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Babysitting: Caring for Kids With Medical Conditions

If a kid you look after has a health problem, you might be more focused on what could go wrong instead of having fun. That doesn't make for the best babysitting experience — for you or the child.

But you can avoid a lot of the worry by learning about the child's health condition, asking the right questions, and preparing for your time together. Here are some tips and ideas to get you started.

Asthma

Pushing Limits

Children with asthma can have flare-ups (also sometimes called "asthma attacks"). This happens when the muscles around the tiny airways tighten, making it hard to breathe. The things that cause asthma flare-ups are known as triggers, and they can be anything from animals to being around people who smoke.

Ask parents:

  • What things trigger your child's asthma?
  • What kinds of activities are OK to do with your child? What's off limits?
  • What are the warning signs that your child might be having an asthma attack?
  • What should I do if your child has an asthma attack?
  • Does your child use an inhaler or take another type of asthma medication? If so, where is the equipment and can you show me how to use it?
  • Should I give the medicine if your child is having an asthma attack or call you first?

Activities and play: Exercise can be a common trigger for asthma. Some kids with asthma aren't affected by running around and being active. But for others, a fast-paced game of tag might set off their symptoms. If you're babysitting a kid with asthma, ask parents to suggest activities.

Signs of trouble: If a child coughs a lot or complains of tightness or pain in the chest, it may be an early warning sign of an asthma flare-up.

Diabetes

Diabetes means there are high sugar levels in the blood. People with diabetes monitor their blood sugar levels to avoid dangerous highs and lows. Kids who develop diabetes usually need insulin to keep their sugar levels in the normal range.

Because diabetes is complicated to manage, it's a good idea to visit with the family before you babysit to learn how to best care for the child. Take notes so you don't forget anything.

Ask parents:

  • How often will your child need to check his or her blood sugar while you're away?
  • How often do I need to give your child insulin or make sure he or she takes insulin?
  • What can I give your child for snacks and meals?
  • How will I know if your child's blood sugar is getting too high or too low? What are the symptoms?
  • What should I do if this happens?

Activities and play: Children with diabetes can do the same activities as other kids. But if the activity is strenuous, like a basketball game, talk to the parents beforehand about whether the child's medication or food should be adjusted.

Signs of trouble: Low blood sugar levels can put a child at risk of fainting or having a seizure — although these things are rare, it's good to be aware of them. If a child complains of being thirsty often or pees a lot, or if the child feels dizzy or acts confused, it could be a sign that blood sugar is too high. If you start noticing these things, call the child's parents right away.

Allergies

Kids can be allergic to a lot of things, including foods, pets, insect stings, or pollen. Some allergic reactions (like to foods or insect stings) can be life-threatening — although it's rare for a reaction like that to happen. Still, it helps to know in advance what to avoid and what to do if a kid has a serious reaction.

Ask parents:

  • What is your child allergic to?
  • What are the symptoms of an allergic reaction for your child? Has it ever been serious?
  • How do I treat an allergic reaction? If your child has an epinephrine injector, can you show me how to use it?
  • If your child is allergic to one food, such as peanuts, which specific foods should he avoid? (Peanut butter is obvious, but sometimes peanuts can be hidden in other treats.)
  • If your child is allergic to more than one food, which specific foods can he eat? (Organizing these foods into a list is a good idea.)

Activities and play: Ask the parents if you should avoid certain places because of the child's allergy triggers. For example, if a child with a pet allergy wants to play at a friend's house but there's a cat there, find out what to do. Maybe it's OK to be at the friend's house as long as the kids play outdoors, or perhaps the parents prefer that the child's friend comes over to their house to play. If a child has seasonal allergies, there might be certain times of year when the parents want their child to do indoor activities.

Signs of trouble: A rare but serious allergic reaction called anaphylaxis can happen quickly. Signs include tightness or swelling in the throat; trouble swallowing and speaking; wheezing, hives, or skin swelling; a fast heartbeat or pulse; and dizziness. If this happens, use an epinephrine auto injector (if the child has one) and call 911 right away.

Sickle Cell Disease

Sickle cell disease causes abnormally shaped red blood cells. This can lead kids to have certain health problems. Two common ones are periods of pain, usually in the arms, legs, or back (known as "pain crises") or shortness of breath and chest pain (which could be something called "acute chest syndrome"). Sickle cell disease also can cause a child to become pale and dizzy due to problems with the spleen.

Ask parents:

  • Does your child have pain crises? If so, do they usually affect a certain part of the body?
  • What should I do if your child has a pain crisis?
  • Has your child ever had acute chest syndrome? What are the warning signs?
  • What should I do if your child has symptoms of acute chest syndrome?
  • Are there any other symptoms (such as fever, dizziness, looking pale, or fatigue) that I should watch out for?

Activities and play: Cold temperatures can trigger a pain crisis. A kid with sickle cell can still go outside in winter, but should be bundled up and not stay out for too long. If you're going swimming, ask the parents what temperature is too cold for their child. Kids with sickle cell are more likely to have pain crises when they're dehydrated, so make sure they drink water and other non-caffeinated drinks.

Signs of trouble: A child having a pain crisis may complain of pain in the back, arms, or legs. With acute chest syndrome, you might notice that the child is coughing a lot, has chest discomfort, and gets a fever. Fever can be a big problem for kids with sickle cell disease, so call the parents right away if the child seems to have a fever. If the child looks pale and becomes dizzy, call the parents immediately.

Cerebral Palsy

Cerebral palsy (CP) is a long-term condition involving brain damage and muscle problems. CP can cause limitations in moving, learning, hearing, seeing, and thinking. Every child with CP is different. Some may only have slight muscle problems. Others may use wheelchairs or walkers to get around. Some kids have no problems with brain function but others have learning problems and delays in their development.

Ask parents:

  • If your child uses a wheelchair, leg braces, or walker, does he or she always need the device?
  • How does your child use the bathroom, get into bed, and sit at the table?
  • Does your child have difficulty swallowing? Does he or she need a soft diet or is it OK to eat regular foods?
  • If your child doesn't speak, does he or she use another form of communication, like sign language or a talking keyboard?

Activities and play: Entertaining a child who has CP depends on the child's mobility and how much he or she is able to understand. Ask the parents to suggest activities for your time with their child. You can start with simple puzzles or coloring and plan other things to do as you get to know the child better.

Signs of trouble: Some kids with CP are at risk of seizures, so ask parents if this could be a problem and what to do. A child with CP may have less muscle control than other kids. Since kids like to push boundaries, some children who use assistive devices (like leg braces) may try to convince you it's OK to go without. This can lead to injury, so be firm — let the child know that when you're in charge, it's your rules!

Once you know what to do, looking after kids with medical needs is just like caring for other children — you have fun while keeping them safe.

Reviewed by: Kate M. Cronan, MD
Date reviewed: August 2011