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Nurse’s Notes: Children with Special Health Care Needs

Child Care providers often have questions about addressing the needs of children with special health care needs. Below is some important information to keep in mind.

Who is a child with special health care needs? OCFS defines a child with special health care needs as a child who has a chronic physical, developmental, behavioral, or emotional condition expected to last 12 months or more and who requires health and related services of a type or amount beyond that generally required by children.

Who would be the children that meet this definition? A chronic physical condition could be a condition such as an allergy, asthma, reactive airway disease (RAD), diabetes, seizures, etc. Developmental conditions would be conditions such as autism, Attention Deficit/Hyperactivity Disorder (AD/HD), brain injury, cerebral palsy, Down Syndrome, spina bifida, intellectual disability, fetal alcohol syndrome, etc. Children who also fall under this definition are those receiving any type of service while in a child care program,  such as speech, PT, and/or OT, and any service provided by a therapist.

Do all children that meet this definition require an Individual Health Care Plan? YES! OCFS regulations state that any child with special health care needs requires an Individual Health Care Plan for a Child with Special Health Care. Refer to Section 2 of your program’s OCFS Health Care Plan (HCP), as it addresses how you obtain a plan for children with special health care needs. Most programs opt to use the OCFS form OCFS-LDSS-7006. Please remember that each child is individual even though their conditions may be similar. Each child needs their own individually tailored plan including but not limited to: the child’s diagnosis, how to safely care for the child; how to respond to an emergency with this child; any training/procedures and/or competences that will be needed; and who will provide this training. This plan is created by the child’s parent AND health care provider and then shared with the child care program.

How do I know if a child in my program has special health care needs? You may notice the diagnosis/es is/are indicated on the child’s medical statement or on the second page of OCFS Medical Statement OCFS-LDSS-4433 under “Health Specifics.”  If “yes” is answered to any of those questions, that child requires an Individual Health Care Plan. Many times parent(s)/guardian(s) will share this information when enrolling in a program either in a verbal conversation or making note in a child care provider’s enrollment packet.

Sometimes, families are hesitant to inform a program of their child’s special health care need. As part of licensing, the program director or on-site provider has signed off the HCP Section 11 and/or 21 thereby stating that the child care program will comply with the Americans with Disabilities Act (ADA) and will follow any necessary steps to meet the need(s) of the child(ren) without making fundamental alteration(s) to the program.

OCFS regulations require all child care programs to be in compliance with the ADA. There have been cases and mediations where the US Department of Justice has resolved formal settlement agreements with child care programs found to be non-compliant. The summary and details can be found at

Parents – work with your provider to ensure your child’s needs are met by sharing as much information about your child, including any health, emotional, behavioral, and/or developmental needs. Communication between you, the provider, and their health care manager(s)/therapist(s) will ensure an inclusive and successful early childhood experience for all.

If you need assistance with a child who has special health care needs and/or have questions about the ADA, please feel free to contact me: 845-425-0009, x493,