Management of medical conditions procedure

1. Purpose

Working in conjunction with the Management of medical conditions policy, this procedure provides guidelines to ensure that Early Learning Victoria staff can respond appropriately to the following medical conditions:

anaphylaxis and allergies
asthma
diabetes
epilepsy and seizures

2. Actions and procedures

To ensure the health, safety and wellbeing of all children attending Early Learning Victoria centres, and to meet obligations under the Education Care Services National Law Act 2010 (the National Law) and the Education and Care Services National Regulations 2011 (the Regulations), Early Learning Victoria must ensure procedures are in place for dealing with medical conditions in children.

At centre level, the nominated supervisor or responsible person must ensure the appropriate Medical Management or specialised management plan, Risk Minimisation and Communication Plans have been developed and communicated, in partnership with the child’s family and medical practitioner.

Anaphylaxis and allergies

Allergic reactions are common in children. Many allergic reactions are mild, but some can be extremely severe. Anaphylaxis is the most severe form of an allergic reaction and is life threatening. The most common causes of allergic reactions in young children are foods, bee or other insect stings, and some medications. An allergic reaction can develop within minutes of exposure to an allergen.

Individualised Anaphylaxis Care Plans

For children with known allergies and anaphylaxis, Individualised Anaphylaxis Care Plan must be completed by the nominated supervisor to document a child’s allergies and the strategies that will be used to reduce the risk of an allergic reaction before a child starts orientation, or when the centre is informed about the child’s allergies.

The Individualised Anaphylaxis Care Plan must include a copy of the child’s current ASCIA Action Plan (see Links). The Individualised Anaphylaxis Care Plan must include appropriate risk minimisation strategies that will be implemented to manage the child’s allergies both onsite and offsite during excursions. The Individualised Anaphylaxis Care Plan must be agreed to and signed by the child’s parent or carer and must be reviewed if the child’s allergies change or they have a reaction while in the care of Early Learning Victoria.

Anaphylaxis Risk Management Plan

The nominated supervisor, in partnership with the child’s family, must develop an Anaphylaxis Risk Management Plan. Anaphylaxis risk management plans should be developed for day-to-day allergy management at the centre and for excursions, as the risks are different.

Anaphylaxis risk minimisation strategies for children’s education and care services provides examples of strategies to help reduce the risk of exposure to known allergens and should be used during consultations with families.

Communication Plan

The nominated supervisor is responsible for ensuring that a Communication Plan is developed to provide information to all centre staff, volunteers, contractors, students and families for each child who is diagnosed with an allergy or anaphylaxis (see Links). The Communication Plan must include strategies for advising staff, volunteers, students and contractors about how to respond to children experiencing an allergic reaction, including anaphylactic reaction in various environments, including during excursions

Signs and symptoms

Signs and symptoms of an allergic reaction to food usually occur within minutes and up to 2 hours after eating the food allergen. Severe allergic reactions to insects usually happen within minutes of the insect sting or bite. Where it is known that a child has been exposed to their allergen, but has not developed symptoms, the child should be monitored, and the child’s family must be contacted and asked to collect their child.

Common signs and symptoms include one or more of the following:

mild to moderate signs and symptoms:
hives or welts
tingling mouth
swelling of the face, lips and eyes
abdominal pain, vomiting or diarrhoea are mild to moderate symptoms; however, these are severe reactions to insects.
anaphylaxis (severe allergic reaction) signs and symptoms:
difficult or noisy breathing
swelling of the tongue
swelling or tightness in the throat
difficulty talking or hoarse voice
wheeze or persistent cough
persistent dizziness or collapse
pale or floppy child (young children)
abdominal pain or vomiting are signs of severe allergic reaction to insects.

