What regulation of the education and care services national Regulations covers giving medication for asthma?

​An important objective of the National Quality Framework is to ensure the safety, health and wellbeing of all children attending education and care services.

When a child who has a diagnosed health care need, allergy or relevant medical condition is enrolled at an education and care service additional requirements must be met to ensure that the child’s safety, health and wellbeing is protected.

If a child has a food preference or dietary restriction, for example not drinking cow’s milk as the parents do not want them to, this would not be considered a diagnosed health care need. Instead, this information would be included in the child enrolment record (regulation 160) by the health information to be kept in the enrolment record (regulation 162).

Once the enrolment record has been completed it should be reviewed to identify whether the child has a diagnosed health care need, allergy or relevant medical condition, specific health care need, allergy or relevant medical condition diagnosed by a registered medical practitioner the service is required to obtain a copy of the child’s medical management plan from the child’s parent and develop and document a risk minimisation plan in consultation with the parents of the child. These plans should be in place before the child commences at the service and be kept in the enrolment record for that child.

Services must have procedures in place for carefully considering enrolment records as part of the enrolment and orientation policy and procedure (regulation 168(2)(k)). Once enrolled, each child’s parents should be regularly consulted regarding any diagnosed health care needs, allergies or relevant medical conditions a child may have developed since enrolment.

When a child with a diagnosed health care need, allergy or relevant medical condition is enrolled at the service

Several issues must be considered when a child with a diagnosed health care need, allergy or relevant medical condition is enrolled at the service. Critically, key requirements must be in place before the child commences attending the service, with several other issues requiring consideration:

• Has the child’s parent provided a medical management plan for the child?
• Has a risk minimisation plan been developed in consultation with the parents of the child?
• Will it be necessary to adjust any of the usual practices of the service to be fully inclusive of the child?

An education and care program must be delivered to all children being educated and cared for that is designed to take into account the individual differences of each child (section 168(1)(d)). All aspects of the service’s operation should be considered about the child’s inclusion at the program and to ensure that their safety, health and wellbeing is protected at all times.

The nature of the specific health care need, allergy or relevant medical condition can vary significantly. Every reasonable precaution must be taken to protect children from harm and from any hazard likely to cause injury (section 167). For example, in some cases, it may be necessary for one or more staff members to access additional professional development or training to assist in meeting a child’s needs.

Each education and care service must have in place policies and procedures for dealing with medical conditions (regulations 168 and 90). This fact sheet presents the relevant requirements of the Education and Care Services National Regulations 2011.

Medical conditions policy

The medical conditions policy must (regulation 168) set out requirements for:

• the management of medical conditions diagnosed by a registered medical practitioner including asthma, diabetes or a diagnosis that a child is at risk of anaphylaxis
• informing the nominated supervisor, staff members and volunteers of practices about managing those medical conditions
• a communications plan that provides information about how the service will ensure that staff members and volunteers are aware of how the service manages any diagnosed health care needs, allergies or medical conditions of children at the education and care service; and how parents can communicate any changes to the service
• the practices about self-administration of medication by children over preschool age if the service permits self-administration and any practices relating to recording in the medication records where medication has been self-administered
• a child enrolled at the service who has a diagnosed health care need, allergy or relevant medical condition, to have in place:
  - a medical management plan provided by the parents of the child and for the medical management plan to be followed in the event of a related incident; and 
  - a risk minimisation plan developed between the service and the parents of the child (regulation 90).

This policy applies at any time that a child with diagnosed health care need, allergy or relevant medical condition is being educated and cared for by an education and care service, including during excursions. Preparations for high-risk scenarios, including establishing clear decision-making processes for calling an ambulance, should be addressed in the medical conditions policy.

The medical conditions policy must provide for the management of any medical condition that an enrolled child may have, which may not be limited to asthma, diabetes and a diagnosis that a child is at risk of anaphylaxis. Diagnosed health care needs, allergies or relevant medical conditions may be ongoing or acute/short term in nature.

The medical conditions policy must be followed (regulation 170) and be readily accessible and available for inspection at all times the service is educating and caring for children or on request (regulation 171). A copy of the medical conditions policy must be provided to the parent of a child enrolled at the service who has a diagnosed health care need, allergy or relevant medical condition (regulation 91).

