Nebulizer?

[nannyde]

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?

I don't do treatments here for reactive airway disease. It's an acute condition and doesn't qualify under the disability act (IMHO) so I would have him stay out of care until he was able to participate without the medication. I don't feel comfortable giving nebulizer treatments.

http://www.mayoclinic.com/health/reactive-airway-disease/AN01420

Reactive airway disease is a general term that doesn't indicate a specific diagnosis. It may be used to describe a history of coughing, wheezing or shortness of breath of unknown cause.

[JJPlaycare]

Well how do you make him stay out of care until he is capable to take part in all activities when he is just fine one minute and then Wha Bam he has a flare up? Like the other day when it was hot and humid he was coughing a little bit in the house, but managable and nothing he needed a nebulizer for then when went outside to play and his coughing suddenly became very harsh. Do I then at that point call his mother who works an hour away and it is about an hour and a half until she is here anyhow? How do you not treat a child for this when it can flare up at anytime of the day? Is it something he isn't going to keel over on me for, is it pertinent he gets these treatments - I have a doctor saying so? So how do I say I am not going to give them to him, that would just lead to them leaving my care, right? Is that how you do it and is that what happens? I am curious because I am unsure what to do at this point....

[JJPlaycare]

I mean more of how do you tell a family that their child can't come to daycare until they can pertake in all activities when it can flare up at anytime? They don't know when it is going to hit...... We have a pretty good idea of weather change causing the flare ups, but weather is unpredictable just as much as this is. If I said he can't come until his cough is gone he would never be able to come.

[GG~DAYCARE]

I think if you are not comfortable giving the nebulizer it would be best to
term him. Its not fair to you or your group or the little boy and his family. My son was diagnosed with RAD and used his nebulizer daily. He was not sick most of the time. I am glad I was home for him because I would have been fired from a job if he wasn't allowed to attend day care because he needed a nebulizer!
I am sure they will be able to find care where giving him his required treatments are OK.
PS...if I knew going outside would send my son into a coughing spasm, I would give him a treatment before going out. My daughter coughs during PE class. She uses her inhaler before she excersizes. Same med just a different form of administering it!
I am not being judgemental. I just think he would be better somewhere else for all involved.

[GG~DAYCARE]

I just read your other posts. I am no doctor...just a Mom with 5 children who suffered through RAD and asthma as younger kids. I really think he is not controlled and that is the problem!! He is using the nebulizer as his "rescue" medicine and sounds to me like he needs meds to get his coughing controlled. Maybe its time his Mom took him to a pediatric specialist to see what is setting him off and to deal with it now. Once the lungs are twitchy, any little thing can set them off.

[JJPlaycare]

What does it mean to be not controlled? Do they send him through testing to see what is setting it off or what? He just turned 2? His diagnosis and the note I have is from an ER doctor, in whom prescribed the nebulizer as well? Another question for you since you do have children with RAD is it common to have a runny nose with it? I have only ever sent him home for a fever, I do not have in my contract anything about coughing.... However up until now I have never had a child like this, I have only experienced kids that have a cough when they are sick. I guess I don't really understand this RAD thing. So they are not contagious, is that right? I think what I see with him is he is set off from weather change and when he does get sick it sets it off. A week or so ago he started this uncontrollable coughing again over the weekend, he came Monday and I sent him home Tues with a fever and the uncontrollable cough, but told the mom she had to pick him up because he has a fever in which he did, then she brought him back Tues full of over the counter meds and a nebulizer! Well of course he didn't have a fever he had IB profen, so how do you know when it is a RAD flare up or when they are actually sick and contagious - I guess I am confused....:confused:

[GG~DAYCARE]

The way I used to tell other parents is..."your kids cold is my kids nightmare". Granted, he probably is sick. Just not sick enough to send him home. Once the lungs get inflamed from the virus, they remain irritable for weeks. Anything could set them off. Running, heat/cold changes,crying, drinks too cold even. I know it is very frustrating if you never know when he will need a treatment. I would sit down with his parents and tell them he needs a full work up and a PLAN for you to use when and if he needs meds. ***GOING TO THE ER FOR TREATMENT IS TEMPORARY*** He needs to be seen by his pediatrician!!
I finally took my son to an allergist to work out a plan for him. Whenever he got a cold we would start treatment with the first cough. He would need steroids alot of times but barely did he need antibiotics.
I know he is only 2 and he is probably too young to test for allergies but an allergist is usually pretty up to date on RAD and asthma treatments.
Good luck!!!

[JJPlaycare]

So the plan I have is give him the neb every 4 hours or as need be.... What other plan could they give him???