Emergency response

If any child is showing signs and symptoms of an allergic reaction:

staff should immediately follow the child’s ASCIA Action Plan if they are known to have allergies
staff should follow the ASCIA First Aid Plan for Anaphylaxis for all other children not previously identified as being at risk of anaphylaxis
for mild to moderate episodes of food allergy, most children will respond well to an oral antihistamine medication
ensure two staff members are present any time medication is administered to check the child's identity, correct dose and how the medication is to be given.

Adrenaline is the first line treatment for anaphylaxis:

if in doubt about whether a child is experiencing anaphylaxis or not, staff should immediately administer the child’s adrenaline injector if they have one
for children with asthma and allergy to food, insects or medication who may have been exposed to an allergen and have sudden breathing difficulty, administer the adrenaline injector before the asthma reliever, even if there are no skin symptoms
for children not previously identified as being at risk of anaphylaxis, staff should immediately administer the centre’s general-use adrenaline injector and follow the ASCIA First Aid Plan for Anaphylaxis
after an adrenaline injector has been administered, the child should be kept still, preferably lay flat
call an ambulance to transport the child to hospital for medical monitoring
another dose of adrenaline can be given after 5 minutes if symptoms continue
phone family member/emergency contact as soon as possible.

Review

After an incident or emergency response, the child’s Individualised Anaphylaxis Care Plan, Anaphylaxis Risk Management Plan and Communication Plan will be reviewed to identify if further risk minimisation strategies are needed, or if some strategies need to be adapted. It is important to understand what could have been improved, to learn from each incident and to put plans in place to help prevent the same incident from happening again. The adrenaline injector must be replaced by the parent or guardian as soon as possible.

Asthma

Asthma is a serious condition that causes a person’s airways to become inflamed or swollen when exposed to a trigger. There are multiple types of asthma, including allergic asthma, thunderstorm asthma, exercise-induced asthma and childhood asthma. Understanding asthma types and triggers is an effective strategy in managing asthma symptoms.

There are 3 types of medications used to treat asthma:

preventers – to reduce the presentation of symptoms
relievers – to treat symptoms caused by asthma triggers
add on medicines – to manage ongoing symptoms or severe asthma.

For all children, including those not previously diagnosed with asthma, staff should monitor weather and pollen conditions and bring children inside before, during and after thunderstorms. This also includes when planning or on excursions.

Thunderstorm asthma

In Victoria, the grass pollen season usually runs from 1 October to 31 December and is associated with increased cases of asthma and hay fever, as well as the risk of thunderstorm asthma.

People at risk of thunderstorm asthma include those with current or past asthma, undiagnosed asthma or springtime hay fever. The risk is even higher for people who have both asthma and hay fever, especially if their asthma is poorly controlled.

Be prepared to follow advice from the Department of Health, when the risk of epidemic thunderstorm asthma is forecast as high including:

avoiding outdoor activities during thunderstorms or strong wind gusts, especially during the winds that precede it
closing doors and windows to limit pollen exposure
turning off any air conditioner system that brings air from outside into the centre to avoid breathing in small pollen particles.

You can monitor the epidemic thunderstorm asthma risk forecast through the Vic Emergency thunderstorm asthma forecast webpage. In addition, individual Early Learning Victoria centre locations can be set up as a “watch zone” in the VicEmergency app (App Store or Google Play) to receive advice and warnings about potential epidemic thunderstorm asthma events during the grass pollen season.

Asthma Action Plan

An Asthma Action Plan must be obtained by the nominated supervisor to document a child’s asthma and management of the asthma, including what to do when the child’s asthma worsens, and the treatment to be administered in an emergency. The Asthma Action Plan must be reviewed annually or sooner if the child’s allergies change.

If the child is also at risk of anaphylaxis (life-threatening allergic reaction) the doctor will provide a separate ASCIA Action Plan.

Risk Minimisation Plan

It is important to consult with families to agree on strategies for reducing a child’s susceptibility to an asthma emergency. For children known to experience asthma, the nominated supervisor, in partnership with the child’s family, must develop a Risk Minimisation Plan (see Links). This plan should be developed for day-to-day asthma management at the centre and for excursions, as the risks are different.