When a child is enrolled who has a diagnosed health care need, allergy or relevant medical condition

A medical management plan and risk minimisation plan must be prepared for every child who is enrolled who has a diagnosed health care need, allergy or relevant medical condition (regulation 90(1)(c)). A registered medical practitioner will have been consulted in the diagnosis and management of a diagnosed health care need, allergy or relevant medical condition.

Medical management plan

A parent of the child must provide a medical management plan for the child. This medical management plan must be followed in the event of an incident relating to the child's diagnosed health care need, allergy or relevant medical condition (regulation 90(1)(c)(i) and (ii)).

The best practice is that the child’s registered medical practitioner is consulted by parents in the development of the medical management plan and that the advice from the medical practitioner is documented in the medical management plan. The medical management plan should detail the following:

• details of the diagnosed health care need, allergy or relevant medical condition including the severity of the condition
• any current medication prescribed for the child
• the response required from the service about the emergence of symptoms
• any medication required to be administered in an emergency
• the response required if the child does not respond to initial treatment
• when to call an ambulance for assistance.

Risk minimisation plan

A risk-minimisation plan must be developed in consultation with the parents of a child and ensure:

• that the risks relating to the child's diagnosed health care need, allergy or relevant medical condition are assessed and minimised
• if relevant, that practices and procedures are in place including the safe handling, preparation, consumption and serving of food are developed and implemented
• that the parents are notified of any known allergens that pose a risk to a child and strategies for minimising the risk are developed and implemented
• that all staff members and volunteers can identify the child, the child's medical management plan and the location of the child's medication are developed and implemented
• if relevant, to ensure that practices and procedures ensure that the child does not attend the service unless the child has at the service their relevant medications if this would pose a significant risk (regulation 90(1)(c)(iii)).

Communications plan

A communications plan must be prepared for the service as part of the medical conditions policy (regulation 90(1)(c)(iv)) to set out how:

• relevant staff members and volunteers are informed about the medical conditions policy; and, the medical management and risk minimisation plans for children at the service who have a diagnosed health care need, allergy or relevant medical condition
• a parent of the child can communicate any changes to the medical management plan and risk minimisation plan for their child.

The communications plan must set out how the above communication will occur. This document can be an overarching communications plan for managing all diagnosed health care needs, allergies or relevant medical conditions of children in the service and it is not required to be developed for each individual child. Further information can be found in the fact sheet Meeting children’s health needs

Child enrolment records

For a child enrolled at the service who has a diagnosed health care need, allergy or relevant medical condition, the health information kept in the enrolment record must include:

• details of any diagnosed healthcare needs of the child, including any medical condition and allergies, including whether the child has been diagnosed as at risk of anaphylaxis
• any medical management plan, anaphylaxis medical management plan or risk minimisation plan to be followed concerning a diagnosed healthcare need, medical condition or allergy and details of any dietary restrictions for the child (regulation 162).

Meeting the requirements for regulation 90 Medical conditions policy

​​Education and care services must:​Parents should be asked to:​All education and care services

• ​have a medical conditions policy in place that meets the requirements of regulation 90
• ensure that the nominated supervisor, staff members (including family day care educators, where applicable) and volunteers understand and implement the medical conditions policy
• review enrolment records and identify any children with medical conditions as part of the enrolment and orientation procedures for the service
• monitor the safety, health and wellbeing of all children being educated and cared for
• ensure all parents are regularly asked if their child has developed any diagnosed health care need, allergy or relevant medical condition.

• ​inform the service at any time of any diagnosed health care needs, allergies or relevant medical conditions for their child

​Before the enrolment of each child

• ​seek information from parents about any diagnosed health care need, allergy or relevant medical condition about individual children, including whether a medical practitioner has been consulted about the diagnosed health care need, allergy or relevant medical condition

• ​inform the service of any diagnosed health care need, allergy or relevant medical condition for their child before enrolment

For each child enrolled who has a diagnosed health care need, allergy or relevant medical condition

​Education and care services must:​Parents should be asked to:Before the first day of attendance at the service

• ​require a parent to provide a medical management plan for the child
• in consultation with the child’s parents, develop a risk minimisation plan for the child
• record any prescribed health information and keep the medical management plan, anaphylaxis medical management plan (if applicable) and risk minimisation plan on the enrolment record
• ensure any relevant authorisations for the administration of medication are recorded on the enrolment record.

