This sub-section contains valuable information on children's special health needs. Click on the links to the right under Special Health Needs on the topics covered below:

• Heart Disease
• Asthma/Lung Disease

Who are children with special health care needs (SHCN)?

Children with special needs are "those children with  developmental disabilities, mental retardation, emotional disturbance, sensory or motor impairment, or significant chronic illness who require special health surveillance or specialized programs, interventions, technologies, or facilities"

Other terms used by programs and agencies to describe children who have been identified as having special needs include:

- children who are developmentally disabled, developmentally delayed, or at risk for developmental delays

- children who are preschool developmentally delayed

- children with cognitive delays or disabilities

- children who are behaviorally-emotionally handicapped

- children with hearing loss or who are hearing impaired

- children with visual impairment or who are visually impaired

- children who are deaf-blind

- children with speech-language delays or disorders

- children who are speech-language impaired

- children with traumatic brain injury

- children with autism

- children with physical disabilities

- children who are orthopedically impaired

The numbers of children with SHCN are increasing. This is due to better health care and increased placement of chronically ill children in homes. Just as parents of children without special needs require childcare, so do parents of special needs children. It is important to include children with SHCN in childcare. Including children SHCN into programs with other children is important for a number of reasons and is called inclusion.

Within this web is information on illnesses and disabilities that can assist child care providers in extending their services to children with SHCN. 

Inclusion is the opportunity for children with special needs to participate in programs and activities alongside children without special needs. Other words used to describe these opportunities include mainstreaming, reverse mainstreaming, and integration. Mainstreaming typically describes the participation of a child with special needs in a program or activity originally designed for children without disabilities. When programs designed to serve children with special needs extend their enrollment to children who are typically developing, this approach may be referred to as reverse mainstreaming. Integrated programs and activities are those that include children with and without special needs. All of these opportunities could be described as inclusive. Inclusion is children learning and growing together regardless of their abilities. Some agencies and programs may use some or all of these terms with very specific definitions. In conversations related to early childhood inclusion, participants may need to define and clarify terms to ensure effective communication.

Just as environments for infants and toddlers are different from environments for older preschoolers, so is the focus of inclusion. Because the most natural environment for infants and toddlers is their home with their families, the focus of inclusion for this age group is ensuring the inclusion of the child into the family and the family into the community. Emphasis is placed on ensuring that the child and family experience mutually satisfying interactions. Equally important is enabling the family to participate in the same activities that they would have enjoyed if their child had not had disabilities.

During the preschool years, the focus of inclusion changes. The focus of inclusion for preschoolers with special needs is on social competence. As children become more interested in their peers, it is important to focus on those skills that enable children to get along with others-sharing, taking turns, conversing with peers, resolving conflicts.

A major argument of advocates for inclusion has been the rights of children with special needs to participate in the activities of daily life available to other children. Many people view inclusion as a moral value and therefore need no legal or empirical foundation on which to stand. Inclusion is simply the right thing to do.

Participating in activities with their peers who are typically developing is important for children with disabilities as they learn skills that will help them get along in the world. In a review of the research on the outcomes for children with special needs, Buysse and Bailey found that children in inclusive settings tend to have an advantage in social and behavioral areas over children in segregated settings. Children without disabilities continue to grow and develop in a typical way and can learn much about themselves by being around children who have disabilities. They may have a greater understanding of disabilities and increase their acceptance of others who are different from themselves.

Young children with disabilities need the same enriching early experiences as children who are typically developing. When compared to segregated programs or classrooms, inclusive programs offer more opportunities for children to learn naturally through play, use a greater variety of materials in new and different ways, interact with other children, and explore the environment.

The Americans with Disabilities Act (ADA), passed in 1991, prohibits the discrimination of persons with disabilities in employment, public services, public accommodations, and transportation. The part of this law that affects child care programs is the section on public accommodations. In addition to hotels, theatres, and restaurants, public accommodations refers to private programs such as family child care homes, child care centers, nursery schools, and preschools. Programs do not have to receive public funding to be considered public accommodations.

ADA requires child care programs to consider making changes in the following areas:

- First, child care programs must eliminate eligibility criteria that screen out or tend to screen out a child with a disability. For example, a child care program must eliminate a provision in the admissions policy which refuses enrollment to children who have not been toilet trained. Such a policy discriminates against children who, because of their disability, have not yet been toilet trained or may never be toilet trained.

- Second, programs must make reasonable modifications in their policies, practices, and procedures in order to accommodate the child with a disability. For example, a program may make a schedule change for a child who takes medication and needs a morning nap.

- Third, child care programs are required to provide auxiliary aids and services for those children with disabilities affecting hearing, vision, or speech. Auxiliary aids and services refer to services and devices designed to ensure effective communication. Examples include learning some sign language to improve communication with a child who has a hearing impairment, and putting a Braille label on the cubby of a child who is blind.

- Finally, architectural barriers that prevent access to services must be removed if removal is readily achievable. For example, furniture may need to be rearranged to enable a child in a wheelchair to access all areas of the program.

With appropriate support, children with special needs in inclusive settings maintain their rate of developmental growth. In fact, research shows an increase in their social skills as compared to children in segregated settings. The stimulation of an inclusive environment increases social interaction with peers and promotes more complex play with toys and materials

An inclusive environment provides opportunities for children who are typically developing to learn about differences in human growth and development. They gain a greater understanding of disabilities and their effects on development. Their experiences with children who have a range of abilities may lead them to become more accepting of people who are different.

The family may develop more positive attitudes toward their child with special needs who is enrolled in a "regular" child care program. An inclusive setting provides the family a "real world" perspective for interpreting their child’s growth and development. Being able to observe their child’s peers who are typically developing may increase the family’s knowledge of typical child development. Furthermore, opportunities to participate in activities with families of children without special needs may decrease feelings of social isolation.

An inclusive program provides families and their children an opportunity to learn about differences in human growth and development. Positive experiences with children with special needs may increase their knowledge and understanding of persons with disabilities. Opportunities to meet and get to know the families of children with special needs may increase their sensitivity to the challenges of caring for a child with a disability.

Experience in inclusive settings may help teachers develop more positive attitudes toward inclusion. They may become more aware of the individual needs of all children. Some teachers may receive additional training for special needs children that is beneficial to all children such as promoting social interactions. Collaboration with specialized therapists such as speech-language pathologists, occupational therapists, and physical therapists may provide teachers with opportunities to increase their knowledge about specific developmental areas.

As communities become more diverse ethnically and culturally, inclusion may influence society to be more accepting of persons who are different. The "real world" experience for persons with special needs may help them to become contributing members of society rather than dependent on society.