We don’t usually think of children with allergies or asthma as children with “special needs,” but they certainly are. In fact, children with these conditions are probably the most frequently encountered “special needs” children. Child care providers can do a great deal to help individual children manage their specific allergy or asthma needs and feel more comfortable in a child care setting.
Allergies
Children with allergies face the same social difficulties as do adults, but they have less maturity and emotional resources to deal with them. Children find that they cannot eat what their friends eat or cannot play outside during some seasons. Until a child is mature enough to understand why she cannot do something, you must be careful to help the child through the difficulties. Start teaching a child early on about what he is allergic to; you will not always be able to monitor everything.
Some foods can cause a life threatening reaction. The mouth, throat, and bronchial tubes swell enough to interfere with breathing. The person may wheeze or faint. Often there are generalized hives and/or a swollen face. This is an emergency!! Call the child’s doctor or your local emergency telephone number! For breathing trouble or loss of consciousness, call the emergency number immediately.
The most common inhaled allergen is household dust, or more precisely, dust mites and their wastes. Every house has them, no matter how clean. Other inhaled allergens include mold, pollen (hay fever), animal dander (especially from cats), chemicals, and per fumes.
The most common allergy symptoms are
� a clear, runny nose and sneezing,
� itchy or stuffed-up nose or itchy, runny eyes, and
� asthma (remember that not all people with asthma have allergies and not all allergies cause or develop into asthma).
Strategies for inclusion
Some parents have found that by volunteering to bring food to certain events, they can provide food their child can have. For example, a parent may want to bring an alternate birthday treat to a party if the child is allergic to wheat, chocolate or other common cake ingredients. If the allergy is life threatening, the parent must take special care to warn all adults who care for the child about the problem. For example, peanut allergies can be quite severe; a caregiver, child, or neighbor could innocently offer a peanut butter sandwich to the child without realizing the consequences.
Asthma
Asthma is a condition in which the airways of the lungs become either narrowed or completely blocked, impeding normal breathing. This obstruction of the lungs is reversible, either spontaneously or with medication.
Although everyone’s airways have the potential for constricting in response to allergens or irritants, the asthmatic child’s airways are oversensitive, or hypereactive. In response to stimuli, the airways may become obstructed by one of the following:
� constriction of the muscles surrounding the airway,
� inflammation and swelling of the airway, or
� increased mucus production that clogs the airway.
Once the airways have become obstructed, it takes more effort to force air through them, so breathing becomes labored. This forcing of air through constricted airways can make a whistling or rattling sound called wheezing. Irritation of the airways by excessive mucus also may cause coughing.
An asthma attack, also known as an asthma episode or flare, is any shortness of breath that interrupts the asthmatic’s well-being and requires either medication or some other form of intervention for the asthmatic to breathe normally again.
Bronchodilators are drugs that open up ordilate the constricted airways, while drugs aimed at reducing inflammation of the airways are called anti-inflammatories. For very young children, the nebulizer is the only practical means of administering inhaled medications. Make sure the child’s parents show you exactly what to do in the event of an asthma attack. Written instructions should also be provided.
If you have a child with allergies or asthma in your program, make sure you have a supply of the child’s medicine and know what to do in case of an attack. Know when and how to contact the child’s doctor and emergency phone numbers (as you would for any child).
Strategies for inclusion
Older children usually can take part in their own treatment, although supervision may be necessary. Ask the child’s parents what level of involvement, if any, the child has in treatment.
Look for ways to prevent or minimize the child’s exposure to allergens. For example, one mother complained that the groundskeeper mowed the lawn right outside her child’s classroom, despite the fact that the dust and pollen coming in the window frequently caused the child to have an allergic reaction. Working with the groundskeeper to alter the schedule for mowing would be a “readily achievable” accommodation for an allergic child.
Technical references
Dekker, C., Dales, R., Bartlett, S., Brunekreet, B. and Zwanenburg, H. (1991). Childhood asthma and the indoor environment.Chest100: 922-926.
National Institutes of Health (1991). Managing Asthma: A Guide for the Schools, NIH Publication No. 91-2650. National Heart, Lung and Blood Institute, Bethesda, Md.
Simeonsson, N., Lorimer, M., Shelley, B., and Sturtz, J.L. (1995). Asthma: New information for the early interventionist. Topics in Early Childhood Special Education 15(1): 32-43.
Taggart, V.S., and Fulwood, R. (1993). Youth health report card: Asthma. Preventive Medicine 22: 579 584.
