarlywarningSigns 5

ii. Emergency

Signs 6

iii. WhatToDoforanAsthmaEmergency(“Asthma

Attack”)

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4. AsthmaControl 8

5. IndividualPlanofCare(IPC)canbeanAsthmaActionPlan 9

6. IdentifyingandAvoidingAsthmaTriggersandAllergens 10

a. AirwayIrritantsandTobaccoSmoke 10

b. PestControl 11

 CleaningProducts/Allergens 12

7. AsthmaMedication 15

a. Quick‐relief(Rescue)Medication 15

b. ControlMedication 16

c. HowtoAdministerAsthmaMedication 17

d. AsthmaMedicationsStorage 20

e. EmergencyAllergyReactions(Anaphylaxis) 21

8. DaycareRegulationsandStatutes 23

9. NurseConsultant/AsthmaEducator 26

10. HandoutsandForms

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11. Resources 28

12. GlossaryofTerms 31

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1. Acknowledgements & Purpose

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Theintentofthismanualistoprovideresourcesandguidanceforprogramsthatcareforchildrenintheirpre‐school

years.TheregulationscitedthroughoutthemanualareapplicabletofacilitieslicensedbytheConnecticut

DepartmentofPublicHealth(DPH).

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ProgramsinschoolsettingsnotlicensedbyDPHare

coveredbyfederalregulationsthatmayormaynotbethesame

astheregulationscontainedinthisdocument.Programsinthesesettingsmustbeawareofandcomplywiththe

applicableregulationsfortheagencythatprovidestheiroversightandcompliance.

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TheStateofConnecticutDPH,AsthmaProgramwouldlike

toacknowledgeandgivecredittothemanyindividuals

andagencieswhogavetheirtimeandsharedresourcestoupdateandrevisethisguideinordertoprovidea

comprehensivemanualtochildcareproviders.

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Disclaimer:

ThisguideisNOTAPOLICYMANDATE.

Instead,itisdesignedtoserveasa

resourcefordaycaresinmanagingasthmaanddoesnotsupersedeanyofthe

provisionsoftheRegulationsofConnecticutStateAgenciesSections19a‐79‐1athrough19a‐79‐13thatgovernchild

daycarecentersandgroupdaycarehomes.Furthermore,thisguideisnotintendedtoendorseany

particularbrand

ofproductdiscussedorshowninitspages.Picturesanddescriptionsofsuchproductsareforillustrativepurposes

only.Finally,thisguideisforeducationalpurposesonly.Itisnotintendedtoreplacethemedicaladviceorservicesof

alicensedhealthcareprovider.

ReneeD.Coleman‐Mitchell,M.P.H.EileenBoulay,B.S.N.,R.N.

SectionChief,HealthEducation,ProgramSupervisor,AsthmaProgram

Management&SurveillanceConnecticutDepartmentofPublicHealth

ConnecticutDepartmentofPublicHealth

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ElizabethD.Reynolds,B.S.N.,R.N.,NCSN  SalinaHargrove,B.S.

NurseConsultant,AsthmaProgramHealthProgramAssistant,AsthmaProgram

ConnecticutDepartmentof

PublicHealth   ConnecticutDepartmentofPublicHealth

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ValerieBryan,R.N.JoanSimpson,M.P.H.S.

DayCareLicensingEnvironmental&OccupationalHealthIndoorAirQuality

SupervisingNurseConsultantConnecticutDepartmentofPublicHealth

ConnecticutDepartmentofPublicHealth

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DevonConover,M.S.

DivisionofCommunityBasedRegulation

ConnecticutDepartmentofPublicHealth

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Permissionwasgrantedtoreprintand/oradaptcomponentsfromthefollowing:

AmericanAcademyofAllergy,AsthmaandImmunology AmericanCollegeofChestPhysicians

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CaliforniaChildcareHealthProgramCentersforDiseaseControlandPrevention

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2. CaringforaChildwithAsthma

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CHECKLIST

□Learnthebasicsaboutasthma

9 Whatisasthma?

9 Whatcausesasthma?

9 Signsandsymptoms

9 Howisitdiagnosed?

9 Asthmacontrol

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□Knowyourresponsibilitiesasachildcareprovider

9 Whichchildrenhaveasthma

9 Howyouhelpthemavoidthethingsthatmaketheirasthmaworse

9 Howyougivethemasthmamedicine

9 Howyouusetheirasthmaplans

9 Whatdoyoudoinanasthmaemergency

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□KnowtheConnecticutstatelawsandregulations

9 Medicationauthorizationsandadministration

9 Cleaninganddisinfectants

9 Environmentalrequirements

9 Illnessprocedures

9 Healthconsultants

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□Knowwhereelsetofindmoreinformationaboutasthmaandenvironmentalhealth

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3. AsthmaFacts

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WhatisAsthma?

Asthmaisaverycommonchroniclungdiseasethat

affectspeopleofallages.Asthmacausestheairway

passagesinthelungstobecomenarrow,makingit

hardertogetairinandoutofthelungs.Whenasthmais

notwellcontrolleditcausesepisodesofdayornighttime

coughing,breathlessness,chesttightness,andwheezing.

Theproblemthatmakesasthmaachronicdiseaseis:

• Inflammation(swelling)oftheliningofthe

airways(bronchusorbronchioles).

Whentheairwaysareinflameditmakesthemmore

sensitiveandlikelytohaveserioussymptomswhen

exposedtoasthmatriggerscausing:

• Tightening(constricting)ofthemusclesthatare

wrappedaroundtheairways

• Increasingmucusthatclogstheairways

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WhatCausesAsthma?

Asthmaisnotcontagious.Thereisnotonespecificthingthatcausessomeonetodevelopasthma.Whatwedoknow

isthattherearecertainriskfactorsthatmakeitmorelikelyforchildrentodevelopasthma,including:

• Ifanimmediatefamilymemberhasasthma(heredity)

• Ifthechildhashadeczema(dry,itchyskincondition)

• Ifthechildhasfoodorenvironmentalallergies

Somechildrenfirstdevelopasthmasymptomsafterarespiratorycoldvirus.Althoughcoldvirusesdon’tcause

asthma,theyareanimportanttriggerformostyoungchildrenthatcanresultinsomeone’sfirstorrecurringasthma

episodes.Anychildwhomightbeatriskfordevelopingasthmacanhavetheirasthmamadeworsebyexposureto

tobaccosmoke,anyotherformofairpollution,orenvironmentalallergens.

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HowisAsthmaDiagnosedinChildren?

Asthmacanbedifficulttodiagnoseinyoungchildren.Healthcareprovidersusenationalguidelinestoidentifyhealth

historyinformation,questionnaires,andphysicalexamfindingstoassistinthediagnosisofasthma.Recurringasthma

symptomssuchaswheezing,difficultybreathing,andexcessivecoughingareusedalongwiththechild’sfamilyand

medicalhistorytohelpmakethediagnosis.

Somechildrenundertheageof5yearsoldhaveahistoryofasthmathattheydoseemtooutgrow.Otherchildren

developasthmaatayoungageandhaveittherestoftheirlives.Childrenover5yearsoldmaybeabletoperforma

spirometrytestthatmeasureshowtheairflowsinandoutoftheirlungs.Thesetestsandassessmentsaredoneat

thechild’sPrimaryCareProvider(PCP)orapulmonaryorallergyspecialist.

AsthmaSignsandSymptoms

EarlyWarningSignsandSymptoms

VisibleSigns

• Breathingharderandfasterthanusual

• Excessiveoruncontrollablecoughing

o Whensleeping

o Whenawake

o Whenactive

 Exercising

 Laughing

 Crying

 Anyhardblowing

• Unusuallytired/notwantingtoplay

• Appearsworried,fearful,orirritable

VerbalStatements

Childrenhavedifferentwaysofdescribingwhattheir

asthmafeelslike.Somecommonphrasesare:

• “it’shardtobreathe”

• “ithurtstobreathe”

• “mychestfeelstight”

• “mythroathurtswhenIbreathe”

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Emergencysignsandsymptoms:“AsthmaAttack”

Whenasthmagetssobadthaturgentoremergencymedicalcareisneededitisoftenrefe rredtoasan“asthma

attack”.However,theterm“asthmaattack”canactuallybemisleadi ng. Most“asthmaattacks”canbeprevented

byfollowingachild’swrittenasthmaplan,stayingondailycontrolmedications,avoidingasthmatriggersand

allergens,recognizingtheearlysignsandsymptoms,andproperlyadministeringmedication.

Signsthatachildmaybehavinganemergencyasthma(orbreathing)probleminclude:

• Thechildisstrugglingtobreath(hardandfast),evenwhenresting

• Youcanhearthechildwheezingwithoutastethoscope

• Thechildishavingdifficultytalking,concentrating,orwalking

• Thechildcan’tseemtocatchhisorherbreath

• Thechild’slipsorfingernailsappearblueorgray

• Paleorsweatyskin

• Thechildappearsextremelyexhaustedorlethargic

• Thechild’schestorneckmusclesseemtobe“suckedin”witheachbreath

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Whattodoforachildhavinganemergencyasthmaproblem(“asthmaattack”)

1. Staycalm,don’tleavethechildaloneandhelpthechildtorelaxasmuchaspossibl e

2. FollowtheIPCorasthmaactionplan(AAP)REDZONE

3. Givequick‐relief(rescue)medicineimmediately

4. Call911,notifyparent

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*Whentocall911*

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• Childisunresponsive

• Breathingissodifficultthechildcan’twalkortalk

• Lipsorfingertipslookgrayorblue

• Therescuemedicineisnotworkingafter10or15minutes

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KeyPoint:

Anytimeyouarenotsureandthinkitisan

emergency,itisbettertocall911thanitistowait

toolong.

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Whenyoucall,don’thangupuntilthe911operator

tellsyouto.

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Onceasthmaisdiagnosed,childrenneedtohaveaPCPwhoisaccessibletothefamily,assessesthechild’sasthmaon

aregularbasis,andworkswiththefamilytodevelopandreviseappropriatewrittenasthmaplans.Ongoing

assessmentofasthmacontrolisoneofthekeystomaintainingeffectiveasthmamanagement–itishowhealthcare

providersdetermineifthechildisonthecorrectmedicineandhowwelltheyareabletoavoidthethingsthatmake

theirasthmaworse.

Goodasthmacontrolis:

• Whenthechildcanplayandexercisejustlikeanyoneelsetheiragewhodoesnothaveasthma

• Mostdaysthechilddoesnotcough,wheezeorfeelshortofbreath

• Thechildcansleepthroughthenight(ornaps)withoutcoughingorwakingupwithuncomfortable

breathing

• Thechilddoesnotneedtousequick‐relief(rescue)medicinemorethantwiceaweek



Youandthef amilycancontributevaluableasthmacontrolinformationtothePCP,including:

• Frequencyofdayornightcoughing

• Abilitytoplayatthesamephysicallevelasotherchildren

• Frequencyofusingquick‐relief(rescue)medicine

• Missedschool,daycare,orparentalworkdaysduetoasthma

Thefollowingisachartofthetypeofquestionsusedtohelpdetermineasthmacontrol:

Inthepast4weeks:



WellControlled



NotWellControlled

VeryPoorly

Controlled



1. Howmanytimesdidyourasthmagetinthewayor

stopyoufromdoinganactivityathome,schoolor

play?

None



Sometimes Frequently



2. Howmanytimesdidyouwheeze,cough,feeltightin

thechest,orhavetroublebreathing?

8orless,butnotmore

thanonceperday



Morethan8,or

morethanonceper

day

Everyday



3. Howmanytimesdidyourasthmawakeyouupatnight

ormakeithardtosleep?

1orless



2‐4 Morethan4



4. Howmanytimesdidyouhavetouseyourrescue

inhalerornebulizer(albuterolorxopenex)?

