Nebulizer?

[JJPlaycare]

Okay, okay where do I begin...... Well I have a 2 year old that comes full time and he seems to have been sick since, well I don't know we'll say July! No joke! Anyway he isn't always sicker than a dog, but I don't think I have EVER seen him without some sort of symptom since July or so..... So I have sent this child home SEVERAL times! Sometimes he has a fever and gets sent home, but mainly my concern has been his cough! It is hard, tight, a HORRIBLE cough! He seems to get it everytime he seems to get sick!! Anyway his mother showed up here a week or so ago with a nebulizer and asked me if I knew how to use it! Apparently they took him to the ER and she told me that they said the area that connects like a flap or something that connects to his bronchial tubes gets inflammed due to coughing so hard! She said it isn't bronchitis or pnemonia or anything. I talked to my licensor who said nope, no nebulizer without a doctors note and it was up to me if I even wanted to do it, in which I knew! So again this week we are back to the HARSH coughing and what I have noticed with him is it seems to really hit home with a weather change! We live in MN and it seriously went from 60 to 80 and humid in 24 hours! Of course he shows up coughing his little lungs out! We went outside and the child could hardly play because he was coughing so hard, he has NO fever but does have a runny nose! I made him sit out, with some water and take a break yesterday while we were outside because I thought he was going to keel over! He is 2 doesn't understand this, starts crying which only makes it worse! He has a hoarse voice and just can't seem to kick this! Today mom shows up again with the neb, she said she will get a doctors note and email it to me today!! I am just unsure how to handle this..... I asked her what the inflammation was caused from and she says the harsh coughing and I said then what is the coughing from! Does he have asthma or allergies or what? She said he could but they don't know for sure they just told her to use the nebulizer as need be!! I told her that I needed as much information from the doctor as possible... so unsure what I will get, but what would you do in this situation!! So unless it shows up today, but not sure how it will since they haven't done any testing, but so far I guess I have to rule him as being sick and that I won't neb for a sickness! Until I get a specific signed note from the doc stating that this child has asthma and needs the neb would you keep telling them you won't neb him and that if you feel he needs to use the nebulizer than he can't be here!! I don't know what to do and I am looking for advice!!

[Unregistered]

I have a few kids that use nebs, some own theirs and use it when they first start to get sick and others come back from the Dr and their rest at home with them. They really seem to work wonders on the kids here. I understand that you want a DR note for lisc reasons and I would require it from the DCM but other than that I don't see why you wouldn't want to use it?

MsMe

[nannyde]

I wouldn't feel comfortable having him in my care. It sounds like he needs one to one care.

Here are a couple of good nebulizer threads:

https://www.daycare.com/forum/showthread.php?t=28342&highlight=nebulizer

https://www.daycare.com/forum/showthread.php?t=26221&highlight=nebulizer

[GG~DAYCARE]

The child may have asthma that is not very well controlled. I have never excluded a child from my dc because they needed a nebulizer ( with a drs note). I have my own children with asthma and if the school had refused to do the treatment my son would have been never been there! LOL I guess it is a personal choice and what you feel comfortable with doing.

[JJPlaycare]

I guess I am going to need a note from the physician stating that this child has asthma and then I will do the neb treatments! However I do not have a noe stating that this child has asthma so am I just having to give this child a neb treatment because they are sick, then I personally am not okay with that - a cough is very contagious when it is caused from a virus and if it is bad enough to need a neb treatment in the middle of the day then I don't want him here! The problem I know I will have with the asthma part is most kids that are diagnosed with asthma aren't diagnosed until they are around 6 and this child is 2!! Is this correct or not? Have 2 year olds been specifically diagnosed with asthma??

[Blackcat31]

According to the CDC, "reports cite that asthma rates among children in North America are four times higher than they were 20 years ago."

which in itself is alarming but in this particular case, I would NOT use a nebulizer until the doctor diagnoses and prescribes it as needed for asthma. I would NOT allow this child to be in care though if he were simply sick. Waaaaay too much liability involved there...what if he does have asthma and does not have a specific health plan from his doctor and then has an attack while in your care? People die from asthma attacks and I would never want to be in that position with a child in my care.

So I think your options are; to exclude until he is well or until he has been properly diagnosed and you are given a written health plan from his doctor outlining EXACTLY what needs to be done in regards to treatment.

Nebulizers are easy so that part shouldn't be an issue...provided he needs one for something other than simple illness. Here are a couple really educational sites about asthma and the facts about diagnosis and treatments.

http://www.aafa.org/display.cfm?id=4

http://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118497.htm

[daycare]

I'm going to assume the difference between you and an elementary school is that the school has a knowledgeable nurse on staff and you don't?
I had a situation like this at the start of the year. The family showed up with it and no answers why.
I have no medical background so I said sorry I dont feel comfortable giving this, you are welcome to do it. I also told them that I would need still need a doctors note stating reason for neb and any special side effects that conside with the medication he's been given.
I made a mistake and let the baby come one more day without doc note because they said they has an appt the following day. Well that day before his appt he had a seizure. He had a reaction from the medication

Again having no medical background or info from the doctor there was not much I could do.