[JJPlaycare]

In my heart I want to help this child and the family.....but..... how do you explain to my other families when he has a bark like no other not to worry about it? I understand it affects him differently and it last alot longer, but they entire time he has this lingering cough can he pass it to the other kids, how am I to know when he is sick, when he isn't, when he is contagious, when he isn't? Is this fair to all of my other families?

[countrymom]

YOU NEED TO SEND HIM HOME. WHY BECAUSE I HAD A KID LIKE THIS. Yup he started in december, always sick, harsh cough, barking cough, ear aches, never a fever. Well he started making the other kids sick, which I thought it was weather related. But then I got sick and so did my sister (she comes once a week with her dd) and dad kept bringing him from dr to dr and they said it was a cold or whatever. So I went on vacation and said that if he doesn't get better then he will have to leave.
I came back and his cough was still awful, the sister (she is never sick) said that he went to the dr and is puffers again and whatever. But finally he had an appointment with and ent (ears, nose and throat) well whatever happened there dad won't tell me, because he pulled him the next day. This kid is constatly going to drs (the sister tells me) but he made us all very sick, so I wonder what he has. Amazing that now that he's gone, no one is sick, I don't hear coughing, and the kids can eat in peace. He needs to go to a specialist, you need to start and become very strict about it

[Blackcat31]

In my heart I want to help this child and the family.....but..... how do you explain to my other families when he has a bark like no other not to worry about it? I understand it affects him differently and it last alot longer, but they entire time he has this lingering cough can he pass it to the other kids, how am I to know when he is sick, when he isn't, when he is contagious, when he isn't? Is this fair to all of my other families?

IMPO, I think you are opening up pandora's box. This family is going to require alot more care and supervision than others. YOU are assuming alot of liability and as you pointed out, giving him different rules and stuff than other families get...even though you know the reasons why, all other parents know then is someone gets special treatment and they don't. You can't go around sharing dck's medical histories with other families due to breach of confidentiality laws and all So, I just think it is much more of a hassle than for what it is worth...kwim?

[nannyde]

In my heart I want to help this child and the family.....but..... how do you explain to my other families when he has a bark like no other not to worry about it? I understand it affects him differently and it last alot longer, but they entire time he has this lingering cough can he pass it to the other kids, how am I to know when he is sick, when he isn't, when he is contagious, when he isn't? Is this fair to all of my other families?

Your whole processing this... every question that there is no answer to... every "can it affect the kids", every "when is it too much? too little?"...........

This WHOLE process ... every single one of your posts... is why I quit doing nebulizer treatments.

[momofboys]

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 have not read many of the other posts, but two of my kids have asthma & from the sounds of this child his asthma is uncontrolled. That being said getting an "asthma diagnosis" is not something doctors do quickly. It took us several years for our dr to actually mutter the words for one of our kids!!! But likely the nebs will help things calm down. Whether you are willing to do them is up to you.

[Unregistered]

you need to decide

In my heart I want to help this child and the family.....but..... how do you explain to my other families when he has a bark like no other not to worry about it? I understand it affects him differently and it last alot longer, but they entire time he has this lingering cough can he pass it to the other kids, how am I to know when he is sick, when he isn't, when he is contagious, when he isn't? Is this fair to all of my other families?

Regardless, you need to decide and soon. If you don't help this child, who will? It's very easy for the other daycare providers to say the child needs one to one care. In our area, nannies cost $900+ per week - I don't know anyone in town that can afford that, that's why most people choose group care in some form. And it's probably not feasible for the mom or dad to quit their jobs to stay home with the child. If grandma or grandpa were available, I'm sure that family would have used them instead of a daycare. Because of this post, I actually looked up RAD - it's not contagious and could be lifelong for this child. The child isn't old enough to go through bronchial testing yet. My child needed a nebulizer for a time because of getting a respiratory virus combined with his asthma and the daycare had no problem with this as long as we had a prescription. May I suggest that if you are outside, bring the nebulizer outside with you - I'm sure you have an electrical plugin near your backdoor area. If he needs a treatment, then you're prepared. Once the child gets used to it, he'll be able to hold the wand himself without assistance. And treatments last a total of 10 minutes max for that age. You'll be doing the child a world of good and the other children won't suffer because of him. Rather, by getting rid of the child, you'd be teaching the kids and their families that it's not ok to be different, so if you get sick, I'm going to term you too. Think about the message you send to the other families and kids before you term this family. You may think the term is a good idea because you're afraid of the germs, but it may end up backfiring. I know if my daycare provider termed my child for a noncontagious sickness that will not inconvenience you, I would file complaints with licensing and would be sure to speak with the other families and other providers and the community. I may even consider writing a letter to the editor of the local newspaper about you for the entire community to read. Terming would be flat out wrong in my opinion.

[JJPlaycare]

So Nannyde would you enroll a child in your care with asthma or with RAD and just let the parents know that you will not neb them or do you just not enroll a child with this condition?