8orless



Morethan8 Atleasteveryday

 Answersinthese

boxesshouldindicate

goodasthmacontrol

Anyanswersinthese

sectionscould

indicatetheneedfor

anasthmavisit

Anyanswersin

theseboxes

indicatesthe

needtocallfor

anasthmavisit

 4. AsthmaControl



The

Plan

”

resp

•

*Se

Aco

tot

pare

inclu



Alth

•

ndividualPl

”

canbeuse

nsibleforc

•

Theprov

•

Theindiv

•

Develop

•

Financial

•

Theasth

CTDayCar

yofthepla

epatient/fa

nt,relative,

dingwhatm

ughtherea

•

Demogra

•

Asthmas

•

Patient‐s

•

3zonest

•

Eachzon



• GreenZ

• Yellow

• RedZon

nofCare(I

asanIPC.T

reofthechi

der’sexpert

dualpatien

entalconsi

healthinsur

aeducatio

Regulation

iskeptint

ilythatcan

aycareprov

edicationst

edifferent

phicandcon

everityclass

ecificasth

atareusual

hastheast

ne–Go!

oasthmas

akedailyco

one–Cauti

arlyasthma

ontinuedai

ddquick‐re

pdatethe

e‐Emergenc

orserioussi

akequick‐r

hildrenexp

mergencyR

all911,noti



C)isrequire

heplanism

ld.Consider

seindeter

/family’she

erations

ancecovera

requiredfo

Section–p

emedicalr

makecopie

iderand/or

take,and

ersionso

IP

tactinforma

fication

atriggersa

lycolorcod

masympto

mptoms

ntrolmedica

n!

signsandsy

ycontrolme

ief(rescue)

arentonchil

!

gnsofan“as

lief(rescue)

riencingem

oom

fyparent/gu

. Ind

foranychil

deinpartn

tionsthatn

iningmedic

lthcarebeli

econsidera

thepatient

ge23ofthi

cordsooth

foranyone

choolnurse.

hentocallf

C/AAPs,the

ion(patient

dallergens

dlikeatraff

sthatare

ionaccordin

ptoms

dicationsAN

edication

’scondition

thmaattack

”

medicationa

rgencysign

rdian

ividu



dwithasth

rshipwitht

edtobema

tionoptions

fsandvalu

ions

familytou

document

rproviders

elsewhoals

TheIPC/AA

rhelp.

basiccompo

andprovide

clight

sedtodeter

gtoplan

D

thatday

”



swrittenby

ofasthmar

lPlan

aintheDa

eprovider/

dewithinth

andmedica

s,including

derstandan

anrefertoi

providesc

identifies

nentstheys

r’s)

inewhat

uthorizedp

quireurgen

ofCa

Caresettin

atient/fami

spartnershi

ionadminis

ulturalcon

beableto

ifneeded.

reforthatc

hattodofo

ouldallcon

edications

escribers

medicalhel

.An“Asthm

yanddayca

include:

rationauth

iderations

arryoutthe

heoriginalc

ild,suchas

rasthmasy

aininclude:

ouldbeuse

fromtheir

Action

estaff

rization

plan

pyisgiven

adivorced

ptoms,



CPoran



 



10



SeeAppendixfor



Asthmatriggersisageneraltermusedtodescribeanythingthatcan

makesomeone’sasthmaworse.Sometriggerscancauseasthma

symptomsquickly,whilesometriggerscausesomeone’sasthmatoo

slowlyandsteadilyworsen.Differe nttypesofasthmatriggersand

stepsthatcanbedonetodecreaseexposurearelistedbelow:



 KeyPoint!

Mostasthmatriggerscanbereducedor

avoided.Thisisanessentialstepin

improvingasthmacontrolandavoiding

theneedforemergencyasthma

treatment!



AirwayIrritants

Airwayirritantsareanythingintheairthatcancauseareactioninthelungs,makingitmoredifficulttobreathe.

Irritantscancauseproblemsforanyone,butyoungchildrenwithasthmahavelungsthatareespeciallysensitive.

*SeeCTDayCareRegulations–page25



Environmentaltobaccosmokeisthesinglemostimportant

airwayirritanttoavoid.Secondhandsmokefromacigarette,

cigar,orpipecontainshundredsofchemicalsthatarepoisons

anddozensofcancercausingsubstances.



KeyPoints!

• Thereisnosafeamountofsecondhandsmoke

• Youcanbreatheinthesmokechemicalslongafteryoucan

nolongerseethesmoke

• Eachyearsecondhandsmoke:

o Causesmorethan25,000childrentodevelop

asthma

o Causesasthmatobeworsenedinthousandsof

children,manyrequiringemergencytreatmentand

hospitalization

o Causesthousandsofchildrenwithoutasthma toget

moreseriousrespiratory(cold)virusesandear

infections

 Whattodo:



9 Neversmokeinany

partofahomeoracar

whereachildwith

asthmaisgoingtobe–

eveniftheyarenot

thereatthetime



9 Encouragepeopletoquitsmoking.The

CTTobaccoQuitLineis:

1‐800‐

QUIT‐NOW



9 Ifsomeonedoessmoke,alwaysgo

outsideandwearacoatorshirtyou

cantakeoffbeforegoingbackin,sothe

smokeparticlesdon’tcomeinside



 6. AsthmaTriggers



 



11



Otherimportantairwayirritantsinclude:

• AirPollutionandcarexhaust

• Perfumes

• Cleaningproducts

• Paint/woodstainingproducts

• Artsupplies

• Aerosolsprays

• Woodburningstovesorfireplaces

• Brandnewcarpetorfurniturewith

odors

 Whattodo:

• Closewindowsifnearhightrafficarea

• Don’tletcarsidlemorethan3minutes(CTlaw)

• UseGreenCleaningsupplies

• Clean,paintanddocertainhomeprojectswhen

childrennotaround

• Don’tuseperfumes,hairsprays,airfresheners,art

supplies,

oranythingwithastrongscentaround

children

• Don’tburnwood,leaves,orgarbage



PestControl



Thebodypartsanddroppingofrodentsand

cockroachescancauseanallergicreaction

thatmakesasthmaworse.Anadditional

concernisthatthepesticidesandspraysthat

manypeopleusetocontrolpestscanbe

seriousairwayirritants,especiallytoyoung

childrenandthosewithasthma.



 Whatto

Do:

9 Cleanupdishes,food,grease,crumbs,andspillsquickly

9 Keepfoodstoredintight,sealedcontainers,includingpet

foods

9 Keepallgarbageinsealedcontainersandtakeout

frequently

9 Repairleakypipesanddrippingfaucets;pestsneedwater

9 Cleanupclutterlikeexcesscardboardand

newspapers

9 Sealcracksinwalls,baseboards,windows,anddoors

9 Usebaittrapsonlyiftheyareoutofreachofchildren

9 Neverusepesticidesprays whenchildrenarearound

9 Ifusingspr ays,avoidwidespreadapplicationbyspraying

smallamountsonlywhereneededandnotonsame

day

childrenwillbepresent

9 Storespraysinasafeplacewherechildrencannottouch

them

*SeeCTDayCareRegulationsSection–page24



KeyPoint:

Themost

importantpartof

pestcontrolis

preventionby

eliminatingpest

access,foodand

watersource



Clea

attr

wor

ben

and

heal

pres

how

eye,





Ana

har

brea

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swel

lung

envi

peo

effe

dete

ofe



Cleani

*SeeCT

ingproduct

ctiveandhe

place.Inad

fitsofcleani

nfectiousag

hfulindoor 

ntseveralh

ver.They

skin,orresp



Allergi



llergyisana

lessformo

hedin,and

ionscanocc

lingandmu

.Mostpeo

onment(in

lehavemild

tonasthma

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arenecess

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ng,therem

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dispo

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normallys

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usproducti

lewithasth

oororoutd

allergies,b

Allergytest

whataller

cts

lationsSect

ryformaint

ionsinthe

bviousaest

valofdust,

ltomaintai

.Cleaningpr

ironmental

emicalsass

ion,orothe

issues.Add

ncentrated

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ctsareclass

dous,creati

ing,storage,

alissuesfor

nsitiveresp

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sesreaction

overaperio

nanywhere

aareallerg

or)thatcan

tforothers,

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ion–page2

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omeand

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oductscan

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oftime,an

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calsthatstil

ngproducts

generalp

bathroom

glassclea

floor finis

handclea

oralabelwi

pendicesof

int!

hingdoesn’

at“cleans

veryirritati

n.



nbe

.These

se

setothe

ly.Some

serious

twayto

severity

napproach

lessirritati

dothejob

renowava

rposeclean

cleaners

ers

esandstrip

sersandso

htheEcoL

SampleofG

haveto“s

ell”(think

gtotheair

KeyPoint!

Themore

identifyw

thechildr

youwillb

andhelp

control.

tousingclea

gfumesand

fcleaning.G

lablefor:

rs

ers

.



goorGreen

reenCleanin

ellclean”to

fbleachan

ays,especi



ouknowab

atcausesa

nyoucaref

abletored

eeptheiras

ning

safer

reen

Seallabel

gRecipes

beclean.In

ammonia)

llyforyoun

outhowto

lergiesfor

r,themore

cethem

hmaunder



 



13



Dustmitesaretinybugsthatyoucan’tsee.

Theyliveandmultiplyincarpets,cloth

furniture,curtains,stuffedanimals,pillows,

bedding,andmattr esses.Theylivebestin

moderatetemperaturesandhumid

conditions.Dustmitesarethemostcommon

allergictriggerforpeoplewithasthma.

KeyPoint!

Roomswheremosttimeisspentaremost

important,especiallythebedroom,sleeping,

andplayareas



 WhattoDo:



9 Ifpillowsareold–getnewones(hypoallergenicarebest)

9 Coverpillows,mattressandboxspringwithallergycovers

o Don’tusepillowsthatcan’tbecovered

o Minimizestuffedanimals,especiallyifnon‐washable

9 Washbeddinginhotwater(atleast130

)weeklyanddry

completely

o Ifbeddingtoobigtowash,putinhotdryerfor20min.

9 Trytokeeproomhumiditylessthan50%usingairconditioning

oradehumidifier,especiallyduringwarmweather

9 Removeasmuchcarpetaspossible

o Dustmitessticktocarpet

fibers

9 Useavacuumwithanallergy(orHEPA)bagandfilter

o Vacuumwhenthechildisnotpresent

9 Checkiffurnaceorairconditioningfiltersneedtobecleanedor

changed



9 Wetcleanwashablesurfacestodecreasedustintheair

Moldgrowswherethereiswetness(visible)

ormoisture(humidity).Moldcanbevisible

inshowers,onwallsandceilings.Itcanalso

beundercarpets,wallpaper,orpanelin g

whereitmaynotbevisible.Anyroomthat

hashighhumidity(bathroom,kitchenor

basement)orhashadanywaterdamage

is

morelikelytohavemold.



KeyPoints!

Moldseldomrequiresprofessionaltesting.A

verypracticalguidelinetogobyis:ifyou

smellmoldorseemold,thereismold.

Moldwillalwaysrecurifthesourceof

wetnessormoistureisnotfixed.

 WhattoDo:

9 Cleanvisiblemoldonhardsurfaceswithagreencleaning

solution

o Donotusecleanerswithstrongscentsorfumes

whenchildrenarearound

9 Fixallsourcesofwaterleaks

9 Useadehumidifier,especiallyinthebasement

o Besuretoemptywhentankisfilled

9 Inspectwallsandceilingsfordiscoloredmoldstains

o Repairorreplace

9 Carpetsthatgetwetforlongerthan48hourswillusually

growmold

o Considerremovingorreplacing

9 Adequateventilation,especiallyinthebathroomand

kitchenhelps

keepmoisturecontrolled

9 Avoidoutdoormoldsinpilesofleaves,grass,orcompost

 



14



Cats,dogs,birdsandotherfurryanimals

causeallergieswiththeir flakingskin

(dander),urine,andtheirsaliva–nottheir

fur.Danderissmallandstickyandcanbe

carriedaroundfrom onebuildingtoanother 

onblankets,clothes,andcoats.Dandercan

stayinahouseformonthsafterananimalis

nolongerthere.