Communication Plan

The nominated supervisor is responsible for ensuring that a Communication Plan is developed to provide information to all centre staff, volunteers, contractors, students and families about asthma and related policies and procedures (see Links). The Communication Plan must include strategies for advising staff, volunteers, students, contractors and families about how to respond to asthma in children in various environments, including during excursions. Any changes to a child’s Asthma Action Plan and Risk Minimisation Plas must be updated in the Communication Plan.

Signs and symptoms

If a child becomes unwell, staff must follow the guidance in the child’s Asthma Action Plan.

Asthma symptoms in children can be more difficult to detect, as young children may not be able to identify or communicate symptoms of asthma. Signs and symptoms of asthma may include:

difficulty breathing/changes in how they breathe
shortness of breath/extended periods of breathlessness after play
chest tightness
wheezing.

Emergency response

An asthma emergency can occur suddenly or develop over hours and up to multiple days. A child experiencing an asthma emergency will show symptoms that are worse than usual after asthma medication is administered or may not be responding to their prescribed asthma medication.

If any child is showing signs and symptoms of asthma:

it is important that first aid is administered immediately in response to symptoms of an asthma flare up, regardless of the severity
first aid must be administered following the child’s Asthma Action Plan and the asthma first aid procedure
for children not previously identified as diagnosed with asthma who present symptoms, staff should follow the asthma first aid procedure
if a child has a known allergy or anaphylaxis and presents with difficulty breathing, always use the adrenaline injector before using the reliever medication
phone family member/emergency contact as soon as possible.

Review

The child’s Asthma Action Plan, Risk Minimisation Plan and Communication Plan will be reviewed to identify if further risk minimisation strategies are needed, or if some strategies need to be adapted. It is important to understand what could have been done differently to learn from each incident and to put plans in place to help prevent the same accident from happening again.

Diabetes

Type 1 diabetes is an autoimmune condition that occurs when the immune system damages the insulin-producing cells in the pancreas. The condition is treated with insulin replacement via injections or a continuous infusion of insulin via a pump. Without insulin treatment, type 1 diabetes is life-threatening.

Diabetes Action and Management Plan

Upon enrolment, or when a child is diagnosed with diabetes, the child’s diabetes treating team, parents and Early Learning Victoria representative must develop and sign a Diabetes Action and Management Plan to support the child’s diabetes care needs.

Risk Minimisation Plan

It is important to consult with families to determine which strategies are appropriate for reducing risks related to the child’s diabetes. The nominated supervisor, in partnership with the child’s family, must develop a Risk Minimisation Plan (see Links). Separate risk management plans should be developed for excursions, as the risks are different.

Communication Plan

At enrolment, or upon diagnosis, the nominated supervisor must develop a Communication Plan in consultation with families to encourage and ensure ongoing communication between families and staff about the management of the child’s medical condition (see Links). Any changes to a child’s Diabetes Action and Management Plan and Risk Minimisation Plan will be updated in the Communication Plan.

Signs and symptoms

If a child becomes unwell, Early Learning Victoria staff must follow the guidance in the child’s Diabetes Action and Management Plan.

Hypoglycaemia (Hypo)

If a child is wearing a continuous glucose monitoring (CGM) device, it will sound an alert when they are below their target range. Symptoms can vary. If caused by low blood sugar, the child may:

tremble, or feel dizzy, weak or hungry
look pale and have a rapid pulse
sweat profusely
feel numb around their lips and fingers
have a change in behaviour – becoming angry, quiet or confused, or be crying
become unconscious or have a seizure.

Hyperglycaemia (Hyper)

If caused by high blood sugar, the child may:

feel excessively thirsty
need to urinate frequently
feel tired or lethargic
feel sick
be irritable
complain of blurred vision
lack concentration
have hot dry skin, a rapid pulse or feel drowsy
have the smell of acetone (like nail polish remover) on their breath
become unconscious.

