Legal Rights of Children with Epilepsy in School & Child Care

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CHILD CARE SEIZURE DISORDER EMERGENCY TREATMENT PLAN Center # Directions: Whenever a child with a seizure disorder is enrolled we require that the following information be provided so that the best possible care can be obtained for your child. The first section is to be completed by the parent or guardian. The next is to be completed by the physician treating the child for the disorder. The Center Director completes the third section. Your child can start attending when all sections are completed and the form returned. Student’s Name Date of Birth Emergency Contacts – Please list three emergency contact numbers in the order you would like to have them called. Parent or guardian must provide valid contacts and keep them updated as needed. Failure to do so may result in disenrollment. Parent Phone # Phone# Parent Phone# Phone # Name Relationship Phone # Name Relationship Phone # Name Relationship Phone # History of Seizure Disorder ______________________________________________________________________ _______________________________________________________________________________________ Describe “typical” seizure behavior _______________________________________________________________ _______________________________________________________________________________________________ Triggering Stimuli Warning Signals ___ heat/cold ___ injury ___ none ___ nausea/vomiting ___ low BS ___ psychosocial issues ___ cold ___ tremor ___ fatigue ___ light ___ numbness ___ auditory aura ___ fever ___ hyperventilation ___ tingling ___ visual aura ___ unknown ___ headache ___ smell/taste aura Other Comments__________________________ Other Comments______________________________ Current Medications – Please list all medications, including prescription, over the counter and herbal preparations, and indicate the dosage that your child is currently taking. Dietary Restrictions _______________________________________________________________________________ _________________________________________________________________________________________________ Seizure Disorder Emergency Treatment Plan Page 1 of 4
Activity Restrictions __________________________________________________________________________ ____________________________________________________________________________________________ Emergency Care to be followed in all instances of a seizure Seizure Care Guidelines/ Protocol 1. Gently protect the child from injury. Turn the child onto his or her side, place something soft under his/her head, loosen tight clothing, and clear the area of sharp or harmful objects. 2. Do not place anything in the mouth of the child. 3. Do not restrain or try to stop purposeless behavior. 4. Observe and record seizure behavior (before/during/after) on seizure observation record (see page 3). 5. Encourage onlookers to leave. 6. Stay with the student until full recovery has occurred. Allow child to rest if he or she needs it. 7. Be reassuring and supportive when consciousness occurs. 8. In addition to the basic emergency care, staff should follow the specific instructions of the physician outlined below, paying special attention to the administration of emergency medication, including diazepam rectal gel. 9. Other first aid steps: _________________________________________________________________________ _____________________________________________________________________________________________ Center Staff Should Call 911 if: • Seizure continues _____ minutes after the administration of diazepam rectal gel or another medication • Child has one seizure after another and seizure activity continues for __ minutes or more • Child is having difficulty breathing • Absence of breathing or pulse • Continued unusually pale or bluish skin/lips or noisy breath after the seizure has stopped • Other: Indicate the person(s) who is/are authorized to monitor and provide care. Check all that apply: ___ Center Personnel ___ Parent(s) or Guardian(s) ___ Other Name(s):________________________; ___________________________; ___________________________ ****************************************************************************************************************************************** I understand that it is my responsibility to keep center management informed of changes in my child’s condition and to immediately notify them and complete a new form if treatment for the condition is changed or modified in any way. In the event that my child has a seizure requiring that 911 be called, I authorize emergency medical technicians to transport my child to the nearest hospital emergency room. Date Signed Parent/Guardian Seizure Disorder Emergency Treatment Plan Page 2 of 4
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AN ADVOCATE’S MANUAL AN ADVOCATE
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User is hereby granted permission t
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CHAPTER TWO What Laws Apply to Chil
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4.35Q: What happens if a parent dis
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ABOUT THE AUTHOR Leslie Seid Margol
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Legal Rights of Children with Epile
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CHAPTER TWO What Laws Apply to Chil
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What Laws Apply to Children with Ep
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Page 99 and 100: Legal Rights of Children with Epile
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Legal Rights of Children with Epilepsy in School & Child Care

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