When an 18-month-old child with brittle bone disease (a disorder where bones can break easily) enrolled at Cottage Kids in Sacramento, teacher Shawn Edwinson toured the center with the child’s parents and a nurse.

The center uses small chairs instead of high chairs at meal times, so they got a seat belt to make sure the child wouldn’t fall. Teachers were taught that, when changing her diaper, they should make sure to lift her by the hips or use something flat and sturdy placed underneath her. Last year, Cottage Kids was awarded “Provider of the Year” in the inclusion category by the local child care planning council.

Child care centers and homes are required by law to include children with special needs. But many teachers and providers aren’t sure how to best accommodate children who have physical disabilities. Teachers and providers offer some tips:

Make changes to your space

After a child with spina bifida (which often causes paralysis in the lower part of the body) enrolled at the Cabrillo College Children’s Center in Aptos, staff realized she had problems using the restroom. So they installed a low changing table in the bathroom that she could climb onto, recalls Interim Director Eric Hoffman. The center also added risers to some equipment and “rearranged furniture in the main play area so her special equipment could easily pass through,” he adds. Parents might also ask for a wheelchair ramp leading to outdoor areas. “No one understands better what that child needs than the parents,” says Edwinson.

“I haven’t had to make any major accommodations” for a four-year-old child with cerebral palsy (which affects the ability to control movement) who is able to crawl but not walk, says Lauren Larson, an Oakland family child care provider. “We keep a stroller available for walks around the neighborhood. Her moms brought in a special seat for mealtimes.” Providers at other centers hold children with special needs in their lap so that mealtimes can be shared.

Parents often provide any necessary equipment, say teachers, and some centers have gotten grants to make changes to the building. Check with your local child care resource and referral agency (see below: Resources) for more information.

Include everyone

At Cabrillo, Hoffman recalls one teacher who used clapping exercises during circle time. “(When) we had a child in our care with one arm, the class helped us figure out that, by giving that child a drum, everyone could participate,” he says.

“During circle time, (the child with cerebral palsy) uses a chair that is quite low and has arms so she feels very secure,” says Larson. “(She sits) as close as possible to the other children on the floor. We make sure children understand she’s not sitting in the chair because she’s our favorite, but because she can’t sit on the floor and we want her to be able to participate.”

A two-year-old child with Down Syndrome who is beginning to crawl is placed with younger children at the Orfalea Children’s Center in Glendora, says Tena Pevehouse, infant center supervisor. “We don’t really modify activities. We do things like putting toys next to him. The children go over to play with him and do their babbling with him. He has a special mat he sits on and the children know it’s for him.” Other centers keep children of the same age together so children with special needs can learn at their age level.

Focus on the child, not the disability

“When a new child comes to our center,” says Hoffman, “I ask them to tell me three things that they’d like to share: it may be that they have a dog or a new baby sister or it may be about their disability. Children do have questions about their special equipment, but I want other children to see them as people, not just a kid in a wheelchair.”

Talk with children about differences

“We try to (teach) respect for (everyone’s) differences,” says Edwinson. “If children want to talk about a child’s disability, we’ll ask the parent’s permission and then talk about it during circle time.”

“(Children) ask questions because they’re curious,” says Larson. “They wonder if (the child with cerebral palsy) is a baby because she doesn’t walk. We tell them, ‘No, she’s four years old.’ (We talk about how) we don’t all look the same or do the same things—some children have curly hair, some have straight, some can tie their shoes, some can’t.”

Children and teachers benefit

“It’s wonderful that families of children with special needs trust us enough to bring their child here,” says Pevehouse. “Other children learn early on not all children are alike, (but) they can still have fun together.”

“The teachers (see) tremendous benefits,” adds Edwinson. “Once they get past that initial ‘I’m not sure how we’re going to make this work,’ they discover the support and resources we have.”

What the law says

• Americans with Disabilities Act (ADA): federal law says centers and family child care homes cannot discriminate against children with special needs. Centers and homes must make “reasonable accommodations” for children, such as making the building accessible, changing practices, and providing special equipment.

• Section 504 of the Rehabilitation Act: programs (including child care and preschool programs) that receive federal financial assistance must meet the educational needs of all children, by making accommodations described above.

• Individuals with Disabilities Education Act (IDEA): states must provide a free, appropriate education to children with more severe special needs, including child care for children aged 3-5. Families can also receive additional free or low-cost services, including an individualized education program.

Sources: National Association for the Education of Young Children, Division for Early Childhood of the Council for Exceptional Children, BANANAS

Resources for parents and providers

• Child care inclusion specialists at child care resource and referral agencies, call 415-882-0234 to find your local agency

• California Child Care Health Program, 800-333-3212, www.ucsfchildcarehealth.org

• Child Care Law Center, 415-394-7144, www.childcarelaw.org

• Center on Inclusion in Early Childhood, 800-235-4122, inclusion tip sheets at www.ccplus.org/tipsheet.html

• Map to Inclusive Child Care Project, 760-682-0271, www.sonoma.edu/

• Summer 2005 Bridges, from the California Head Start State Collaboration Office, discusses issues in integrating children with special needs into preschool programs, www.cde.ca.gov/sp/cd/re/documents/bridges05.pdf

Extra resources from the Children's Advocate bulletin

• California Disability Community Action Network provides information on state and local public policy issues affecing Californians with disabilities, (916) 446-0013; http://cdcan.us

• Family Voices of California offers information and education to help improve health care for children with special needs and chronic conditions, (415) 282-7494, http://familyvoicesofca.org

• Exceptional Parent Magazine offers information, support, and outreach for families of children with special needs and people who work with them, online at http://www.exceptionalparent.com
  
• WestEd's Center for Prevention and Early Intervention provides services and supports for young children with special needs and their families. Also offers training and technical assistance for professionals. More information and a list of programs online at http://www.wested.org/cs/we/view/pg/16

• Your child in special education, an article in the Children's Advocate, includes contact information for parent training, information, and resource centers around California, as well as nonprofit advocacy organizations, online at http://www.4children.org/news/
  1101spe.htm#res

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