A Unique Child: Inclusion - Room for all

The EYFS (2012) requires practitioners to provide 'equality of opportunity and anti-discriminatory practice, ensuring that every child is included'. However, there is limited information to guide practitioners in achieving inclusion for children with chronic medical conditions such as eczema, asthma and epilepsy.

Little research has been carried out on how early years practitioners create inclusive environments for these children, so I decided to explore this for my doctorate. I knew that my foundation degree students had developed their own approaches and, in some cases, innovative practice to support children with chronic medical conditions.

The questions I asked were:

• How do practitioners identify and accommodate the needs of children with chronic medical conditions?

• Do chronic medical conditions impact on young children's education and inclusion in daycare settings?

• What are practitioners' views and experiences caring for children with chronic conditions in daycare settings?

• How is inclusion promoted?

• What are the experiences of working with parents of children with chronic medical conditions?

• What are the experiences of parents of children in daycare settings with chronic conditions?

• How can the voice of young children with chronic medical conditions in daycare settings be heard?

The impact of chronic conditions on young children can include:

• Tiredness during the day due to disturbed sleep or medication

• Parental and practitioner anxiety about food

• Exclusion from social events.

My survey of 60 settings revealed that the most common chronic condition diagnosed is eczema. This is the most common reason for children under two going to see their general practitioner.

However, there is no guidance (not even in the Managing Medicines in Schools and Early Years Settings guidance) for practitioners about how to adapt activities for children with eczema in order to make them inclusive.

Children with eczema have sensitive skin and materials used for sensory, messy play activities can trigger inflammation of the skin. Sensory play is a valuable learning experience; so activities need to be adapted to make them inclusive.

One practitioner adapted a shaving foam activity she had planned for her key children by wrapping the shaving foam in cling film. Although this was not exactly the same sensory experience, the child was able to be included without having the contact of the shaving foam with his skin, which would have resulted in painful weals.

As the weals dry out, the skin begins to itch and children can scratch so vigorously that their skin can bleed. It may be less obvious, but constant scratching can reduce children's ability to concentrate and this in turn can affect their cognitive development.

One manager's chef had sourced dairy-free chocolate so that a child with an allergy to dairy could be involved in making Krispie cakes.

Research findings to date

• Parents and practitioners working together and communicating effectively are vital ingredients to promote optimal health and to ensure the safety in settings of children with these conditions. The importance of good communication and positive relationships with parents is not surprisingly a key ingredient to creating an inclusive environment for children with chronic medical conditions. One practitioner said, 'We are not the experts in this, the parents are.'

• Knowledge and training are essential to staff in settings being able to identify and meet the needs of children. However, training is inconsistent and can depend on the professional network of practitioners. That for practitioners in private, voluntary and independent settings was mostly related to health and safety policy rather than specific health issues, such as chronic medical conditions.

• The provision of food and snack and mealtimes is a source of anxiety for practitioners who are responsible for keeping children with life-threatening allergies safe in daycare settings. This is illustrated by Charlotte's (deputy manager of a setting) comment about managing mealtimes for a child who had anaphylaxis to food: 'It was more emotionally draining for staff because it was more of a life-threatening condition. We were always double-checking things and making sure he wasn't sitting right next to other children (when eating). You didn't want to ostracise him, but you didn't want him too close in case he touched something that could make him go into shock.'

• Outdoor play for children with asthma and eczema is an area that requires consideration for practitioners who are aiming to offer learning opportunities without provoking symptoms of chronic medical conditions. For example, physical exercise, such as running, and cold weather can trigger the symptoms of asthma; children with eczema can be sensitive to sun and sun cream.

• Practitioners believe that under-threes have the ability to make connections between the effects of their condition and how to manage it. A child aged 20 months noticed differences in food, for example.

The findings from the study highlight how the practitioners who participated work tirelessly with parents to learn how to adapt the environment in order to make it inclusive.

The most challenging aspect may be trying to balance the need to reduce triggers of the symptoms, which will help to keep such children healthy, at the same time as ensuring that children are included in all aspects of the EYFS.

References

• Department for Education (2012) Statutory Framework for the Early Years Foundation Stage: Setting the standards for learning, development and care for children from birth to five. Downloaded from http://media.education.gov.uk/assets/files/pdf/e/eyfs%20statutory%20fram ework%20march%202012.pdf

CHRONIC CHILDHOOD CONDITIONS

A chronic childhood condition is on-going, lasting longer than three months, and incurable.

Chronic medical conditions that affect children in the developed world include anaphylaxis (a severe allergy to substances, often food, that is potentially fatal, but fortunately this is rare), asthma, diabetes, eczema and epilepsy.

Although these conditions cannot yet be cured, it is possible to reduce the risk of symptoms being triggered.

First of all, the signs and symptoms of anaphylaxis, asthma and eczema can be provoked by 'triggers', which are substances in the environment to which an individual is allergic.

For example, a trigger for children with anaphylaxis can be food (such as nuts or kiwi fruit) or latex (a constituent of some toys), so removing the substance is a way of adapting the environment.

A second approach is to give regular medication in order to suppress the symptoms.

For example, the symptoms of asthma can be reduced by giving medication in the form of inhalers that either open up swollen airways, or reduce the inflammation that can cause wheeze and lead to asthma attacks.

Jackie Musgrave is senior lecturer at the University of Worcester.