Emergency response

A diabetic emergency may result from too much or too little insulin in the blood. There are two types of diabetic emergency:

Very low blood sugar – hypoglycaemia (or ‘hypo’), usually due to excessive insulin.
Very high blood sugar – hyperglycaemia (or ‘hyper’), due to insufficient insulin.

If a child suffers from a diabetes-related emergency, the centre staff must:

ensure an educator remains with the child at all times
follow the guidance in the child’s Diabetes Action and Management Plan
immediately dial 000 for an ambulance if the child does not respond to steps in the Diabetes Action and Management Plan or symptoms are severe
continue first aid measures and follow instructions provided by emergency services
contact the child’s family as soon as possible.

Review

The child’s Diabetes Action and Management Plan, Risk Minimisation Plan and Communication Plan will be reviewed annually to ensure they remain current and effective. In addition, if an incident occurs, the plans will be reviewed to identify whether further risk minimisation strategies are required or whether existing strategies need to be adapted. It is important to understand what could have been done differently to learn from each incident and to put measures in place to help prevent a similar incident from occurring again.

Epilepsy and seizures

Epilepsy is a common, serious neurological condition characterised by recurrent seizures due to abnormal electrical activity in the brain. While about 1 in 200 children live with epilepsy, the impact is variable – some children are greatly affected while others are not. Approximately 70% of people living with epilepsy have good control of their seizures through medication.

Epilepsy Management Plan

For children diagnosed with epilepsy, an Epilepsy Management Plan must be completed by a medical practitioner and provided to the nominated supervisor to document a child’s seizures and the strategies that will be used. This must be done before the child’s orientation, or when the centre is informed about the child’s diagnosis.

The plan must include appropriate risk minimisation strategies that will be implemented to manage the child’s epilepsy and seizures, both onsite and offsite during excursions. The plan must be agreed to and signed by the child’s parent or guardian, and must be reviewed annually or sooner, if the child’s diagnosis or management change.

If the child has been prescribed emergency medication, this should be documented in an Emergency Medication Management Plan completed with the child’s doctor.

Risk Minimisation Plan

It is important to consult with families to determine which strategies are appropriate for reducing the risks related to the child’s epilepsy and seizures. This should be done as part of developing the child’s Epilepsy Management Plan.

The Risk Minimisation Plan must be developed in partnership with families and in consultation with the child’s medical practitioner, or with the Epilepsy Foundation. The Risk Minimisation Plan should be developed for day-to-day seizure management at the centre and for excursions, as the risks are different (see Epilepsy Foundation: Epilepsy and Seizure Management Plan).

Communication Plan

The nominated supervisor is responsible for ensuring that a Communication Plan is developed to provide information to all centre staff, volunteers, contractors, students and families about epilepsy and seizures and this policy (see Links). The Communication Plan must include strategies for advising staff, volunteers, students and families about how to respond to a child experiencing seizure in various environments, including during excursions.

Signs and symptoms

The key symptom of epilepsy is seizures. Seizures are episodes of changed electrical activity in the brain and can vary a lot depending on the part of the brain involved. Seizures usually last 1 to 3 minutes.

Seizures can cause symptoms such as:

loss of consciousness (passing out)
unusual jerking movements (convulsions)
staring, loss of expression, unresponsiveness and stopping activity
other unusual movements, feelings, sensations or behaviours.

Emergency response

In the instance of any seizure, Early Learning Victoria staff must follow the seizure first aid and emergency response instructions in the child’s Epilepsy Management Plan.

If the child has an Emergency Medication Management Plan, only staff trained to do so should follow the instructions in the plan. If no staff present are trained to administer emergency medication, an ambulance should be called immediately.

If there is no Epilepsy Management Plan, an ambulance should be called immediately and standard seizure first aid principles followed. This includes timing the seizure, protecting the child from injury, rolling them onto their side if they are not alert and staying with them until the seizure has resolved.

