by Jerri J. Kropp, Ph.D. and Marianna A. Voiselle, M.Ed.

It seems to be a parental rite of passage to go in search of the perfect child care program. You’ve probably been there. You have talked with friends who’ve gone before you, taken the recommendations from pediatricians, you’ve read every copy of Parenting magazine for the past six months, and even made appointments to visit the site and interview the caregiver. To an outsider your actions may seem to border on obsessive; after all, this is one of the most important decisions you will make in your child’s young life.

But what if you have a special needs child? How do you determine who will be responsible enough to keep your child on the correct medication regimen every day? To inform you immediately if there is a case of the chicken pox or flu? Who will report lethargy or other symptoms?

Children who are transplant recipients, as well as those living with liver disease in all its various stages, need caregivers who will be vigilant where their health and well being is concerned. As daunting a task as this is, it will pay to use common sense in finding the right program for your child.

In order for any child to have a positive experience in a group setting it is crucial for the parents and caregiver to maintain open lines of communication. This is especially true for children whose health is compromised; their support team includes not only parent and teacher, but doctor as well.

Beverly Kosmach, a clinical nurse specialist at the Starzl Transplantation Institute in Pittsburgh, Pennsylvania, recommends that post-transplant children stay at home for the first three months after surgery. "It is during this time that the child’s immune system is most compromised. After that point though we like for our kids to resume as many normal activities as feasible." Ms. Kosmach also notes that some children may need to ease into daycare slowly by going half days for a few months. Since children heal at different rates and experience varying degrees of complications post-surgery, parents should always check with the transplant team before enrolling their child in a school or daycare center. Once the medical all-clear has been given, the search for the perfect daycare center can begin in earnest.

It is possible that you will come across daycare directors who feel uncomfortable in accepting your child due to his or her health history. According to the Americans with Disabilities Act (1992), children with special needs cannot be denied care at any public child care program (centers, preschools, family child care homes). Each child’s needs must be evaluated on an individual basis to determine whether a program can reasonably accommodate the child’s needs. Reasonable accommodation may include changes in policies, practices, and procedures. Planning prior to enrollment should include educating the staff on the illness itself, coordination of home and school regarding medication, and special care instructions.

Above all, be certain that your child care center is state licensed. Licensing regulations provide minimum health and safety standards for children. All states in the U.S. have some type of licensing regulations but they vary widely. In most states, licensing is supervised by social service agencies or departments of education, public health, or child welfare. There may also be state, federal, and local requirements. You should note that some child care centers are exempt from licensing requirements. In general, programs covered by other regulations may qualify for exemption (such as centers within the public school system). In some states, churches and/or family daycare homes are not required to be licensed. Licensing guidelines serve as a baseline for minimum standards. Laboratory schools in colleges or universities, Head Start, and other federally funded agencies have their own standards which are usually higher.

For additional assurance in your search, look for a center that is accredited by the National Academy of Early Childhood Programs (a division of the National Association for the Education of Young Children - NAEYC). Accreditation is voluntary. These centers are held to higher standards in several categories. The most important reasons to try to find an accredited center is that they pay particular attention to health and safety, the teacher-pupil ratio is low, and the teachers are required to possess more training and qualifications. To request a listing of accredited centers in your state, you can call the Academy in Washington, D.C., at 1-800-424-2460.

While child care centers have a responsibility to your child, remember that you do too. The health lessons your child must practice in order to live must be learned from you and be second nature to him or her. Handwashing should be as natural as breathing.

Be sure to keep the lines of communication open with your child’s caregiver and consult your transplant coordinator with any questions or concerns. Joint communication between the three of you will provide the best opportunity for your child to flourish in a daycare setting.

Dr. Kropp is an associate professor of Family and Child Studies, and Director of the Georgia Southern University’s Family Life Center which is accredited by the National Academy of Early Childhood Programs.

Ms. Voiselle is a certified elementary school teacher and mother of two-year-old Sarah, a liver transplant recipient.