When your baby has special needs, it adds another layer of stress to your quest to finding a trustworthy, capable child-care provider. "Under the Americans with Disabilities Act (ADA), licensed child-care facilities must be accessible and they can't refuse to provide care for an infant who has special needs," says Amy Houtrow, M.D., Ph.D., M.P.H., a member of the American Academy of Pediatrics' (AAP) Executive Committee for the Council on Children with Disabilities. (There are exceptions, including child-care centers run by religious entities such as churches.) Still, that doesn't mean it's easy to find a provider that has an opening for your baby and that meets your standard of care.
All states require child-care centers to be licensed; this means that they must meet minimum health, safety, and caregiver training standards. These facilities are subject to yearly inspections. But licensing is not an indicator of quality. You'll need to visit several centers and ask questions to find the one that is the best fit for your baby. While checking out the center, find out more about these important child-care criteria:
Ask for a dossier of the staff's training and education. Determine who will be your baby's primary caregiver and find out what (if any) special training or experience she has caring for children with disabilities. "Ideally, the provider should have some familiarity with special needs or at least be very willing to learn," says Adam Hartman, M.D., assistant professor of Neurology and Pediatrics at the Johns Hopkins Children's Center in Baltimore. You may be able to spend a few days at the center training your baby's caregiver or you can ask to bring in an aide to do this. Inquire about staff turnover, too. Getting used to a new caregiver can be difficult for both your baby and you. It's best if your baby has the same caregiver for at least a year.
Before you begin your quest, you should become familiar with your child's legal rights as guaranteed by the ADA. For instance, even though most child-care centers have policies prohibiting the administration of medication to children, this should not apply to your baby if she needs medicine to treat her disability. The center may ask you to provide instructions from your child's doctor. If your child needs adaptive equipment, such as a special feeding chair, the center is obligated by the ADA to provide it. Usually, child-care centers can get deductions or tax credits to offset the costs of purchasing this equipment.
Child-care experts recommend a ratio of no more than four infants per one adult. Your baby may require extra attention, so it's important that his caregiver isn't stretched too thin with the needs of multiple infants. Group size also matters. In general, your child will get better-quality individualized care if he is in a group of 10 one-year-olds with one adult caregiver instead of a group of 20 one-year-olds with two caregivers.
The staff at accredited child-care centers voluntarily receive additional training above and beyond state-mandated requirements. The National Association for the Education of Young Children (NAEYC) and The National Association for Family Child Care (NAFCC) offer child-care accreditation programs.
Child-care centers are breeding grounds for germs like the ones that cause the common cold. If your baby's disability places her at higher risk for health complications from infections, it's essential that the child-care center practice good sterilization and hygiene. "A high presence of alcohol-based hand gel, soap, and sinks are good signs," says Susanna McColley, M.D., professor of pediatrics at Northwestern University Feinberg School of Medicine in Chicago. Tables, cribs, and shared toys should be disinfected regularly. Get a printout of the center's policy on sick children and when they must stay home.
To learn more about finding a quality child-care center for your baby with special needs, visit the websites of Easter Seals and Child Care Aware. Children with disabilities and special needs make up 25 percent of enrollment at the 80 Easter Seals child-care centers operated nationwide. Child Care Aware, partly funded by the U.S. Department of Health and Human Services, connects parents with state child-care resource and referral agencies.
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