Early Learning Victoria should call an ambulance immediately if:

there is no Epilepsy Management Plan
a serious injury has occurred
the child’s airway or breathing is compromised
other factors outlined in the Epilepsy Management Plan(opens in a new window) are occurring.

Review

The child’s Epilepsy Management Plan, Risk Minimisation Plan and Communication Plan will be reviewed annually to ensure they remain current and effective. In addition, if an incident occurs, the plans will be reviewed to identify whether further risk minimisation strategies are required or whether existing strategies need to be adapted. It is important to understand what could have been done differently to learn from each incident and to put measures in place to help prevent a similar incident from occurring again.

Incident reporting

If a child experiences a medical emergency related to a medical condition, Early Learning Victoria centre staff must complete an incident report (see the Incident, injury, trauma and illness policy). The nominated supervisor will work with Early Learning Victoria central office staff to:

notify the Regulatory Authority of serious incidents online through the NQA IT System, if required
record the incident appropriately (using, for example, the Incident, Injury, Trauma and Illness Record or EduSafe Plus for staff-related incidents)
if a child has had an allergic reaction to a packaged food or to a meal provided by Early Learning Victoria, it must be reported to the local food authority for investigation.

Early Learning Victoria staff will be offered a debrief after each incident, recognising an emergency can cause distress not only for the child, but for staff and other children, especially if the event was life-threatening.

3. Resources

Definitions

Absence seizure: Occurring mostly in children, this consists of brief periods of loss of awareness, most often for less than 10 seconds. Some children can experience these types of seizures multiple times during the day, which may compromise learning. Absence seizures can be mistaken for daydreaming.

Adrenaline injector: An intramuscular injection device containing a single dose of adrenaline, designed to be administered by people who are not medically trained. Two brands of adrenaline injectors are currently available in Australia – EpiPen® and Anapen®. As EpiPen® and Anapen® products have different administration techniques, only one brand should be prescribed per individual and their ASCIA Action Plan for Anaphylaxis must be specific for the brand they have been prescribed. Staff should know how to administer both brands of adrenaline injectors, as per their accredited training. Adrenaline injectors that have been used in an emergency response should be placed in a hard plastic container or similar and given to the paramedics.

Adrenaline injector kit: An insulated container with an unused, in-date adrenaline injector, a copy of the child’s ASCIA Action Plan for Anaphylaxis or ASCIA Action Plan for Allergies, and telephone contact details for the child’s family, doctor/medical personnel and the person to be notified in the event of a reaction (if the family cannot be contacted). If prescribed, an antihistamine should also be included in the kit, which must be in the original packaging with a visible expiry date. Adrenaline injectors must be stored away from direct heat and cold.

Anapen®: A type of adrenaline injector containing a single fixed dose of adrenaline. The administration technique in an Anapen® is different to that of the EpiPen®. Three strengths are available and each is prescribed according to a child’s weight. The Anapen® 150 is recommended for a child weighing 7.5–20kg. An Anapen® 300 is recommended for use when a child weighs more than 20kg.The child’s ASCIA Action Plan for Anaphylaxis must be specific for the brand they have been prescribed (that is, Anapen® or EpiPen®).

Anti-seizure medications (ASMs): Anti-seizure medications used for the treatment of many epilepsy syndromes. ASMs do not cure epilepsy, but most seizures can be prevented by taking medication regularly once or more a day. For approximately 70% of people with epilepsy, medication makes it possible to obtain seizure control and live a normal, active life, free of seizures. The remaining 30% of people will continue to have seizures, with the medication acting to reduce the severity and/or frequency of seizures.

Asthma Action Plan: A record of information on an individual child’s asthma and its management, including contact details, what to do when the child’s asthma worsens and the treatment to be administered in an emergency.

Asthma first aid kit: Kits should contain:

reliever medication
2 small volume spacer devices
2 compatible children’s face masks (for children under the age of four)
record form
asthma first aid instruction card.

