It can be extremely challenging to find daycare and childcare providers for children with feeding tubes, even when their needs are minimal. Even though children should be allowed to attend most daycares and childcare centers under the Americans with Disabilities Act, many facilities use exemptions to avoid accepting a child with a feeding tube.

There are, however, many options for families, such as home-based daycares, medical daycares, special needs daycares, Medicaid and Medicaid waiver services, as well as nannies and other individual caregivers.

Know the Law

Children with feeding tubes are typically considered children with disabilities, and are therefore covered by the Americans with Disabilities Act. This Act forbids daycares and childcare facilities from discriminating against children with disabilities, including all daycare and childcare centers, even small home-based programs. Daycares and childcare centers must accept children with disabilities as long as they do not pose a threat to other children, and they can be accommodated without a fundamental alteration to the program. Daycares must be willing to make reasonable modifications to accommodate a child. Note: these laws do not apply to daycares/childcare centers that are run by religious institutions.

Daycares are not required to hire a nurse or an aide to administer tube feedings to your child. This is considered a “fundamental alteration” of their program. However, if you provide a nurse/aide funded by Medicaid or another source, they cannot turn down your child simply because he has a feeding tube.

Many daycares consider the care required by a child with a feeding tube to be too great, and will automatically turn down your child. Know that case law has demonstrated that children with diabetes and children who need medications should be able to be accommodated by daycares. The same should be true of feeding tubes. Unfortunately, unless you are willing to file a complaint, a daycare can turn your child down by claiming her care would require them to fundamentally alter their program. In some states, however, state laws require tube feedings to be given by a nurse, and that may limit the ability of daycares and child care centers to accept children with feeding tubes.

For more information on the relevant laws, see the ADA’s page on Childcare Centers.

Options for Childcare

Regular Daycare

Many children can be accommodated in a regular daycare setting with minimal extra supports. Often, it is simply a matter of training several of the staff members to give a feeding and operate a feeding pump. Sometimes individuals in home daycares are more willing to learn these skills. In addition, Headstart programs may be more likely to have an individual on staff who is willing to learn how to use a feeding tube.

Regular Daycare with Supports

All children who receive Medicaid or a Medicaid waiver are entitled to personal assistant, CNA, or nursing services if these services are medically necessary. If a child has an aide, CNA, or nurse, that individual may attend daycare with the child.

Home Services

Children who participate in Medicaid or a Medicaid waiver can receive home care services, which are typically provided by a CNA or nurse, if a doctor says they are medically necessary. These services can be used for childcare while parents are working.

Medical or Special Needs Daycares

Some cities have medical or special needs daycares available to care for children with complex medical issues. In some cases, these are part of hospitals or are publicly funded through Medicaid. In other cases, they may be run by private groups, therapy centers, or disability centers. Easter Seals and UCP sometimes offer these services. Many of these facilities are able to take children with feeding tubes.

Nannies and Caregivers

You can hire your own caregiver if you choose. Services such as care.com often match caregivers with special needs experience with families. Typically, these highly trained individuals cost a little bit more. Sometimes, nursing students or PT/OT students can be used as part-time caregivers.

Practical Issues

If you find a daycare or childcare willing to take your child, you will likely be responsible for training the staff at the facility to care for your child. The staff should learn the following:

  • How to prepare a feed and store formula/food
  • How to give a feed
  • How to vent, if applicable
  • How to use and troubleshoot the feeding pump
  • How to flush
  • How to give medications
  • How to change a feeding tube in an emergency

Most of the practical issues are identical to those for children who attend school. For more information, see the Feeding at School page. Helpful guides include the Moog Infinity Field Guide and Quick Guide.

Often, daycares include younger children, who may have curious hands. Your child may need to use special products, such as a G-tube belt to keep the tube safe while at daycare.