• ​provide a medical management plan to the service for their child
• participate in the development of a risk minimisation plan about their child’s diagnosed health care need, allergy or relevant medical condition

During the attendance of the child at the service

• monitor the safety, health and wellbeing of the child
• regularly review the risk minimisation plan for the child
• ensure that parents are regularly asked to provide any updated information relating to the nature of, or management of, their child’s diagnosed health care need, allergies or relevant medical condition
• if necessary, ensure an updated medical management plan is provided by the child’s parents
• ensure the practices and procedures of the service are inclusive of the child.

• ​inform the service of any relevant changes relating to the nature of, or management of, the child's diagnosed health care need, allergies or relevant medical condition
• if necessary, provide an updated medical management plan for the child

Other considerations

• Every reasonable precaution must be taken to protect children from harm and from any hazard likely to cause injury (section 167). What precautions may be necessary to protect the safety, health and wellbeing of a child who has a diagnosed health care need, allergy or relevant medical condition?
• An education and care program must be delivered to all children being educated and cared for that is designed to take into account the individual differences of each child (section 168(1)(d). Will it be necessary to adjust any of the usual practices of the service to be fully inclusive of the child?

Notification of changes to the medical conditions policy

Parents of children enrolled at the service must be notified at least 14 days before making any change to the medical conditions policy if the change may have a significant impact on the service's provision of education and care to any child enrolled at the service, or the family's ability to utilise the service (regulation 172).

If the notice period would pose a risk to the safety, health or wellbeing of any child enrolled at the service, the parents of children enrolled at the service must be notified as soon as practicable after making a change to a relevant policy (regulation 172(3)).

Medication

In most cases, medication must not be administered to a child being educated and cared for unless the administration is authorised. The enrolment record kept for each child must include details of any person who is authorised to consent to medical treatment or administration of medication to the child (regulations 160 and 161).

A medication record is kept for each child to whom medication is to be administered by the service. The record must include the authorisation to administer medication (including, if applicable, self-administration, regulation 96), signed by a parent or a person named in the child's enrolment record as authorised to consent to the administration of medication (regulation 92).

The medical conditions policy of the education and care service must set out practices about self-administration of medication by children over preschool age if the service permits self-administration (regulation 90(2)).

In the case of an emergency, an authorisation may be given verbally by a parent or a person named in the child's enrolment record as authorised to consent to the administration of medication or, if such a person cannot reasonably be contacted in the circumstances, a registered medical practitioner or emergency service (regulation 93). Medication may be administered to a child without authorisation in case of an anaphylaxis or asthma emergency (regulation 94).

Incidents, injuries, trauma and illness

The incident, injury, trauma and illness policies and procedures must include procedures to be followed if a child is injured, becomes ill or suffers a trauma (regulation 85).

An incident, injury, trauma and illness record must be kept that includes details of any illness that becomes apparent while a child is being educated and cared for and details of any medication administered or first aid provided and any medical personnel contacted.

First aid, anaphylaxis management and emergency asthma management training

Centre-based education and care services

At least one educator who holds the following qualifications must be in attendance at any place where children are being educated and cared for by the service, and must be immediately available in an emergency, at all times that children are being educated and cared for by the service:

• at least one educator or one nominated supervisor who holds a current approved first aid qualification
• at least one educator or one nominated supervisor who has undertaken currently approved anaphylaxis management training
• at least one educator or one nominated supervisor who has undertaken approved emergency asthma management training (regulation 136(1)).

A person may hold one or more of the above qualifications. Where children are being educated and cared for on a school site this requirement may be met if the educator(s) or at least one staff member of the school are in attendance at the school site and are immediately available in an emergency.

Family daycare services

A family daycare service must ensure that each family daycare educator and family daycare assistant engaged or registered with the service:

• holds a current approved first aid qualification; and
• has undertaken currently approved anaphylaxis management training; and 
• has undertaken currently approved emergency asthma management training (regulation 136(3)).

Health, hygiene and safe food practices

The service must implement adequate health and hygiene practices, and safe practices for handling, preparing and storing food to minimise risks to children being educated and cared for by the service (regulation 77).

Any food provided by the service must be nutritious, adequate in quantity and be chosen having regard to the dietary requirements of individual children including any health requirements (regulation 79).

Specialist advice regarding medical conditions

Below are links to organisations that provide specialist advice, medical management templates or training in the management of diagnosed health care needs, allergies or medical conditions, including asthma, diabetes or a diagnosis that a child is at risk of anaphylaxis.