Asthma Australia recommends that spacers and face masks are for single use only. It is essential to have at least 2 spacers and 2 face masks in each first aid kit, and these should be replaced once used. These used items can be provided to the child or family as a means of suitability.

Blood glucose meter: A compact device used to check a small blood-drop sample to determine the blood glucose level.

Continuous glucose monitor: Continuous glucose monitoring (CGM) is a means of measuring glucose levels continuously, in contrast to a blood glucose meter that measures a single point in time. A CGM system sensor is inserted into the skin separately to the insulin pump and measures the level of glucose in the interstitial fluid (fluid in the tissue). The CGM receiver and/or compatible smart device can usually be set to send custom alerts to the user when certain glucose thresholds are reached, or if levels are changing rapidly, reducing or eliminating the need for blood glucose finger-prick tests and enabling early intervention to prevent the person becoming ‘hypo’ or ‘hyper’.

Emergency epilepsy medication: Medication that has been prescribed for the treatment of prolonged seizures or a cluster of seizures. The most common type of emergency medication prescribed is buccal or intranasal Midazolam. Medication information is included in a child’s Emergency Medication Management Plan, and this must be kept up to date. Only staff who have received child-specific training in the emergency administration of Midazolam can administer this medication.

Epileptic seizures: Epileptic seizures are caused by a sudden burst of excess electrical activity in the brain resulting in a temporary disruption in the normal messages passing between brain cells. Seizures can involve loss of consciousness, a range of unusual movements, odd feelings and sensations or changed behaviour. Most seizures are spontaneous and brief. However, multiple seizures, known as ‘seizure clusters’, can occur over a 24-hour period.

EpiPen®: A type of adrenaline injector (refer to Definitions) containing a single fixed dose of adrenaline that is delivered via a spring-activated needle that is concealed until administration is required. Two strengths are available – EpiPen® and EpiPen Jr® – and each is prescribed according to a child’s weight. The Epipen Jr® is recommended for a child weighing 10–20kg. An EpiPen® is recommended for use when a child weighs more than 20kg. The child’s ASCIA Action Plan for anaphylaxis must be specific for the brand they have been prescribed.

Focal (previously called ‘simple partial’ or ‘complex partial’) seizures: Focal seizures start in one part of the brain and affect the area of the body controlled by that part of the brain. The symptoms experienced will depend on the function that the focal point controls (or is associated with). Focal seizures may or may not cause an alteration of awareness. Symptoms are highly variable and may include lip smacking, wandering behaviour, fiddling with clothes and feeling sick, ‘edgy’ or strange. Focal seizures where a person has full awareness were previously called ‘simple partial seizures’. Focal seizures where a person has an altered sense of awareness were previously called ‘complex partial seizures’. Focal seizures can progress into a generalised seizure (see below).

Generalised seizure: Both sides of the brain are involved, and the person will lose consciousness. A tonic-clonic seizure is one type of generalised seizure.

General-use adrenaline injector: A 'back up' or 'unassigned' adrenaline autoinjector purchased by Early Learning Victoria.

Hyperglycaemia (high blood glucose): Hyperglycaemia occurs when the blood glucose level rises above 15 mmol/L. Hyperglycaemia symptoms can include increased thirst, tiredness, irritability and extra toilet visits. It can affect thinking, concentration, memory, problem-solving and reasoning. Common causes include but are not limited to:

taking insufficient insulin or missing insulin doses
eating more carbohydrates than planned
common illnesses or infections, such as a cold
excitement or stress.

The child’s Diabetes Action and Management Plan will provide specific guidance for preventing and treating a high glucose level.

Hypoglycaemia or hypo (low blood glucose): Hypoglycaemia refers to having a blood glucose level that is lower than normal – that is, below 4 mmol/L, even if there are no symptoms. Neurological symptoms can occur at blood glucose levels below 4 mmol/L and can include sweating, tremors, headache, pallor, poor coordination and mood changes. Hypoglycaemia can also impair concentration, behaviour and attention, with symptoms including a vague manner and slurred speech.

