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Out-of-Home Child Care/Day Care

Finding an out-of-home child care center is overwhelming for any parent and may seem doubly challenging for a parent of a child with a bleeding disorder. The suggestions below will help ease and conquer your stress. Remember, your Hemophilia Treatment Center (HTC) or local bleeding disorders organization is available for support.

Information on Center-Based Child Care

Center-based care, including preschools, may be organized by school districts, public or private agencies, religious groups, agencies serving handicapped children, or child development centers. Usually these centers serve children of working parents and are often open from very early in the morning to early in the evening. There are licensing requirements for the number of staff to children (called staff-child ratio). The required number depends on the age of the children, the size of the facility, the nature of the program, and the state in which the center is located.

In general, the staffing recommendations are:

  • Under 2 years old: 1 staff person to 3 children
  • 2-3 years old: 1 staff person per 8 to 10 children with a teacher’s aide
  • 3-4 years old: 1 staff person per 10 to 16 children with a teacher’s aide
  • 5-6 years old: 1 staff person per 20 children with a teacher’s aide

The program goals and policies at day care centers vary. Whenever possible, meet with the day care staff to discuss details of the center’s program and daily schedule to learn whether the facility and program meet your family’s needs. Feel free to ask any questions, including the questions provided below, keeping in mind your child’s habits, personality, needs, and likes and dislikes. Remember, although your child has a bleeding disorder, his or her needs are the same as that of any other child.

Here are some things to look for in a child care center and school:

  • Well-trained staff. The professional qualifications and training of staff are crucial to a quality program. Ask about the degrees and certificates held by the program’s director and teachers. Find out what steps they take to provide staff with ongoing training.
  • Group size. In addition to low child-to-teacher ratios, the overall size of the program is important. Look for a program with fewer than 6 to 8 infants in a group, 10 to 12 toddlers, and no more than 18 or 20 preschoolers.
  • Low staff turnover. Teachers who have been in a program longer establish bonds with the children, and those relationships help children grow and learn. Low turnover is also usually a sign that the program values good staff and works to keep them.
  • A safe and healthy environment. First and foremost, check that the program is licensed by the state. Make sure that the child care facility looks clean and that all children are under adult supervision at all times. Staff should be able to clearly describe health and safety procedures, as well as policies for handling emergencies.

Questions to Ask at Your Child Care Center Visit

You can make visits to day care centers and talk to their staff before you make a final decision. Below is a list of questions that you can use to begin a conversation. Think about the other things that are important to you. Make a list of your questions. Plan what you want to ask before you go.

  • Is the center licensed? Is the staff licensed? By whom?
  • How many of your staff are trained in CPR and first aid?
  • How are substitutes hired and used in case of staff illness? Do they have the same type and amount of training as your regular staff?
  • Do you have experience working with children with health issues? What types of health issues do you have experience with?
  • What ages do you serve? What ages are placed together?
  • What is the procedure for dealing with illness or accidents involving children?
  • Is your facility handicap accessible? What do you do if my child needs to use crutches, a wheelchair, or has mobility issues?
  • What is the procedure for reporting unusual marks on my child?
  • Does your staff carry emergency phones when taking children to activities outside the center’s facilities?
  • Do you have a regular schedule for each day?
  • What is the napping policy/procedure?
  • What regular communication plan is in place for your reporting on my child’s day-to-day activities? Does it include health- and diet-related information?
  • What kinds of meals are served? What provisions are made for special dietary needs, including allergies? Is there a menu?
  • Do you have a parent handbook?
  • What is your policy on parent visits?
  • Does your center hold meetings for parents?
  • What are the hours of operation? For what holidays is the center closed? What is the policy on late or early pick up or drop off?
  • What are the emergency preparedness plans in case the facility needs to be evacuated? How will you contact parents? Where does the center evacuate in an emergency? (For more information about emergency preparedness, see Emergency Preparedness and the Child Care Center section below)
  • Are you willing to keep my child’s medication (clotting factor) in the refrigerator for use in an emergency?
  • Will my child be allowed to take medication or infuse while at the center?

To print out a copy of the Questions to Ask at Your Child Care Center Visit, click icon:

Things to Look for When Visiting a Child Care Center

  • Are children occupied with activities? Are they playing together? Sharing? Fighting? Looking lost or bored?
  • Is the play equipment well designed, safe, creative, clean, and age-appropriate? Is there enough staff to supervise all the children on the equipment?
  • Does the staff relate to the children with patience and warmth?
  • Are staff members motivated to learn more about your child’s medical condition? Are they motivated to meet and learn from you and from your child’s healthcare providers?
  • How does it feel to be in the center? Does it feel tense? Cheerful? Relaxed? Will you be able to leave for work feeling comfortable about leaving your child in the care of this staff?

Emergency Preparedness and the Child Care Center

When you visit the child care center, you will want to ask how they properly prepare for fires, weather-related emergencies, and medical emergencies. It’s important that you feel comfortable that the center considers the safety and well-being of your child a top priority and that they have an emergency action plan firmly in place. This will also be the perfect opportunity to talk to them about your own family’s preparedness plan.

Here are some questions to ask the child care center about emergency preparedness:

  • Do you have a plan for local emergencies (such as hurricanes or snow storms), and is it possible to have a copy of the plan?
  • Do you have an evacuation plan to a safe, predetermined location? How will you evacuate children with mobility issues or special needs?
  • How and when will I be notified if there is an emergency? Do you have a central phone number that I can call? (some facilities also use e-mails and text messaging)
  • Have you and your staff been trained on the emergency plan? How often?
  • Do you have emergency drills for the children? For the parents?
  • Do you have supply kits to meet the children’s needs for an extended amount of time? For how long? Are you willing to keep an extra supply of my child’s medication for emergencies?
  • Do state and local emergency agencies know of your center and its location?
  • How do you notify parents of any updates or changes to the emergency plan?

To print out a copy of the Questions to Ask the Child Care Center About Emergency Preparedness, click icon: