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Good Childcare is hard to find for caregivers of kids with T1D!

As a school year wraps up, covid restrictions ebb, some who have been at home may be considering returning to the workplace, and caregivers turn our attention ahead to planning for fall (Because doesn’t life with type 1 make us just a little type A calendar loving planning obsessed people now and then… or all the time?) many parents are struggling with all the details, organization, and applying that goes into finding childcare. 

As a mom of a 5 yr old who has had to move and change care three times through Covid and is now starting Kindergarten in the fall (Did you know they were cruel enough to tell me that my baby boy is part of the class of 2035?!! That’s not a graduation year! It’s the setting of a Tom Cruise movie where AI takes over the world…. Sorry Mom tangent) I too am overwhelmed with the options or the lack of options in childcare. With staffing shortages making finding everything from certified teachers, to a teenager to watch kids on a Friday night, scarce;  just having people available to provide safe effective care for kids with type 1 is more of a challenge than ever! What are caregivers to do?

parent and kid

As a mom, a nurse, and a former director of a childcare center, here are my tips for making this process easier for caregivers of kiddos with type 1 diabetes.

> The unfortunate bottom line is that any institution or business that does not accept state or federal funding has the right to deny services as they see fit.
This means parents might hear no when asked to provide care for children with medical needs, including diabetes, from private schools or childcare centers.

> So the first tip, if they get a no, walk away!
Trying to push people into providing care they’re not prepared for is a BAD situation. At least they are being forthright with their lack of ability! If they are open to education or asking questions then provide calm and practical education and resources.

I LOVE the Safe Sitters Guide from Insulet.

> Search smarter, not harder.

  • Care.com is a good place to look for nannies and sitters who are open to working with kids with medical needs
  • There are also childcare programs specifically for children with medical needs like nursesnkids.com (this would be my last choice as it can be a tough message to give a kid with diabetes that they are “Disabled” and they may not be able to have the level of social growth with heir peers that a more “typical” program might offer. But for kids with secondary medical needs, or parents really in a bind, it’s a viable option and some programs have a “diabetes care” day program.)
  • Connect with your local JDRF connections groups and ask other parents in your area who they’ve used for care!
  • A Nanny or au pair is the best option because this is someone that the parent can directly hire and instruct in diabetes management and have close communication with. Investing in people is a great option! From a few trusted teens or young adults that you can train in your family’s diabetes management needs, to private duty para professionals who can attend to your child. And again, NETWORK! A Nanny for one is pricey, but if you share the services among several children you can share the wealth!

> Family-based daycare is going to be the next easiest to deal with.

  • When it comes down to it, these people don’t have lawyers and franchises to answer to so they can take on kids who are going to need more care and communication with guardians than the typical.
  • Centers are going to need strict dosing instructions and will probably be more open to kids with pumps than injections, and CGM is a MUST for any care environment
  • I have yet to see a childcare program that have a nurse on staff, at most they might have a director or other management position individual who is “med certified” to safely administer medications. But this will be by doctors orders only, no carb counting, no guess work, just by wrote instructions.

> Offer education!

From Safe sitters, to online courses at https://www.type1university.com,  to having an IDS clinician provider an educational session remotely or in person for your child’s care providers, school staff etc offering to provide education to staff members goes a long way to opening doors if a center or program is on the fence about providing care, but is not a “hard no” The centers and school districts will also often have funding available to cover this training fort their staff to cover or defer costs.

> I also recommend looking into insurance coverage for an assistant for the child during the school day.

This could be as much as a one on one LPN or med trained CNA whose entire job is to hang out at school in case your kid needs them, to a part-time Nurse who can stop by at meal times/ snack times, etc to administer insulin as needed if this is the central barrier. Companies like Bayada and other home health nursing companies would be able to assist with staffing for these individuals. Again, you may be able to team up with other families in your child’s school with medical needs to increase the amount of hours you can get covered to have this person “on site”

>The biggest tip is to come in from day one with information

  • Letting them know that you don’t expect them to “manage your kids’ diabetes” just to respond as needed just like they would for a kid who had ashthma. If ANY kid faints the reaction is the same, call 911, call guardians. that just because a kid has diabetes does not mean they are a walking time bomb.
  • Asking questions is good: “How have you worked with families with specific medical needs in the past? What worked best for you in those situations?” “How can I fit my child’s diabetes needs into your schedule and processes?”  or “What would a benefit for you and the other children be to having a child with diabetes in the classroom?” These kinds of positive questions immediately get one’s mind looking for how to overcome barriers, instead of putting them up.

A WORD OF FRANK WARNING: Parents need to have healthy expectations too. School/childcare time is not a time for nail-biting tight control. It’s a time for “good enough to get by” If Mom goes in talking about the 800 things a school needs to do for her kid, that kid is not getting in! Diabetes or not!

Instructions for diabetes management should be able to fit on one sheet of paper, not a binder. Keep it simple rather than overwhelming. One teacher probably has 8-15 kids to deal with at a time! They can’t know everything about all of them and the bottom line is that no one child is entitled to more of that teacher’s time or focus than others.

If Dad goes in acting like one false move is going to kill his kid, that kid is not getting in, diabetes or not! (I once had a parent come in with a child with a feeding tube, I was completely equipped to handle a kid with a feeding tube, but the parents were so convinced that their child was going to be harmed if anyone around them made the slightest deviation from their plan, that I did not accept that child into care, because I knew Mom and Dad were not ready)

Parents need to go in with the attitude that diabetes is a part of everyday life, and that the child care provider’s primary role is to keep their child SAFE not “healthy” and to help foster a caring and supportive environment for developmental growth.

My kid doesn’t have diabetes, but has been in childcare since he was 8 weeks old. Inherent to that is that he got sick more than at home kids; he got hurt more, he probably had more juice and less rest and learned more interesting behaviors. That’s the nature of letting them have more room to grow and independence.

But on the upside he is more resilient, learned faster than his at-home peers, progressed through milestones like talking walking and potty training at blazing speed, is more empathetic and is an amazing problem solver. It’s a trade-off that I happen to find well worth it.

Remember, starting care or school is a time to model to our kids.

Show them an open mind, a desire to cooperate and build a community, and you will all have a much healthier happier transition time.

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