My advice to you is don't do it, doctors note or not. If the Childs health is that unstable he needs one on one care else where.

[JJPlaycare]

I am not administering ANYTHING without a complete discription, diagnosis and plan from a docter, don't worry! I guess my question is this, what do I send him home for? He is playing, in good spirits just coughing his GUTS out with increased activity and outside time! Is this good enough reason to send him home today?? I don't know.....

[Blackcat31]

I am not administering ANYTHING without a complete discription, diagnosis and plan from a docter, don't worry! I guess my question is this, what do I send him home for? He is playing, in good spirits just coughing his GUTS out with increased activity and outside time! Is this good enough reason to send him home today?? I don't know.....

I say YES! it is enough to send him home because of his history with these symptoms. I would be super uncomfortable with providing care for him when you know it is more than just a cold. I would tell mom, I am sorry but it is just too much of a liability to have him stay without him having a doctors visit stating he does or does not have asthma or some other respitory illness.

I would probably keep the child IF he didn't have the history of being so sick as you stated in your original post. But since he has had a history of this, it is telling me something is wong.....and not knowing is as dangerous as ignoring IMHO. Good luck and don't feel bad...you are advocating for this child. What you described is not normal.....

[Symphony]

I've used nebulizers on many occasions with different children for different reasons. Some chronic and some acute (but no longer need to be excluded). It is really easy, and ime, the other kids find it fascinating, so I have never had a supervision issue surrounding it.

I do require a physician's note and since I am licensed I have to take a medication administration class each year.




***I say this very gently...your posts are really difficult to read with all the exclamation points. I don't know if anyone else feels this way, but I have a hard time.

[JJPlaycare]

Ha I guess I am rather exclammation point crazy. I am not yelling, I didn't even realize I was doing this. Sorry.... Thanks for pointing that out though

[sharlan]

I guess I am going to need a note from the physician stating that this child has asthma and then I will do the neb treatments! However I do not have a noe stating that this child has asthma so am I just having to give this child a neb treatment because they are sick, then I personally am not okay with that - a cough is very contagious when it is caused from a virus and if it is bad enough to need a neb treatment in the middle of the day then I don't want him here! The problem I know I will have with the asthma part is most kids that are diagnosed with asthma aren't diagnosed until they are around 6 and this child is 2!! Is this correct or not? Have 2 year olds been specifically diagnosed with asthma??

Yes, children under the age of 6 are diagnosed and treated for asthma. It sounds like this child needs a good checkup from his dr to get at the root of his coughing.

I would tell the parent that you have to have a note from his dr before giving him the inhaled medications.

[jojosmommy]

I am in MN also and have a severe athsmatic here in care also. He uses his neb here regularly. I have dr note and follow the guidelines for how/when to use it. He also has other inhalers.

He has been taken by ambulance from school to ER two times in the last year b/c of athsma sx.

The weather here is always the contributing factor and as you mentioned huge changes here in spring and fall make the coughing terrible.

He too was always sick prior to the neb treatments.

I would get tough on the mom and say he can not come UNTIL you have a doctors note and a written plan for managing his athsma at daycare. For example, if the child in my care can not function normally (take walks etc) then he needs to go home. She also knows I do one call to mom, one to dad and if he needs to be picked up immediately I will not hesitate to call the ambulance.

[harperluu]

Because you're in MN, you need to have a medication administration form filled out by the parent as the albuterol (or whatever else??) used in the nebulizer is a prescription medication.

My daughter is 2 also and can hold the air mask near her face on her own. My general guideline is if the child is unable to participate in daily activities (outside time for instance) comfortably no matter what the symptoms then they may not attend.

[JJPlaycare]

Okay so I have a doctors note stating that the child has restrictive airway disease and that he needs the nebulizer treatment every 4 hours if needed for shortness of breath and cough. Not sure what to do with this.... What I have noticed is with huge weather changes he has a VERY hard time, well we live in MN and our weather here is really unpredictable. How do you guys handle this? He seems fine right now, but hard telling what will happen if we get outside if we get there because it is raining. Anyway what do you do because there has been lots of days where he has been fine in the house and once we get outside and running around it really flares up. What am I suppose to do make all the kids come inside so he can have a nebulizer treatment and have them all miss some of their outside time? How do you handle this if you do or would you recommend not handling it? Is this something I can say ya know what I don't have time, don't feel comfortable doing and don't want to do so you can give it to him in the morning before comming and then at night after you pick him up?