Caring for Children with Special Needs: A Guide for Nannies

Level: Intermediate · Reading time: 9 minutes

Many families look for a nanny who can care for a child with special needs. This can be one of the most rewarding jobs in childcare. You get to know a child very well, you see their progress up close, and you can make a real difference to the whole family.

This article explains what "special needs" means, how to support a child day to day, and how to work well with the family. Remember: you don't need to be an expert in every condition. The most important skills are patience, curiosity, and a willingness to learn from the parents and the child.

What does "special needs" mean?

"Special needs" is a general term for children who need extra support because of a disability, a medical condition, or a difference in how they learn, communicate or move. In the UK, you will often hear the term SEND, which means special educational needs and disabilities.

Some needs you may meet include:

Autism, which affects how a child communicates, understands the world and experiences their senses

ADHD, which can affect attention, activity levels and impulse control

Speech and language delay, when a child is slower to understand or use words

Down syndrome, a genetic condition that affects learning and development

Cerebral palsy, which affects movement and muscle control

Hearing or sight loss

Dyslexia and other learning differences

Medical conditions like epilepsy, diabetes or serious allergies

Some needs are easy to see, and some are invisible. Some children have one need, and others have several.

Every child is different

Two children with the same diagnosis can be completely different. One autistic child may love hugs and talk all day. Another may not like being touched and may communicate with pictures.

So the most important thing is to get to know the individual child: what they love, what upsets them, how they communicate, and what helps them feel calm and safe. The parents are the experts on their child, so learn from them first.

Questions to ask the parents

On your first days, ask lots of questions. Parents usually appreciate a nanny who wants to understand their child.

"What does a good day look like for her?"

"What does he love? What does he find difficult?"

"How does she tell you she's upset, hungry or in pain?"

"What helps him calm down?"

"Are there any words or phrases you use at home that I should use too?"

"Does she have any medical needs I should be trained for?"

"Who else works with him, like a speech therapist or a teacher?"

It's a good idea to write the answers down, or ask if the family has a written care plan you can read.

Communication

Not all children communicate with spoken words. Some use other methods, and you may need to learn them. These can include:

Signs, such as Makaton, which uses simple hand signs and symbols alongside speech. It's widely used in the UK.

Picture cards, for example the Picture Exchange Communication System (PECS), where a child gives you a picture to ask for something.

Communication devices, like tablets with apps that speak words aloud.

Tips for all children:

Get down to the child's level and make sure you have their attention before you speak. For some children, this means saying their name first. Don't force eye contact.

Use short, clear sentences. "Shoes on" is easier than "Can you go and find your shoes and put them on for me, please?"

Give time. Wait a few seconds for an answer. Some children need longer to process what you said.

Show as well as tell. Point, use gestures, or hold up the object.

Remember that all behaviour is communication. If a child hits, screams or runs away, ask yourself: "What is this child trying to tell me?"

Routines and visual timetables

Many children with special needs feel safer when they know what will happen next. Sudden changes can be very stressful.

A visual timetable is a set of pictures that shows the day in order: breakfast, getting dressed, car, school, and so on. The child can see what's coming and remove each picture when it's finished.

Helpful habits:

Keep the family's routines as much as possible.

Warn the child before changes: "Two more minutes, then bath time." A timer can help too.

Use "first... then...": "First shoes, then park."

Prepare for new places by talking about them, or showing photos first.

Sensory needs

Some children, especially autistic children, experience their senses differently. Noises, lights, smells, textures and crowds can feel much stronger, or sometimes weaker, than they do for us.

A child might:

cover their ears when a hand dryer or vacuum cleaner is on

refuse clothes with labels or certain fabrics

only eat foods with a particular texture

love spinning, rocking, jumping or pressure (like tight hugs or heavy blankets)

These are not "bad habits". They are the child's way of coping with how their body feels. The parents or an occupational therapist may give you ideas, such as ear defenders, quiet spaces, or movement breaks.

Meltdowns are not tantrums

A tantrum usually happens when a child wants something and is frustrated. A meltdown is different. It happens when a child is completely overwhelmed by their feelings or their senses, and they can't control it.

During a meltdown:

Keep the child and others safe. Move dangerous objects away.

Stay calm and quiet. Use very few words.

Reduce noise and lights, and give them space if they need it.

Don't punish or shout. The child is not being naughty.

Wait. Offer comfort when they are ready.

Afterwards, think about what caused it. Was it noise? Hunger? A change in routine? Tell the parents, so you can avoid it next time.

Medical needs and training

Some children need medical care during the day, for example medication, epilepsy rescue medicine, blood sugar checks, tube feeding or moving and lifting. Never do any medical task without proper training. Ask the parents to arrange training, and make sure you have a written plan explaining what to do and when to call for help.

A paediatric first aid certificate is essential, and extra training in the child's specific needs will make you much more confident.

Working with other professionals

Children with special needs often have a team around them. You might meet:

a speech and language therapist, who helps with communication

an occupational therapist, who helps with everyday skills, movement and senses

a physiotherapist, who helps with movement and strength

a SENCO (Special Educational Needs Co-ordinator), the teacher responsible for special needs at school or nursery

If the parents agree, ask the therapists for activities you can practise during the week. You spend a lot of time with the child, so you can help them make real progress.

Using respectful language

The words we use matter. Some useful guidelines:

Say "a child with special needs" or "a disabled child", not "a special needs child".

Some families prefer "autistic child", and others prefer "child with autism". Use the words the family uses.

Avoid words like "normal children". Say "other children" or "typically developing children".

Never talk about a child's needs in front of them as if they can't hear or understand.

Remember the whole family

Siblings may sometimes feel left out, because their brother or sister needs a lot of attention. Try to give them special one-to-one time too.

Parents of children with special needs are often very tired and have many appointments and forms to deal with. A reliable, kind nanny can be a huge support to them.

Keep information private. Don't share details about the child's needs with other nannies, parents at the park, or on social media.

Look after yourself

This work can be tiring, both physically and emotionally. Take your breaks, ask for help when you need it, and celebrate small successes: a new word, a calm trip to the shops, a first time trying a new food. These moments are big achievements.

Useful phrases

With the child:

"First lunch, then iPad."

"All done. Now it's bath time."

"You're safe. I'm here."

"Do you want the red cup or the blue cup?" (Show both cups.)

With the parents:

"He seemed upset in the supermarket. I think the noise was too much for him."

"She used her picture card to ask for water today!"

"Could I come to one of his speech therapy sessions, so I can practise the same activities?"

"I'd like some training before I give her the medicine. Could we arrange that?"

Vocabulary

WordMeaning

diagnosiswhen a doctor officially identifies a condition

meltdowna loss of control caused by being overwhelmed

sensoryconnected to the senses: sound, touch, sight, smell, taste

visual timetablepictures that show the order of the day

Makatona communication system using signs and symbols

ear defendersheadphones that block out loud noise

SENCOthe teacher responsible for special needs in a school

care plana written plan explaining a child's needs and support

UK vs US English: in the US, you'll often hear special education or special ed, an IEP (Individualized Education Program), and disabilities is also widely used.

Quick quiz

What is the difference between a tantrum and a meltdown?

What is a visual timetable?

What should you do before giving a child medical care?

If you're not sure whether to say "autistic child" or "child with autism", what should you do?

Answers: 1) A tantrum usually happens when a child wants something; a meltdown happens when a child is overwhelmed and can't control it. 2) Pictures that show the order of the day. 3) Get proper training and a written plan. 4) Use the words the family uses.

This article gives general information only. Every child's needs are different, so always follow the family's guidance and any professional advice they have.