KeyPoint!

Thereisnosuchthingasacompletely

“hypoallergenic”catordog–somearejust

lessallergenictoindividualpeoplethan

others

 WhattoDo:

9 Ifsomeonehasapetallergy,keeppetsoutsideorfindthe

petanewhomeifpossible

9 Ifthepetmuststayinthehome:

o Keeppetsoutofthebedroomandoffcarpetsand

upholsteredfurniture

o Avoidtouching,holding,or

pettinganddon’thold

closetothechild’sfaceofthechildwithasthma

9 Ifyouhaveachildinyourhomewithasthma,newpets

shouldnotbeintroducedwithoutfirstcheckingwiththe

healthcareprovider

9 Ahigh‐efficiencyparticulateair(HEPA)roomaircleaner

mightbe

helpful



Pollen,trees,flowers,grassandweedsare

seasonalallergensthatcanbedifficultto

avoid.



KeyPoint!

Seasonalpeaksofpollens:

Trees–March,April,andMay

Grass–JuneandJuly

Weeds–August,September,andOctober

 WhattoDo:

9 Trytokeepwindowsclosedsopollendoesn’tblowintothe

home,especiallythebedroomorwherethechildsleeps

9 Washhairnightlysopollendoesn’tgetonpilloworbed

9 Checkpollencountsandavoidoutdooractivities

inthe

earlymorningorafternoonwhenpollencountsarethe

highest

9 Donotdryclothesoutdoors



 



15



Afterachild’sasthmaisassessedbyahealthcareprovider,thechild’sindividualtriggersandallergiesareidentified

andstepsaretakentoreduceoreliminateexposuretothesetriggers.Thenextstepistoidentifywhatmedication

willbeneededtohelpwiththeirasthmamanagement.Theprimarymedication

usedtotreatasthmaisuniqueinthat

itistheonlymedicationthatchildrenneedtolearnhowtoinhale.Properinhalationtechniqueisoneofthemost

importantstepstosuccessfulasthmamanagement.Thissectionwilldiscussdifferenttypesofasthmamedication,as

wellasstepsandtips

toensureproperinhalationtechnique.

Therearetwomaincategoriesofasthmamedicationthatarepartofachild’sIPC/AAP:

Quick‐relief(rescue)medicationisusedtotreatincreasedasthmasymptomsandimprovebreathingbyreducing

coughingandwheezingwithinminutesafterinhaling.

• Thismedicationprovidestemporaryreliefbyrelaxing

themusclesthatarewrappedaroundtheairways

• Itisimportanttousethismedicationwhenasthma

symptomsfirstoccurandnotwaituntilthechildactually

looksliketheyarehavingdifficultybreathingorsound

liketheyarewheezing

• Iftheasthmasymptomsworsenordon’timproveafter

givingthismedication,checktheIPC/AAPforguidance

torepeatdoses

o Ifnoimprovementcall911andnotify

parent/guardian



SideEffects:

Usedasprescribed,thesideeffectsarenot

consideredseriousandincludemild

tremors,poundingheart,nervousnessand

restlessness



 7. AsthmaMedication

KeyPoint!

Ifthismedicationneedstobeusedonafrequentorrecurringbasis,anassessmentbythehealthcareprovidermaybe

indicatedtodetermineasthmacontrolandifchangesareneededtotheasthmaplan

Asimpleguidelineisifquick‐reliefmedicationisneededmorethan2x/week

for4weeks,asthmacontrolneedstobe

re‐assessedbythehealthcareprovider

*SeeFluShotRequirementsforDayCare–page25

 



16



Dailycontrol(maintenance)medicationisusedeverydayevenwhenfeelingwell

ControlMedication:

• Reducestheswelling(inflammation)insidetheairways

• Helpspreventacute,uncontrolledasthmaepisodes

(“asthmaattacks”)

• Needstobeusedeveryday,evenwhennothavingany

asthmasymptomsorproblems

• Familiesunsureifdailycontrolmedicationisstill

necessaryshouldbeencouragedtodiscussoptionswith

theirhealthcareprovider

• Themostcommonandeffectivedailycontrol

medicationsareinhaledsteroids

KeyPoint!

Inhaledsteroidsoranydailycontrolmedicationshouldneverbe

usedtotreatacuteasthmasymptoms–theyworkslowlyovera

longperiodoftime



SideEffects:

• Usedasprescribedandwithproper

inhalationtechnique,thesemedications

donothavetheserioussideeffectsof

othertypesofsteroids.

• Thecommonsideeffectsinclude:

o Hoarsevoice

o Thrush(throatinfection‐white

patchesinthemouth)



KeyPoint!

Properinhalationandrinsingmouthoutafter

usingcanusuallypreventsideeffects–

brushingteethisideal



NamesofCommonAsthmaMedicationforChildren



Quick‐relief(rescue) DailyControl(maintenance)



BrandName GenericName DeliveryDevice BrandName GenericName DeliveryDevice

VentolinHFA Albuterol MDI Flovent HFA Fluticasone MDI

ProAirHFA Albuterol MDI

‐Var HFA Beclomethasone MDI

ProventilHFA Albuterol MDI PulmicortRespules Budesonide Nebulizer

Albuterolsolution Albuterol Nebulizer PulmicortFlexhaler Budesonide DPI

Xopenex Levalbuterol Nebulizer AsmanexTwisthaler Mometasone DPI

XopenexHFA Levalbuterol MDI Symbicort

(Pulmicort+Foradil)

Budesonide+

Formoterol

MDI

MDI=MeteredDoseInhaler

DPI=DryPowderInhaler

Nebulizer=anaircompressormachinethatturns

liquidmedicationintoamist



AdvairDiskus

(Flovent+Serevent)

Fluticasone+

Salmeterol

DPI

AdvairHFA

(Flovent+Serevent)

Fluticasone+

Salmeterol

MDI



 



17



MedicationDeliveryDevices

Thereareanumberofdifferentwayschildrencaninhaletheirasthmamedication.Thechoiceofwhichonetouseis

basedonwhatworksbestforanindividualchild.Thetwomostimportantconsiderationsare:

• Whatisthebestasthmamedicineforthechild

• Whatdevicecanbe

usedwiththechildthatgetsthemostasthmamedicineintotheirlungs

Metereddoseinhaler(MDI)isthemostcommonandpractical

medicationdeviceforyoungchildren.TheMDIisasmall

pressurizedmetalcanisterfilledwithasthmamedicationthatis

suspendedinapropellant.Whenthecanisteris

pusheddownin

itsplasticholder,adoseofmedicationis“puffed”out.



KeyPoint!

EvenveryyoungchildrencanuseaMDI;

however,allchildren(andadults)shouldusea

spacer/holdingchamberwiththeirMDI

becauseit:

• Leaveslessmedicineinthemouthand

throat

• Getsmoremedicineintothelungs

whereitneedstogotowork

• Decreasesthechanceofsideeffects,

especiallyfrominhaledsteroids



Thespacerisatubethatallowsthepuffof

medicationtobebreathedinmoreeffectively.

Somespacershavefacemaskstousewith

differentagedchildren.Whenachildisableto

holdaspacerintheirmouth,thefacemaskis

nolonger

needed.



ToUseaSpacer:

1. Shaketheinhalerwellbeforeuse(3‐4shakes)

2. Removethecapfromyourinhalerandfromyour

spacer,ifithasone

3. Puttheinhalerintothespacer

4. Breatheout,awayfromthespacer

5. Bringthespacertoyourmouth,putthemouthpiece

betweenyourteeth

andcloseyourlipsaroundit

6. Pressthetopofyourinhaleronce

7. Breatheinveryslowlyuntilyouhavetakenafull

breath.Ifyouhearawhistlesound,youarebreathing

intoofast.Slowlybreathein.

8. Holdyourbreathforabouttensecondsandthen

breatheout.

 

 



18



SpacerwithMask

1. Followsteps1‐3

2. Holdthespacerwithmasktothefacesothat

boththenoseandmoutharecovered.Itis

importanttomakeagoodsealbetweentheface

andmasksothatallthemedicinegetsbreathed

inthroughthespacer

3. Pressthetop

ofyourinhaleronce

4. Holdthemaskfirmlyinplacewhilethechild

takes4‐6breaths

5. Removethemaskfromthefaceandrepeatif

morethanonepuffisprescribed

6. 

ImportantRemindersAboutSpacersandMDIs

• Alwaysfollowtheinstructionsthatcomewith

yourspacerandMDI(inhaler)

• OnlyuseyourspacerwithaMDI,notwithadry‐

powderinhaler

• WhentheMDIisneworhasn’tbeenusedfora

while,it’sagoodideato“prime”itbypuffinga

dose

outintotheair(awayfromanyone)tomake

sureitisworkingproperly

• Sprayonlyonepuffintoaspaceratatime.

• Useyourspacerassoonasyou'vesprayedapuff

intoit

• Itisveryimportantthatyouconsultyourdoctor,

asthmaeducator

orotherhealthcareprofessional

toreviewproperinhalertechnique

• Neverletanyoneelseuseyourspacer

• Keepyourspacerawayfromheatsources

• Ifyourspacerhasavalvethatisdamaged,orif

anyotherpartofthespacerisdamaged,donot

useit,thespacer

willhavetobereplaced

• Somespacershaveawhistle.Yourtechniqueis

fineifyoudonothearthewhistle.Ifyouhearthe

whistle,youshouldslowyourbreathdown

Tocleanyourspacer(onceaweek)Followtheinstructions

thatcomewithit.Mostwilladviseyouto:

1. Takethespacerapart.

2. Gentlymovethepartsbackandforthinwarmwater

usingamildsoap.Neverusehigh‐pressureorboiling

hotwater,rubbingalcoholordisinfectant.



3. Rinsethepartswellincleanwater.

4. Donotdryinsideofthespacerwithatowelasitwill

causestatic.Instead,letthepartsairdry(for

example,leavethemoutovernight).

5. Putthespacerbacktogether.



TocleaningyourMDI(every2‐3

daysofuse)

1. Takethemetalcanisteroutofthe

plasticholder

2. Neverputthemetalcanisterinwater

orwashit

3. Rinseonlytheplasticholderunder

warmwater

4. Letairdry

5. Replacemetalcanisterand“prime”a

dosebeforeusingagain

 



19



MedicationDeliveryDevices

isamachinethatworkslikeanaircompressor,convertingliquid

medicationintoafinemistthatcanbebreathedin.Itrequiresa

matchingfacemask,oramouthpieceheldinthemouthand

usuallyrequires10–15minutestoadminister.



KeyPoint!

Themedicationmistfromanebulizermustbeindirectcontact

withthechild’smouthusingamaskormouthpiece–mistheld

anydistanceawayfromthemouthwastesmostofthemedication

andverylittleofitisactuallyinhaled





ToUseaNebulizer

1. Setupandpluginthenebulizermachineina

locationwherethepowersourceisclosetoa

comfortablelocationforthemedicationtobe

administered

2. Followthedirectionsforthespecificbrandof

nebulizermachineandcup

3. Mostnebulizercupsunscrewfromthetop

4. Most

nebulizedmedicationcomespackagedina

unit‐doseformat,requiringtheentirecontentsto

besquirtedintothebottomhalfofthenebulizer

cup

5. Screwthetopofthecupbackonandattachthe

tubingfromthecuptothenebulizermachineand

thecupontothefacemask

ormouthpiece

6. Placeeitherthefacemaskonthechildorthe

mouthpieceintheirmouthandturnonthe

machine–amistofmedicationshouldrapidly

appear

7. Instructthechildtotakenormalslowdeep

breaths

8. Thecupmayrequiresometappingonthesides

towardthe

endofthetreatmenttogetallthe

medicinecompleted

9. Thetreatmentiscompletewhenthereisnomore

mistfromthecup

10. Alwaysunplugthemachineafter

eachuseandstoreinacleandry

place



Cleaninganebulizercup

1. Aftereachtreatment,rinsethenebulizercupwithwarmwater,shakeoffexcesswaterandletitairdry.

2. Attheendofeachday,thenebulizercup,mask,ormouthpieceshouldbewashedinwarm,soapywaterusing

amilddetergent,rinsedthoroughly,andallowedtoairdry.