Causes of hypoglycaemia (hypo) are:

taking too much insulin
delaying a meal
consuming an insufficient quantity of carbohydrate at a meal
undertaking unplanned or unusual exercise
illness.

It is important to treat hypoglycaemia promptly and appropriately to prevent the blood glucose level from falling even lower, as very low levels can lead to loss of consciousness and possibly convulsions. Never leave the child alone during a hypo episode.

The child’s Diabetes Action and Management Plan will provide specific guidance for services in preventing and treating a hypo.

Insulin: Medication prescribed and administered by injection or continuously by a pump device to lower the blood glucose level. In the body, insulin allows glucose from food (carbohydrates) to be used as energy and is essential for life.

Insulin pump: An insulin pump is a small battery-operated electronic device that holds a reservoir of insulin. It is about the size of a mobile phone and is worn 24 hours a day. The pump is programmed to deliver insulin into the body through thin plastic tubing known as the ‘infusion set’ or ‘giving set’.

Ketoacidosis: Ketoacidosis is related to hyperglycaemia. It is a serious condition associated with illness or very high blood glucose levels in type 1 diabetes. It develops gradually over hours or days. It is a sign of insufficient insulin. High levels of ketones can make children very sick. Symptoms of ketoacidosis may include high blood glucose levels and moderate to heavy ketones in the urine, with rapid breathing, flushed cheeks, abdominal pain, sweet acetone (similar to paint thinner or nail polish remover) smell on the breath, vomiting and/or dehydration. It is a serious medical emergency and can be life-threatening if not treated properly. If symptoms are present, contact a doctor or call an ambulance immediately.

Midazolam: In epilepsy, midazolam is used for emergency management of seizures, as it can stop the seizures quickly. Once absorbed into the blood, Midazolam also works by relaxing muscles, which is particularly beneficial in many types of seizures. The effects of Midazolam should occur rapidly.

Midazolam is most commonly administered buccally (inside cheek) or intranasally.

It is fast-acting and can be easily administered by family and carers in a variety of settings. Only staff specifically trained to the requirements of a child’s Emergency Medication Management Plan can administer Midazolam.

Midazolam kit: An insulated container with an unused, in-date Midazolam ampoule/s, a copy of the child’s Emergency Medication Management Plan and Epilepsy Management Plan (which includes a picture of the child), and telephone contact details for the child’s families, doctor/medical personnel and the person to be notified in the event of a seizure requiring administration of Midazolam if families cannot be contacted. Midazolam must be stored away from light (cover with aluminium foil), and in temperatures below 25ºC.

Non-epileptic seizures (NES): Also known as dissociative seizures. There are 2 types of non-epileptic seizures:

organic NESs, which have a physical cause
- psychogenic NESs, which are caused by mental or emotional processes.

Reliever medication: This comes in a blue/grey metered dose inhaler containing salbutamol, an ingredient used to relax the muscles around the airways to relieve asthma symptoms. This medication is always used in an asthma emergency. Reliever medication is commonly sold by pharmacies as Airomir, Asmol, Ventolin or Zempreon.

Seizure triggers: Seizures may occur for no apparent reason, but common triggers include forgetting to take medication, lack of sleep, other illness, heat, stress/boredom, missing meals and dehydration. Flashing or flickering lights can trigger seizures in about 5% of people living with epilepsy

4. Authorisations and review

This procedure is the responsibility of Early Learning Victoria. Contact: ELV@education.vic.gov.au

It was approved by the CEO Early Learning Victoria on 6 February 2026.

Early Learning Victoria regularly reviews its policies and procedures. This policy is due for review on 6 February 2027 unless changes in legislation or Department of Education policy require it to be reviewed sooner.

Reviewed by Director Early Learning ELV and Director Quality ELV.

Early childhood

Updated 16 June 2026