9 Note:Thereisnoneedtocleanthetubingthatconnectsthenebulizertotheaircompressor

9 Donotputthesepartsinthedishwasher

3. Everythirdday,afterwashingyourequipment,disinfecttheequipmentusingavinegar/watersolutionorthe

disinfectantsolutionyoursuppliersuggests.

Tousethevinegarsolution,mix1/2cupwhitevinegarwith1‐1/2cupsofwater.Soaktheequipmentfor30

minutesandrinsewellunderasteadystreamofwater.Shakeofftheexcesswaterandallowtoairdryona

papertowel.Alwaysallowtheequipmenttocompletely

drybeforestoringinaplastic,zipperstoragebag.



Dry

med

able

inha

instr



•

owderInha

cineinthef

tosealtheir

erscomein

uctiononpr

. Holdthe

onthegr

snapsint

. Holdthe

willgo.Y

comforta

. Putthe

through

. Holdyou

theDISK

Prope

•

Shallbe

•

Alwaysr

•

Alwaysc

•

Storeinh

•

Liquidm

9 C

•

Storeme

•

Iftransp

•

Foilpouc

KeyPoint!

Thistypeof

childrenan



er(DPI)isa

rmofafine

lipsaroundi

ifferentsha

peruse.

DISKUS

ino

p.Pushawa

place.

DISKUS

lev

ushouldhe

ble.(Never

outhpiecet

heDISKUS

.

breathfor

.

Storage

toredinasa

adthepack

ecktheexp

lers(MDIs)

dicationfor

ution:liqui

everuseliq

icationsaw

rtingmedic

onotleave

esmaycon

sthmamed

adults

reathactiv

powder.Th

andbreath

pesandsize

ehand.Pla

fromyou,

l.Slidethel

araclick.Br

reatheouti

yourlips.B

bout10sec

ofAsth

emanner,i

geinsertso

rationdate

troomtem

nebulizerss

nebulizers

idnebulizer

yfromdire

tionsonan

nymedicati

ainmedicat

cineisusual

teddevicet

personusi

infastand

–eachone

ethethum

ntilthemo

verawayfr

atheoutas

totheDISK

eatheinqui

nds.Breath

aMedi

accessiblet

eachmedic

nddonotu

erature

ouldnotbe

lutionshoul

medicineth

tsunlight

typeoffiel

nsinacart

on.Onceop

ymoreappr

atdelivers

gaDPIhast

deep.Dryp

requiresspe

oftheothe

thpieceapp

myouasfa

farasis

).

cklyanddee

out.Then

ations

children,al

tionandfol

eafterthel

refrigerated

dlooklike

tiscloudy,

trip,becar

atmightge

ned,datea

priateforo

obe

wder

ific

hand

arsand

asit

ply

LOSE



lowforquic

lowspecific

stdayofth

aterandsh

iscolored,o

fultokeept

extremely

dusebefor

der

accessina

nstructions

monthprin

uldneverb

crystallized

hemfromg

otorcold

expiration

emergency

orstoragea

tedonthe

ingestedby

ttingtooho

ndstorein



duse

edicine

mouth

ortoocold

hepouch



 



21



Allergymedication

Sinceallergiescanbesuchanimportanttriggerforsome

children’sasthmaandnotallallergiescanbeavoided,allergy

medicationisoftenusedaspartoftheIPC/AAP.These

medicationscomeinmanyformsincluding:pills,liquid,

chewabletabletsandnosesprays.



KeyPoint!

Someallergymedicationneedstobetaken

everydayaspartofthecontrolmedicationin

thegreenzoneoftheIPC/AAP,whileother

allergymedicationisusedseasonallyoras

needed



EmergencyAllergyMedication

Somechildrenwithasthmaalsohavelife‐threateningallergies.Themostcommononesare:peanuts,treenuts,

shellfish,fish,milk,andinsectstings.Onlyahealthcareprovidercandetermineifanallergyispotentiallylife‐

threatening,cancausingananaphylacticreactionand/orrequireaprescriptionforanemergencymedication

commonlyknownasanEpiPenorEpiPenJr.AnEpiPenisapre‐filledinjectiondevicethatautomaticallyinjects

epinephrine.Caregiversforchildrenwi thknownlife‐threateningallergiesmustbetrainedinthesignsandsymptoms

ofanaphylaxisandhowtoadministeranEpiPen.Thesechildrenshouldallhaveemergencyallergyplansthatexplain

whattodo.

KeyPoint!

Mostanaphylacticallergyreactionscanbepreventedbyavoidingaccidentalcontactoringestionwithaknown

allergen.Carefullyreadingfoodlabelsandrestrictingthepresenceoffoodthatyouknowachildisallergictoare

essentialtopreventingemergencyallergyreactions.



SymptomsofLIFE‐THREATENINGanaphylaxis:

Usuallyoccurswithinminutes,butmayoccurupto2hoursafterexposure

• Facial,lips,tongueswelling • Itchyskin,hives

• Chesttightness,wheezing,cough,shortnessofbreath • Difficultyswallowing,tightnessinthroat

• Dizziness,fainting,“feelingofimpendingdoom” • Abdominalcramping,nausea,vomiting



*Se



touse

. Flipopen

capofth

. Remove

tube.

. Graspth

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 



23



AdministrationofMedicationsinDayCares

19a‐79‐9a.AdministrationofMedications



 

*SeeAppendicesforSampleForm



*SeeAppendicesforsampleofIndividual

PlanofCareform



 Agroupdaycarehomeorchilddaycarecentershallnotdenyservices

toachildonthebasisofachild'sdiagnosisof

asthmaorbecausea

childhasaprescriptionforaninhalantmedicationtotreatasthma.



(b)AdministrationofMedicationsOtherThanNonprescriptionTopical

Medications

inhalant medication used to treat asthma on site during all hours when

a child who has a diagnosis of asthma and who has a prescription for

an inhalant medication to treat asthma is on-site.



(D)Thefacilityshallhavestafftrainedintheuseofanautomatic

prefilledcartridgeinjectororsimilarautomaticinjectableequipment

used

totreatanallergicreactiononsiteduringallhourswhenachild

withaprescriptionforanautomaticprefilledcartridgeinjector or

similarautomaticinjectableequipmentusedtotreatanallergic

reactionison‐site.



(3)OrderFromAnAuthorizedPrescriber/Parent'sPermission

(A)Exceptfornonprescriptiontopicalmedications

describedin

section19a‐79‐9a(a)(1)oftheRegulationsoftheConnecticutState

Agencies,nomedication,prescriptionornonprescriptionshallbe

administeredtoachildwithoutthewrittenorderofanauthorized

prescriberandthewrittenpermissionofthechild'sparent(s)which

shallbeonfileatthefacility

foratleasttwo(2)yearsafterthechildis

nolongerattendingtheprogram.



(5)StorageandLabeling

(A)Medicationshallbestoredintheoriginalchild‐resistantsafety

container.Thecontainerorpackagingshallhavealabelwhich

includesthefollowinginformation:

(i)thechild'sname;

(ii)the

nameofthemedication;

(iii)directionsforthemedication'sadministration;and

(iv)thedateoftheprescription.



8. DayCareRegulationsandStatutes

KeyPoint!

StateDayCareLicensingrequires

anIndividualPlanofCarein

additiontoamedication

authorization.

 



24



CleaningandDisinfecting

19a‐79‐7a. Physical Plant Toilet and

WashingFacilities



19a‐79‐10. Physical  Plant Linens and

ClothingandBedding



19a‐79‐10.ToysandOtherObjects







SanitizersandDisinfectantsforDayCares



*UsetheEnvironmentalProtection

Agenciesdefinitionandlistofapprove d

productsat:http://www.epa.gov/



 

 (G)(5)Walls,

ceilings,floorsandrugsshallbemaintainedinastateof

goodrepairandbewashableoreasilycleanable. 



(2)Allchildren'slinensshallbewashedatleastweeklyandasneeded.

(4) When cribs and cots are shared, they must be washed and

disinfectedandlinenschangedbetweenchildren.



(1) Toys used for infants shall be kept separate, washed and

disinfected atleast daily. Toys for toddlers, includingfloor and riding

toys,shallbewashedanddisinfectedatleastweekl yandasneeded.





Environment

19a‐79a.PesticideApplicationsatDay

CareFacilities



*PublicActNo.99‐165,Sec.2Pesticide

ApplicationsatSchoolsandDayCare

Centers.Thisisinadditiontowhatisin

theStateLicensingDayCareRegulations.



(b)Noapplicationofpesticidemaybemadeinanybuildingoronthe

groundsofanychilddaycarecenter,group daycarehomeorfamily

daycarehome,eachasdescribedinsection19a‐77,duringregular

businesshoursexceptthatanemergencyapplicationmaybemadeto

eliminate

animmediatethreattohumanhealthif(1)itisnecessaryto

maketheapplicationduringregularbusinesshours,and(2)such

emergencyapplicationdoesnotinvolvearestrictedusepesticide,as

definedinsection22a‐47.Nochildenrolledatsuchcenterorhome

mayenteranareawhere

pesticideshavebeenapplieduntilitissafe

todosoaccordingtotheprovisions onthepesticidelabel.

*Sec.2.(NEW)OnandafterJuly1,2000,noperson,otherthana

pesticideapplicatorwithsupervisorycertificationmayapplypesticide



KeyPoint!

Sanitizer–Asanitizerreducesbutdoesnotnecessarilyeliminate

microorganismsonatreatedsurfacetolevelsthatareconsidered

acceptableaccordingtocurrenthealthcodesorregulations.EPA

registersfood‐contactsurface sanitizersforsurfacessuchassanitizing

rinsesfordishes,utensilsandfoodprocessingequipment,andnon

‐

food‐contactsurfacesanitizers.

Disinfectant–Adisinfectantdestroysorirreversiblyinactivates

microorganisms,butnotnecessarilytheirspores,onhard,inanimate

surfacesandobjects.EPAregistersthreetypesofdisinfectantsbased

onthetypeofefficacydatasubmitted:Limited,General(orBroad‐

spectrum),andHospital.

 



25



Smoking

19a‐79‐7aPhysicalPlant



 (9)Smokingisprohibitedinallchilddaycarecentersorgroupdaycare

homesandoutdoorareasexceptindesignatedsmokingareas,

providedtheseareasareseparate,properlyventilatedandenclosed

awayfromanychildrenpresentatthefacility.Signsshallbeposted,

visible

tothepublic,onentrancetothefacilityindicatingthatsmoking

isprohibitedexceptindesignatedareas.Matchesandlightersshallbe

inaccessibletochildrenatalltimes.



FluShotRequirementsforDayCares



*FluGuidancechangeseachseasonto

ensureyouhavethemostup‐to‐dateflu

informationvisit: 

http://www.flu.gov/prof essional/school/



 InaccordancewithConnecticutGeneralStatutes(CGS)19a‐7f

(StandardofCareforImmunizationofChildreninConnecticut),

childrenwhoareenrolledorareenrolling

inalicensedfamilydaycare

home,alicensedchilddaycarecenteroralicensedgroupdaycare

homearerequiredtoshowproofofimmunitytoinfluenza.



ByJanuary1,2011andeachJanuary1thereafter,childrenaged6–59

monthsattendingachilddaycarecenter,groupdaycare

home,or

familydaycarehomeshallreceiveatleastonedoseofinfluenza

vaccinebetweenSeptember1andDecember31ofthepreceding

year.IfchildrenarevaccinatedduringAugustwiththeupcoming

seasonalfluvaccine,thesevaccinationswillbeacceptedandcount

towardthemandaterequirement.Allchildren

aged6–59monthswho

havenotreceivedvaccinationagainstinfluenzapreviouslyshall

receive2dosesofvaccine thefirstinfluenzaseasonthattheyare

vaccinated.ChildrenenrollingbetweenJanuary1andMarch31shall

receiveinfluenzavaccinepriortodaycareentry.Childrenenrolling

afterMarch31duringanygivenyearare

notmandatedtomeetthe

influenzavaccinerequirementuntilthefollowingJanuary,asthe

influenzaseasonhasgenerallypassedbythisdateandvaccinemayno

longerbeavailable.



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 

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

SampleFormsFlyers&Brochures



1. AsthmaActionPlan



2. AsthmaFriendlyChildCareChecklistfor

ParentsandProviders



3. DailyAsthma/AllergyCommunication

(English/Spanish)



4. IndividualPlanofCareForm



5. MedicationConsentForm





1. AsthmaTriggersintheChildCareEnvironment



2. CDCFluGuidelines



3. GreenCleaningRecipes



4. HowdoIKnowifmyChildShouldgottoChild

CareToday(English/Spanish)



5. CTNursesAssociation‐MedicationTraining



6. MajorCausesofFoodAllergies



7. QuitLine‐SmokingCessation



8. TipsforFamilieswhohaveChildrenwithAsthma

(English/Spanish)



 



 10.HandoutsandForms

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29



GovernmentAgencies



ConnecticutDepartmentofPublicHealth

AsthmaProgramWebpage



ConnecticutDepartmentofPublicHealth

DaycareLicensingProgram



ConnecticutDepartmentofPublicHealth

TobaccoProgramWebpage



 Providesthelatestinformationandeducationforchildcare

providers,children,and,parentsContacttheAsthmaProgramat

(860)509‐8251

www.ct.gov/dph/asthma 

Providesthelatestinformationandeducationforchildcare

providersTheChildDayCareLicensingHelpDeskiscoveredeach

dayduringcustomarybusinesshourstoassis tyouwithgeneral

questionsconcerningthelicensingregulationsandrequirements,

thechilddaycarelicensingprogram'spoliciesandprocedures,

verifystaffapprovalorother

generalinformation.Contactthe

DaycareProgramat(860)‐509‐8045http://www.ct.gov/dph/

Provideseducationinformationforthegeneralpublicandparents

ofchildrenregardingsmokeexposureandothertopicsrelatedto

smokingaswellassmokingcessationprograms.Contactthe

TobaccoProgramat(860)509‐8251

http://www.ct.gov/dph/

tobacco 



Parents



AsthmaMoms



YouCanControlAsthma:ABookforthe

FamilyandYouCanControlAsthma:A

BookforKids



TheFamilyDoctor

 



Anetworkofconcernedparentsofchildrenwithasthma.

Providesextensivelistsoflinkstoasthma‐relatedinformationfor

families,includingresourcesaboutasthmatriggers,medications,

legislation,medicalliterature,statistics,initiatives,andcamps.

InformationinSpanishisavailable.www.asthmamoms.com



Asetofeasy‐to‐readbooksinbothSpanishandEnglish.

Onebook

isforthefamilyandtheotherisforchildrenages6‐12tohelp

learneverythingaboutasthma.Orderbytelephone800‐7‐

ASTHMA.(AsthmaandAllergyFoundationofAmerica)



Asthmarelatedhealthinformationforthewholefamilybythe

AmericanAcademyofFamilyPhysicians.

http://familydoctor.org/online/famdocen/home/common/asthm

a/basics/014.html





 



30



Trainings

DayCareStaff:AmericanLung

Association



DayCareStaff:ConnecticutNurses

Association



DayCareNurseConsultants:Train‐the‐

trainercurriculumforlicensedmedical

consultants



AisForAsthma

Apreschooleducationalprogramdesignedforchildcare

professionalsinEnglishandSpanish.ItwasdevelopedbyChildren's

TelevisionWorkshopandfundedbythePrudentialFoundationfor

theAmericanLungAssociati on.Thefullybi‐lingualpackage

includes:a15‐minutevideo,aCaregiverGuidetosharewithother



adultsinyourchildcareprogramandaposterthatreinforcesthe

video'simportantmessages.Toorder,pleasecalltheAmerican

LungAssociationofConnecticutat(860)289‐5401orthenational

numberat800‐LUNGUSA.



MedicationAdministrationTraining

http://www.ctnurses.org/

ConnecticutMedicationAdministrationinEarlyEducationand

ChildCareSettingshttp://www.ct.train.org



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RespiratorySystem

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Sanitizer

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Triggers

 

Adeviceforadministeringmedicationsbyinhalation.



Amachinethatpumpsairthroughaliquidmedicinemakingthemedicine

bubbleuntilafinemistisformedthatisbreathedin.Itis

usuallyusedinthe

hospitaloratthedoctor’soffice.



Asmalltube‐likehand‐helddeviceusedtomeasurethespeedatwhicha

personcanpushairoutoftheirlungs.Monitoringpeakflowcantellhowwell

asthmaisbeingcontrolledevenbeforesymptomsappear.



Short

termmedicationsthatprovideimmediaterelieftotheairwaysduring

anasthmaattack.



Thegroupoforgansresponsibleforbreathing.Thisincludesthenose,throat,

airways,andthelungs.



Anagentreducestheamountofbacteriaonasurface.



Adevicethatattachestoaninhalerthathelpsdirect

themedicationintothe

lungs.Theseareusefulforveryyoungchildrenwhohavedifficultygetting

adequatemedicineintotheirlungswithaninhaleralone.



Physicalchangesorfeelingsexpressedhatshowadiseaseorconditionexists.

Forasthma,thesemaybecoughing,wheezing,breathingdifficulty,ora

tightnessin

thechest.



Activities,conditions,orsubstancesthatcausetheairwaystoreactand

asthmasymptomstooccur.Someexamplesofpossibleasthmatriggersare

dustmites,mold,changesintemperature,tobaccosmoke,andfurrypets.

Triggersaredifferentforeachperson.



 

Name: Birth Date: Date:

Parent/Guardian Phone #’s: Provider Phone #:

Fax #:

(or stamp)

Important! Things that make your asthma worse (Triggers): ☒ smoke ☐ pets ☐ mold ☐ dust

☐ tree/grass/weed pollen ☐ colds/viruses ☐ exercise ☐ seasons: other:

Severity Classification: ☐ Severe Persistent ☐ Moderate Persistent ☐ Mild Persistent ☐ Intermittent



Make an appointment with your primary care provider within two days of an emergency visit, hospitalization, or anytime for ANY problem or question with asthma

SchoolNurse:Call provider for control concerns or if rescue medication is used more than 2 times/week for asthma symptoms

Parents: Call your doctor for control concerns or if rescue medication is used more than 2 times/week for asthma symptoms

EALTHCARE PROVIDER SCHOOL MEDICATION AUTHORIZATION REQUIRED FOR ___________________as stated in accordance with CT State Law and Regulations 10-212a

Self–Administration:  This student is capable to safely and properly self-administer this medication OR  This student is not approved to self-administer this medication

Signature:_________________________________Provider Printed Name:___________________________Date:_____________ For use from ______ to ______

Parent/Guardian Consent: REQUIRED

 I authorize this medication to be administered by school personnel OR  I authorize the student to possess and self-administer medication.

I also authorize communication between the prescribing health care provider, the school nurse, the school medical advisor and school-based clinic providers necessary for

asthma management and administration of this medication.

Parent/Guardian Signature: ____________________________________ Date: _____________ * Bring asthma meds and spacer to all visits

You have any of these:

 First signs of a cold

 Exposure to known trigger

 Cough

 Wheeze

 Tight chest

 Coughing at night

Your asthma is

getting worse fast:

 Medicine is not helping

 Breathing is hard and fast

 Nose opens wide

 Can’t talk well

 Getting nervous

GO – You’re Doing Well! USE THESE MEDICINES EVERY DAY TO PREVENT SYMPTOMS

CAUTION – Slow Down! Continue with Green Zone Medicine and Add:

DANGER

–

Get Hel

! TAKE THESE MEDICINES

ND SEE

MEDICAL HELP NOW!

You have all of these:

 Breathing is good

 No cough or wheeze

 Sleep through

the night

 Can work

and play

CONTROLLER MEDICINE DIRECTIONS

___________________________________ ______________________________________

☐Ifyourchildusuallyhassymptomswithexercisethengive:

___________________________________ ______________________________________

 Inhalers work better with spacers. Always use with a mask when prescribed.

RESCUE MEDICINE DIRECTIONS



___________________________________________________________________________

Then:Wait20minutesandseeifthetreatment(s)helped

 IfyouareGETTINGWORSEorNOTIMPROVINGafterthetreatment(s)GOTOREDZONE

 IfyouareBETTER,continuetreatmentsevery4to6hoursasneededfor24to48hours

Then: Ifyoustillhavesymptomsafter24hours,CALLYOURDOCTORandifhe/sheagrees:

 Start:

________________________________________________________________



Ifrescuemedicationisneededmorethan2timesaweek,callyourdoctorat:_______________________

RESCUE MEDICINE DIRECTIONS



_____________________________________________________________________________

Then: Wait15minutesandseeiftreatmenthelped

 IfGETTINGWORSEorNOTIMPROVING,gotothehospitalorcall911

 IfyouaregettingBETTER,continuetreatmentsevery4to6hoursandcallyourdoctor–sayyouare

havinganasthmaattackandneedtobeseenTODAY

!

Then: Ifyourdoctoragrees,start:_________________________________________________

Peak Flow may be useful

for some kids.

Asthma Action Plan

Ages 0 – 11 Years

STATE OF CONNECTICUT

DEPARTMENT OF PUBLIC HEALTH

www.ct.gov/dph/asthma

STATE OF CONNECTICUT

DEPARTMENT OF PUBLIC HEALTH

www.ct.gov/dph/asthma

Nombre de paciente: Fecha de nacimiento: Fecha:

# teléfono del Padre/Guardián: # teléfono del Médico:

# fax:

¡Importante! Cosas que hace peor el asma: □ humo □ mascotas □ moho □ polvo

□ polen de árbol/hierba □ resfriado/virus □ ejercício □ cambio de clima: □ otras cosas:

Clasificación de Severidad: □ Severo persistente □ Moderado persistente □ Leve persistente □ Leve Intermitente

 Haga una cita con su proveedor de cuidado primario dentro de dos días a partir de una visita al ED o una hospitalización, o en cualquier momento para cualquier

problema o pregunta sobre asma.

SchoolNurse:Call provider for control concerns or if rescue medication is used more than 2 times/week for asthma symptoms

Padre/Guardián: Llame al médico para discutir preguntas sobre control del asma o si uso de medicina de rescate es más que 2 veces/semana

EALTHCARE PROVIDER SCHOOL MEDICATION AUTHORIZATION REQUIRED FOR ___________________as stated in accordance with CT State Law and Regulations 10-212a

Self–Administration:  This student is capable to safely and properly self-administer this medication OR  This student is not approved to self-administer this medication

Signature:_________________________________Provider Printed Name:___________________________Date:_____________ For use from ______ to ______

Padre/Guardián: OBLIGATARIO

 Autorizo al empleados medicos de la escuela para dar estas medicinas a mi niño/a O  Autorizo al estudiante para tener estas medicinas y tomárselas a si mismo

Autorizo también la comunicación, entre el médico que prescribe las medicinas, la enfermera escolar, el consejero médico escolar, y professionales de clínica basados en la

escuela que es necesario para el manejo de asma y administración de estas medicinas.

Firma del Padre/Guardián: ___________________________ Fecha: _____________ Traiga medicinas para asma y espaciador a todas citas.

Rápidamente, su asma

está empeorando:

 La medicina no le ayuda

 Respiración es difícil y rápido

 Las fosas nasales se abre ancha

 No puede hablar bien

 Se

one nervioso

Si tiene estos sintomas:

 Síntomas iniciales del resfriado

 Contacto con alguna cosa que

provoca asma

 Tos

 Sibilancia

 Pecho apretado

 Tos por la noche

Usted tiene todos estos

sintomas:

 Respira bien

 No hay tos o sibilancias

 Duerme toda la noche

 Puede trabajar y jugar

Proceda – ¡Está haciendo bien! USE ESTAS MEDICINAS CADA DÍA PARA PREVENIR SÍNTOMAS

PRECAUCIÓN – ¡Detengase! Continúe con medcina de la Zona Verde y Añade:

MEDICINA DE CONTROL COMO DEBERÍA TOMARLA

___________________________________ ______________________________________

☐SiporlogeneralsuniñotienesÍntomasdeasmaduranteelejercicio,déle:

___________________________________ ______________________________________

 Inhaladores funciona mejor con un espaciador.

Siempre use con el espaciador con mascarilla o boquilla.

MEDICINA DE RESCATE COMO DEBERÍA TOMARLA



___________________________________________________________________________

Entonces:Espere20minutosyevalúesieltratamientoayudó

 SiESTÁEMPEORANDOoNOHAYMEJORÍAdespuésdeltratamiento,PROCEDAALAZONAROJA

 SiHAYMEJORÍA,continúeconlamedicinaendosisindicadacada4a6horascomonecesario

durante24a48horas

Entonces:Sitodavíatienesíntomasdespúesde24horas,LLAMEASUMÉDICO.Sié

l/ellaestádeacuerdo:

 Empiece:________________________________________________________________



Sinecesitamedicinaderescatemásquedosvecesenunasemana,llameasumédico:_________________

MEDICINA DE RESCATE COMO DEBERÍA TOMARLA



_____________________________________________________________________________

Entonces:Espere15minutosyevalúesieltratamientoayudó

 SiESTÁEMPEORANDOoNOHAYMEJORÍA,vayaalhospitalollame911

 SiHAYMEJORÍA,continúeconlamedicinaendosisindicadacada4a6horasyllameasumédico–

DígalequeestáteniendounataquedeasmaynecesitaunacitaHO

Y!

Entonces:Siél/ellaestádeacuerdo,empiece:_________________________________________________

Información sobre flujo máximo

podría ser útil para niños que no

perciben bien sus síntomas.

Plan de Acción Contra el Asma

Niños 0 – 11 años

PELIGRO

–

Obten

a a

uda! TOME ÉSTAS MEDICIN

SYCOJA

YUDA MEDICA AHORA MISMO!

■

TIPS for PARENTS with CHILDREN with ASTHMA

 Letthechildcareproviderknowthatyourchildhasasthma.



 Determinewhetherornotyourchildcareprovideradministers

medication.



 Letthechildcareproviderknow:

 Whattriggersyourchild’sasthma

 Ifyourchildistakinganymedications

 Thesymptomsyourchildusuallyexhibitsbeforean

attack



 Provideacopyofyourchild’sAsthmaActionPlan.Makesureboth

youandtheproviderunderstandtheAsthmaActionPlanandagree

onthestepstofollow.TheAAPdescribesstepstotakeifachildwith

asthmaisexperiencinganyasthmasymptoms.



 IfyourchilddoesnothaveanAsthmaActionPlan(AAP),talktoyour

healthcareprovideraboutgettingone.Besuretodiscussstepsto

takeintheeventoftheasthmaattack,ifyourchilddoesn’thavean

AsthmaActionPlan.



 Ifyourchildrequiresasthmamedication,besuretogivethechild

careprovidermedicationintheoriginalpharmacycontainer.

MedicationmustalwaysbeaccompaniedbyaMedication

AuthorizationFormcompletedbythechild’shealthcareprovider.



 Talktoyourchildcareproviderregularlyaboutyourchild’sasthma.

Itisagoodideaforparentsandproviderstocommunicateaboutthe

child’sasthmasignsorsymptomseveryday.



 Makesurethecontactinformationyougiveyourchild

careprovideriscurrentandup‐to‐date.Thisisvery

important,sothatyoucanbereachedinthecaseofan

emergency.

How Do I Know if My Child

Should Go to Child Care Today?

May attend child care if:

 Child has a stuffy nose, but no wheezing

 Child has wheezing which goes away after taking medication

 Child is able to perform usual activities (getting dressed,

eating) without using extra effort to breathe

The child should not attend child care if:

 Wheezing or coughing continues after treatment

 Child has trouble breathing or is breathing fast

 Child has a fever over 100 degrees

 Child is too weak or tired to take part in normal

activities (dressing self, eating)

Adapted from: Illinois Department of Human Services

StateofConnecticutDepartmentofPublicHealth

CommunityHealthandPrevention

AsthmaProgram

410CapitolAvenue,MS#11HLS,POBox340308

Hartford,CT06134‐0308

Phone:(860)509‐8251,Fax:(860)509‐7854



http://www.ct.gov/dph/asthma

Fish

Milk

Eggs

Peanuts*

Shellfish

Soy

Tree Nuts

(Walnuts, Pecans)

Wheat

*Peanuts are the leading cause of severe allergic reactions.

From The Food Allergy Network

Breathe Easy While Cleaning

Hazardous chemicals can often be found in common cleaning products. For example, products containing

ammonia or chlorine bleach are highly irritating to the lungs and are harmful to the environment if disposed

improperly. Companies are not required to list ingredients so you may not be able to tell if hazardous

chemicals are in the product. Protect yourself by looking for the signal word on product labels. Below

is a chart to help you understand what the signal words mean. Look for environmentally-friendly,

healthier cleaning products that are now available in most stores or you can make your own.

For more information and recipes (such as furniture polish and drain cleaner), visit www.ct.gov/deep/greencleaning.

CT Department of Environmental Protection, 79 Elm St., Hartford, CT 06106-5127, (860) 424-3297. Revised 03/2012

Recipes for Healthy Cleaners

All Purpose Cleaner – Pour 3 Tablespoons vinegar, 1 teaspoon borax and 2 cups hot water into a spray bottle.

Shake until dissolved. Then add 1 teaspoon liquid soap (or dishwashing liquid) to the bottle and shake it again. Spray

on surface and then wipe clean. For tough dirt, leave cleaner on for a few minutes and then wipe off.

Glass Cleaner – Pour 2 Tablespoons of vinegar and 2 cups of water into a spray bottle. Add 2 drops of

liquid soap (or dishwashing liquid) and shake to mix. Spray on glass and wipe with lint-free cloth. Dry off

with a second lint-free cloth.

Sink, Tub and Tile Cleaner – Sprinkle on baking soda, rub with wet sponge or scrub cloth and rinse.

For mineral deposits, soak a cloth in vinegar and leave it on the deposit for about an hour and then

clean off area. For soap scum deposits, spread liquid soap or clarifying shampoo on the surface and

leave it for about an hour. The deposits will be softened and then can be cleaned away with a scrub

cloth or a brush. For mold or mildew, make a paste of borax and water and put it on the surface to

be cleaned. Leave paste on the area for about an hour and then scrub it off.

Toilet Bowl Cleaner – Squirt vinegar from squeeze bottle under the rim. Pour about ½ cup borax into

the toilet and use a toilet brush to clean the bowl. For mineral deposits, leave mixture in toilet for at

least an hour. Then use the brush again to clean. Use the all-purpose cleaner and a sponge or scrub cloth

to clean the seat and outside of the bowl.

Oven Cleaner – Make sure oven is turned off. Make a paste of baking soda and

water and put on the sides and bottom of the oven. Let it set overnight. Scoop out baking soda and

then wipe clean with damp cloth. Use scouring pad for tough spots.

Hazard Level

Signal

Word

What the Label Means

MOST DANGEROUS

POISON

Highly toxic

DANGER

Extremely flammable,

corrosive or highly toxic

WARNING

Moderate hazard

LEAST DANGEROUS

CAUTION

Mild or moderate hazard

Tobacco Use Cessation Programs in Connecticut

Connecticut Quitline

Telephone Tobacco Use Cessation Assistance available 7 days a week

1-800-QUIT-NOW, or 1-800-784-8669

Birmingham Group Health Services, Inc. ***

435 East Main Street

Ansonia, CT 06401

Attn: Pamela Mautte

203-736-8566

Harbor Health Services***

14 Sycamore Way

Branford, CT 06405

Attn: Maggie Goodwin

203-483-2630 Ext. 241

Bridgeport Hospital QuitSmart

267 Grant Street

Bridgeport, CT 06610

Attn: Gretchen May Fendo

203-336-7375

St. Vincent’s Medical Center Foundation

Teen Smoke Stoppers Program

2800 Main Street

Bridgeport, CT 06606

Attn: Mary Ellen Bolcer

203-576-5451

Mountainside Treatment Center

Nicotine Anonymous

P.O. Box 717

Canaan, CT 06018

Attn: Matt Eikan

800-762-5433

Danbury Hospital

Quit Now Smoking Cessation Program

24 Hospital Avenue

Danbury, CT 06810

Attn: Marianne Mitchell

203-739-8161

United Services, Inc. ***

1007 North Main Street

PO Box 839

Dayville, CT 06241

Attn: Earl Henrichon

860-774-2020

American Lung Assoc. Helpline

45 Ash Street

East Hartford, CT 06108

Attn: Michelle Marichal

860-838-4370

Intercommunity, Inc. ***

281 Main Street

East Hartford, CT 06118

Attn: Jessica LeRoy

860-690-1707

Town of Fairfield

725 Old Post Road

Fairfield, CT 06824

Attn: Sarah Levy

203-256-3150

Uconn Health Center

Smoking Cessation

263 Farmington Ave

Farmington, CT 06032

Attn: Peter Krzykowski

860-679-3136

Attn: Karen

860-372-8418

Greenwich Hospital

Community Health Smoke Stoppers

5 Perryridge Road

Greenwich, CT 06830

Attn: Diane DeMain

203-863-3786

Ledge Light Health District

943 North Road

Groton, CT 06340

Attn: Kerensa Mansfield

860-448-4882

Town of Guilford Health Dept.

VNA Community Healthcare

50 Boston Street

Guilford, CT 06437

Attn: Kathy Hand

203-458-4239

Hartford Behavioral Health ***

One Main Street

Hartford, CT 06106

Attn: Judith Vazquez

860-727-8703

Hartford Hospital

80 Seymour Street

Hartford, CT 06102

Attn: Jeremy Barbagallo

860-545-3127

St. Francis Hospital & Medical

Center

Break Free From Smoking

114 Woodland Street

Hartford, CT 06105

Attn: Sally Lerman

877-783-7262

Rushford Center ***

883 Paddock Avenue

Meriden, CT 06450

Attn: Melissa Hall

203-630-5280

City of Meriden **

Dept. of Health and Human

Services

165 Miller Street

Meriden, CT 06450

Attn: Geralyn Laut

203-630-4003

Life Changes LLC

193 Main Street

Middletown, CT. 06457

Attn: Andrew Degling

860-944-1171

Middlesex Hospital Center for

Chronic Care Management **

80 South Main Streets

Middletown, CT 06457

Attn: Beth Roberts

860-358-3003

Bridges: A Community Support

System ***

949 Bridgeport Avenue

Milford, CT 06460

Attn: Jane Skolnick

203-878-6365

BecomeAnEX.org

Re-learn Life Without Cigarettes

National Alliance for Tobacco Cessation

Milford Hospital Education

Dept, Freedom From Smoking

300 Seaside Avenue

Milford, CT 06460

Attn: Diane Frankel Gramelis

203-876-4003

AIDS Project New Haven, Inc.

1302 Chapel Street

New Haven, CT 06511

Attn: Seph Mayo

203-624-0947 Ext. 227

Fair Haven Community Health

Clinic, Inc.

374 Grand Ave

New Haven, CT 06513

Attn: Anne Somsel

203-777-7411

Fellowship Place***

441 Elm Street

New Haven, CT 06511

Attn: Carol Legmen

203-401-4227 Ext. 127

Hospital of Saint Raphael **

Haelen Center

1450 Chapel Street

New Haven, CT 06511

Attn: Doreen DeCerbo

203-789-4146

Yale School of Medicine

50 York Street

New Haven, CT 06511

Attn: Susan Neveu

203-974-7588

VA CT Healthcare System

Smoking Cessation Treatment

555 Willard Avenue

Newington, CT 06111

Attn: Regina Gilbert

860-594-6302

New Milford Hospital Freshstart

21 Elm Street

New Milford, CT 06776

Attn: Dorothy Christman

203-794-5429

Newtown Health District *

3 Primrose Street

Newtown, CT 06470

Attn: Donna Culbert

203-270-4291

Girl Scouts of Connecticut

20 Washington Avenue

North Haven, CT 06473

Attn: Cathy Monckton

203-239-2922 Ext 3342

Norwalk Hospital Stop Smoking

34 Maple Street

Norwalk, CT 06856

Attn: Margaret Haggerty

203-852-2484

Day Kimball Hospital

Wellness Program

320 Pomfret Street

Putnam, CT 06260

Judith Hansen

860-928-6541 Ext. 2015

The Stamford Hospital

Tully Health Care Center

32 Strawberry Hill Court

Stamford, CT 06904

Attn: Mary Judge

203-276-7875

Charlotte Hungerford Hospital

Pulmonary Education (FFS)

780 Litchfield Street

Torrington, CT 06790

Attn: Sandy Markus

860-738-6661

Heart Center of Greater

Waterbury

Freedom from Smoking

1075 Chase Parkway

Waterbury, CT 06722

Attn: Mary Hallenbeck

203-575-1992

Tobacco Use Prevention & Control

Program

410 Capitol Avenue

Hartford, CT 06134

860-509-8251

www.ct.gov/dph/tobacco

Generations Family Health

Center

Healthcare Access & Promotions

1315 Main Street

Willimantic, CT 06226

Attn: Giselle Lopez

860-450-7456

Community Health Resources***

995 Day Hill Road

Windsor CT. 06095

Attn: Malike Jonas

860-646-3888

National Cancer Institute

U.S. National Institutes of Health

800-4-cancer (800-422-6237)

www.cancer.gov

* Program funded from 7/1/11-

6/30/12 by DPH with funding

from the Preventive Health

Block Grant

** These community-based

programs are funded from

11/01/11 to 10/31/13 by DPH

through Tobacco and Health

Trust Funds

*** These tobacco use cessation

services target individuals with

mental illness, funded by DPH

through Tobacco and Health

Trust Funding for the period

from 9/1/09 to 12/31/2012

Child’s Name ____________________________________________ Date ______________________

Child’s Current Physical – Emotional Status (Check or circle those that apply)

Current Symptoms (Check or circle those that apply)

Factors that may have triggered these symptoms:

❑ Tired

❑ Increased appetite

❑ Decreased appetite

❑ Restless/fussy

❑ Trouble feeding (sucking)

❑ Other:

❑ Hyperactive/agitated

❑ Needs extra attention

____________________________________________

❑ Coughing

❑ Runny nose

❑ Sneezing

❑ Wheezing

❑ Congested

❑ Itching:

❑ Upset stomach

❑ Nauseated

❑ Other:

______________

❑ Physical activity

❑ Insect sting

❑ Exposure to

❑ Other:

_____________________________________________

________________________________________

Note: This form is provided as a tool to facilitate daily communications between parents/guardians

and child care providers. Please refer to the child’s Asthma Action Plan for the routine plan of care.

Adapted from: Asthma & Allergy Essentials for Child Care Providers. Asthma and Allergy

Foundation of America (AAFA).

Infor

mation for Parent/Guardian

In addition to the normal daily medications, the following were given to your child today:

What ___________________ How Much ___________________ When ___________________

____________________ ____________________ ___________________

Peak flow readings today were: _____________________________________________________

Other information:

_________________________________________________________________________________

Activity level for today:

❑ Normal activity (running and active play) ❑ Quiet indoor activity only

❑ Outdoor activity with no running

Child Care Provider

aily Asthma/Allergy Communication

Child Care Provider to the Family

Nombre del Niño _________________________________________ Fecha ______________________

Estado Físico-Emocional Actual del Niño (Marque o haga un círculo en los que apliquen)

Síntomas Actuales (Marque o haga un círculo en los que apliquen)

Factores que pueden haber desencadenado estos síntomas:

❑ Tos

❑ Nariz coriza

❑ Estornudos

❑ Sibilancias

❑ Congestionado

❑ Picazón:

❑ Descompostura estomacal

❑ Con náuseas

❑ Otro:

________________

❑ Actividad Física

❑ Picadura de insecto

❑ Exposición a

❑ Otro:

_______________________________________________

________________________________________

Nota: Este formulario se brinda como herramienta para facilitar las comunicaciones diarias entre

padres/tutores y proveedores de cuidado infantil. Por favor consulte el Plan de Acción contra el

Asma del niño para el plan de cuidado de rutina.

Adaptado de: Asthma & Allergy Essentials for Child Care Providers. Asthma and Allergy Foundation of

America (AAFA). (Conceptos Esenciales de Asma y Alergias para Proveedores de Cuidado Infantil. Fundación

de Asma y Alergias de (Estados Unidos de) América.

Información para el Padre/Tutor

Además de los medicamentos diarios normales, se le dieron los siguientes a su niño hoy:

Qué ____________________ Cuánto ____________________ Cuándo ____________________

_____________________ _____________________ _____________________

Los valores de flujo pico hoy fueron: _________________________________________________

Otra información:

_________________________________________________________________________________

Nivel de actividad hoy:

❑ Actividad normal (correr y juego activo) ❑ Sólo actividad tranquila bajo techo

❑ Actividad al aire libre sin correr

Del Proveedor del Cuidado Infantil

omunicación Diaria sobre Asma/Alergias

Del Proveedor del Cuidado Infantil a la Familia

❑ Cansado

❑ Apetito aumentado

❑ Apetito disminuido

❑ Inquieto/molesto

❑ Problemas para alimentarse (chupar)

❑ Otro:

❑ Hiperactivo/agitado

❑ Necesita atención extra

_____________________________________________________

ASTHMA – FRIENDLY CHILD CARE

A Checklist for Parents and Providers

Asthma is the most common chronic childhood disease. Children with asthma have sensitive airways. They are

bothered by many things that start (or “trigger”) their symptoms and make their asthma worse. The most

common asthma triggers are allergies to dust mites, cockroaches, animal dander, mold, and pollens, and

exposure to irritating smoke, smells, or very cold air. Children's asthma can also be triggered by excessive

exercise or an upper respiratory infection. The airways of people who have asthma are “chronically" (almost

always) inflamed or irritated, especially if they are exposed to their triggers every day. This makes it hard for

them to breathe.

Asthma can be controlled by being aware of its warning signs and symptoms, using medicines properly to treat

and prevent asthma episodes, and avoiding the things that trigger asthma problems. Each child's asthma is

different, so it is important to know the asthma triggers and treatment plan of each individual.

Use this checklist to learn how to make your child care setting a safe and healthy environment for children with

asthma and allergies, or to help you choose a health child care placement for your child.

Avoiding or Controlling Allergens

Dust mites

Needs

Improvement

O.K.

Surfaces are wiped with a damp cloth daily. (No aerosol "dusting" sprays are used.)



Floors are cleaned with a damp mop daily.



Small area rugs are used, rather than wall-to-wall carpeting. Woven rugs that can be

washed in hot water are best. (Water temperature of at least 130

F/54

C kills dust mites.)



If wall-to-wall carpeting can't be avoided, children are prevented from putting their faces,

nap mats, blankets or fabric toys directly on the floor.



Children's bed linens, personal blankets and toys, are washed weekly in hot water.



Fabric items (stuffed toys or "dress up" clothes) are washed weekly in hot water, to kill

dust mites.



Furniture surfaces are wiped with a damp cloth.



Soft mattresses and upholstered furniture are avoided.



Beds and pillows that children sleep or rest on are encased in allergy-proof covers.



Curtains, drapes, fabric wall hanging and other "dust catchers" are not hung in child care

areas.



If light curtains are used they are washed regularly in hot water.



If window shades are used, they are wiped often with a damp cloth.



Books, magazines and toys are stored in enclosed bookcases, closed boxes, or plastic

bags.



Supplies and materials are stored in closed cabinets; piles of paper and other clutter are

avoided.



Animal substances:

(both pets and pests shed dander, droppings and other proteins which cause allergic responses and trigger

asthma symptoms)

Needs

Improvement

O.K.

Furry or feathered pets are not allowed anywhere on the premises (cats, dogs, gerbils,

hamsters, birds, etc.).



Cockroaches and mice infestation are aggressively controlled, using preventive practices

and least toxic extermination methods.



Feather-stuffed furnishings, pillows or toys are not used.



Mold and mildew:

Needs

Improvement

O.K.

Exhaust fans are used in bathrooms, kitchens and basement areas to help remove humidity.



Wet carpeting and padding are removed if not dry within 24 hours to prevent mold growth.



Mats that are placed on carpeted floors (especially in basement areas) are vinyl-covered,

and wiped regularly with diluted chlorine bleach and water (1/4 cup bleach in 1 gallon

water).



Mildew growth in bathroom and other damp areas (such as refrigerator drip pans) is

prevented by regular wiping with diluted chlorine bleach and water.



Indoor houseplants and foam pillows, which can develop mold growth, are not used.



Outdoor pollen and mold spores:

Needs

Improvement

O.K.

If ventilation is adequate, windows are kept closed during periods of high pollen count



Air conditioners with clean filters are used during warm seasons, if possible.



Outdoor yard and play areas are kept clean of fallen leaves, compost piles, and cut grass.



Latex: (products made with natural rubber)

Needs

Improvement

O.K.

Avoid latex gloves. If gloves are used, only non-powdered, non-latex gloves.



Avoid latex balloons, pacifiers, koosh balls and other latex products (if child or staff

member has latex sensitivity).



Avoiding or Controlling Irritants

Tobacco Smoke: (triggers asthma symptoms; causes children to have more respiratory and ear infections, and to

need more asthma medication)

Needs

Improvement

O.K.

Smoking is not allowed anywhere on the premises. This rule is strictly enforced.



Staff and parents are encouraged to participate in smoking cessation programs, and given

referrals and assistance.



Chemical Fumes, Fragrances, and Other Strong Odors:

Needs

Improvement

O.K.

Arts and crafts materials with fragrances or fumes are avoided (e.g., markers, paints,

adhesives). If they are used, extra ventilation is provided.



Staff does not wear perfume or other scented personal products. (Use products labeled

"fragrance-free" whenever possible.)



Personal care products (such as hair spray, nail polish, powders) are not used around the

children.



Air fragrance sprays, incense, and "air fresheners "are not used. (Open the windows

and/or use exhaust fans instead.)



New purchases (such as pressed-wood furnishings or plastic laminated products) are

checked for formaldehyde fumes, and aired out before installation.



Cleaning supplies and home repair products with strong smells are not used when

children are present; indoor spaces are carefully ventilated during and after their use.



Office equipment that emits fumes (e.g., photocopy) are in vented areas away from

children.



Other Irritants:

Fireplaces and wood or coal stoves are not used.



Policies and Practices

Asthma Management and Care:

Needs

Improvement

O.K.

All staff are trained to watch for symptoms of asthma, warning signs that asthma is flaring

up, and how to recognize emergency situations. New staff receive this training when

hired.



Every child with asthma has a written plan on file, listing allergies and asthma triggers,

medication schedule, and emergency instructions.



Staff is trained to administer medication, and in the use and care all of nebulizers,

inhalers, spacers and peak flow meters.



Parents and providers communicate regularly about child's asthma status.



Outdoor time is adjusted for cold-sensitive children, and alternative indoor activities are

offered (after an asthma episode or viral infection, they are also more sensitive.)



Staff and children wash hands frequently; toys and surfaces are wiped often, to prevent

the spread of viral infections that can trigger asthma.



Ideas for improvement: _________________________________________________________

_____________________________________________________________________________

General Physical Site/Space:

Needs

Improvement

O.K.

Ventilation provides good air flow in all rooms and halls in every season. There is no

stale or musty smell. Outdoor intake and inside supply vents are checked for blockages.



Heating or cooling system filters are properly installed and changed often; other service

guidelines and routine maintenance procedures are followed.



Heating or cooling ducts are professionally cleaned once a year.



Outdoor fumes (such as from car exhaust, idling vans or buses, or nearby businesses) are

prevented from entering the building through open windows or doors.



The building is checked periodically for leaks and areas of standing water.



Plumbing leaks are fixed promptly.



Humidity level is monitored, using a humidity gauge, if possible. Humidifiers are not

used; dehumidifiers are used if necessary. (Dust mites and mold thrive on humidity.)



Wet boots and clothing are removed and stored where they don't track wetness into

activity space.



Doormats are placed outside all entrances, to reduce tracking in of allergens.



Cleaning and Maintenance:

Needs

Improvement

O.K.

If rugs or carpets must be used, they are vacuumed frequently (every day or two).



High efficiency vacuum cleaner (ideally with the "HEPA" filter) is used. (Others blow

tiny particles back into the air.)



Dusting is done often, with a damp cloth, to avoid stirring up the dust.



Vacuuming and other cleaning is done when children are not present.



Integrated pest management techniques are used, to limit amount of pesticide needed

(e.g., seal all cracks in walls, floors and ceilings; eliminate clutter; keep food in air tight

containers).



Pesticides are applied properly, with adequate ventilation, when children are not present.



Garbage is kept in tightly covered containers, and removed promptly to outdoor enclosed

trash area that is not accessible to children.



Painting, repairs or construction work is done when children are not present. Indoor

spaces are protected from construction dust, debris, strong odors and fumes.



Shampooing of rugs and upholstery is done with low emission, fragrance-free products.

They are dried thoroughly to prevent growth of mold and dust mites.



Ideas for improvement: _________________________________________________________

_____________________________________________________________________________

FAMILY DAY-CARE: Special Concerns

When children are cared for in "family day-care" settings, they are exposed to things that are part of daily life in that

household, some of which may be harmful for children with asthma. Parents and providers need to have honest

discussions about these issues, which may involve sensitive matters. For example:

 members of the provider’s family may smoke cigarettes in the home, or use strong smelling perfumes or lotions;

 the family may have pets, or acquire new pets, to which the asthmatic child is allergic;

 the home may have a wood stove, fireplace or space heater that produces particles or fumes that irritate sensitive

airways;

 home furnishings are likely to include upholstered chairs and sofas that contain dust mite allergen;

 hobbies or home repairs may produce fumes strong odors.

The habits and activities of a child care provider’s family may need to be adjusted, in order to provide a healthy

environment for all children who spend time in the household. Parents of children with asthma need to find out whether

asthma triggers are present. In some circumstances, they may need to make other child care arrangements. Child care

centers housed in public or private buildings may also have limits on their ability to improve their indoor air quality and

remove all asthma triggers.

This checklist was developed by the Asthma & Allergy

Foundation of America, New England Chapter, with the

support of a grant from the U.S. Environmental Protection

Agency, Region. I.

For more information:

Asthma & Allergy Foundation of America - New England Chapter

109 Highland Avenue, Needham, MA 02494 781-444-7778 (Toll Free: 1-877-2-ASTHMA)

Web-site: www.asthmaandallergies.org.

National Resource Center for Health & Safety in Child Care

www.nrckids.org; 800-598-KIDS

Qué hacer si su niño contrae la inﬂuenza

Los niños menores de 5 años corren mayor riesgo de desarrollar problemas

graves a causa de la inuenza. Los niños que tienen una enfermedad crónica

como el asma o la diabetes, por ejemplo, también corren mayores riesgos de

desarrollar problemas graves de inuenza.

Si su hijo tiene menos de 5 años o padece de una enfermedad crónica (como

el asma o la diabetes) y presenta con síntomas de inuenza, puede correr el

riesgo de desarrollar complicaciones graves a causa de esta enfermedad.

Si es necesario consulte a un médico para que examine a su hijo.

La mayoría de los niños mejorarán sin tener que acudir a un médico, pero

algunos niños pueden enfermarse gravemente con la inuenza. No importa

la edad que tengan: los niños con síntomas graves de inuenza deben

consultar al médico.

Los medicamentos antivirales para tratar la inuenza dan mejores resultados

si se administran dentro de los primeros 2 días (48 horas) de contraer la

enfermedad.

Es posible que el médico le recete medicamentos antivirales a su hijo

incluso después de las 48 horas desde que comenzaron los síntomas de la

inuenza, en especial si su hijo está hospitalizado o tiene más posibilidades

de desarrollar enfermedades graves a causa de la inuenza.

CS 236240-E/2012

INFLUENZA

(GRIPE)

Si su niño contrae la inuenza

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

INFLUENZA

(GRIPE)

Si su niño contrae la inuenza

Las personas tienen ebre cuando su temperatura es igual o mayor de los

100 grados Fahrenheit (37.8 grados Celsius). Si no tiene un termómetro,

toque la cara de su niño. Si la cara está más caliente de lo normal, enrojecida,

sudando o si el niño tiene escalofríos, es posible que tenga ebre.

Si su hijo tiene ebre, hay medicamentos que pueden ayudar a bajarla. Estos

se venden en tiendas (sin receta) y se pueden comprar sin dicultad. Otros

requieren una receta del médico. Hable con su médico para averiguar que

medicamento es indicado según la edad de su niño.

Existen medicamentos que se venden en tiendas (sin receta) que pueden

aliviar los síntomas de la inuenza en los niños. Consulte con su médico

para averiguar cuales de estos medicamentos son los adecuados para su hijo.

Tenga en cuenta que nunca debe darle aspirina a los niños que puedan tener

inuenza.

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

INFLUENZA

(GRIPE)

Si su niño contrae la inuenza

Mientras su hijo está enfermo, asegúrese de que descanse bien y beba

líquidos transparentes (como agua, caldo, bebidas para deportistas, bebidas

electrolíticas para bebés, Pedialyte®) a n de evitar la deshidratación.

Los niños pueden regresar a la escuela 24 horas después de que la ebre desaparezca SIN el uso de medicamentos

antifebriles.

Para reducir el contagio de la inuenza, su hijo debe permanecer en su

casa al menos 24 horas después de que la ebre desaparezca, excepto para

recibir atención médica.

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

INFLUENZA

(GRIPE)

Si su niño contrae la inuenza

Cosas que hacer en el hogar para evitar el contagio de la inﬂuenza:

Mantenga al niño enfermo en una habitación apartada el mayor tiempo

posible para limitar el contacto con las demás personas del hogar que no

están enfermas.

No permita que su hijo comparta alimentos o bebidas con otras personas.

Trate de que sea solo una persona la que cuide principalmente al niño

enfermo. En lo posible, la persona encargada de la atención no debe ser

alguien que corra un alto riesgo de sufrir complicaciones graves a causa de la

inuenza, como mujeres embarazadas o personas con enfermedades crónicas

como el asma o la diabetes.

Para obtener información, llame los CDC al 1-800-CDC-INFO (232-4636) o visite www.cdc.gov/u.

W:\Regulatory Services\Comm Program & Lic & Investigations\Division\Licensure\Grp&Ctr\Field Forms\G_C_AdminMeds.doc 05 2011 (Website)

Authorization for the Administration of Medication by Child Day Care Personnel

In Connecticut, licensed Child Day Care Centers, Group Day Care Homes and Family Day Care Homes administering

medications to children shall comply with all requirements regarding the Administration of Medications described in the State

Statutes and Regulations. Parents/guardians requesting medication administration to their child by daycare staff shall provide

the program with appropriate written authorization(s) and the medication before any medications are dispensed. Medications

must be in the original container and labeled with child’s name, name of medication, directions for medication’s

administration, and date of the prescription. All unused medication will be destroyed if not picked up within one week

following the termination of the authorized prescriber’s order.

Authorized Prescriber’s Order (Physician, Dentist, Physician Assistant, Advanced Practice Registered Nurse):

Name of Child ___________________________ Date of Birth ____/____/____ Today’s Date ____/____/____

Medication Name _____________________________________________ Controlled Drug? YES NO

Dosage ___________________ Method _________________ Time of Administration____________________

Specific Instructions for Medication Administration _______________________________________________

Medication Administration Start Date _____/_____/_____ Stop Date _____/_____/_____

Is this medication to be self-administered by the child? Yes No

Relevant Side Effects of Medication __________________________________________________________

Plan of Management for Side Effects _________________________________________________________

Known Food or Drug: Allergies? YES NO Reactions to? YES NO Interactions with? YES NO

If “yes” to any of the above, please explain _____________________________________________________

Prescriber’s Name ____________________________________ Phone Number (_____)_________________

Prescriber’s Address ________________________________________________ Town _________________

Signature ___________________________________________________

Parent/Guardian Authorization:

I request that medication be administered to my child as described and directed above and attest that I have

administered at least one dose of the medication to my child without adverse effects.

I request that medication be self-administered to my child as described and directed above.

Name of Day Care Program _____________________________________ Today’s Date _____/_____/_____

Child’s Name __________________________ Address __________________________Town_____________

Name of Parent/Guardian Authorizing Administration of Medication __________________________________

Relationship to Child: Mother Father Guardian/Other explain: _____________________________

Address _______________________________ Town ______________Phone Number (_____) ___________

Signature of Parent/Guardian Authorizing Administration of Medication _______________________________

Name of Childcare Personnel Receiving Written Authorization and Medication _____________________

Title/Position ____________________ Signature (in ink) ________________________________________

W:\Regulatory Services\Comm Program & Lic & Investigations\Division\Licensure\Grp&Ctr\Field Forms\G_C_AdminMeds.doc 05 2011 (Website)

Medication Administration Record (MAR)

Name of Child ___________________________________________ Date of Birth ______/______/______

Pharmacy Name _________________________________________ Prescription Number _______________

Medication Order__________________________________________________________________________

Date

Time

Dosage

Remarks

Was This

Medication Self

Administered?

Signature of

Person

Observing or

Administering

Medication

Yes No

*Medication authorization form must be used as either a two-sided document or attached first and second page.

Authorization form is complete Medication is appropriately labeled

Medication is in original container Date on label is current

Person Accepting Medication (print name)________________________________ Date _____/_____/_____

INDIVIDUALIZED HEALTH CARE PLAN

________________________________________________________________________________________________________________________

NAME: _____________________ DOB: _________ SEX: ____ ALLERGIES: _______________________ PHYSICIAN__________________

RELEVANT DIAGNOSIS (ES): _________________________________________________________________________________________

DIET: _____________________ MOBILITY: __________________________ EQUIPMENT: _______________________________________

MEDICAL HISTORY: _________________________________________________________________________________________________

MEDICATION/TREATMENT: __________________________________________________________________________________________

SIGNATURE: __________________________ SIGNATURE: _________________________ SIGNATURE: ___________________________

(parent) (student) (School Nurse)

________________________________________________________________________________________________________________________

HEALTH CARE GOAL

DATE

HEALTH PROBLEM/

NURSING DIAGNOSIS

STUDENT OBJECTIVES INTERVENTION AND RESPONSIBLE PERSON EVALUATION

AND TIMELINE

NAME: __________________________

DATE HEALTH PROBLEM/

NURSING DIAGNOSIS

STUDENT OBJECTIVES INTERVENTION AND RESPONSIBLE PERSON EVALUATION

AND TIMELINE

Adapted from Hartford Public Schools for use in Connecticut Department of Education Guidelines for Students with Special Health Care Needs.

Fill Online, Printable, Fillable, Blank Revised 2011 (Connecticut Office of Early Childhood) Form

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