Nebulizer?

[nannyde]

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?

From my policies:

Children with medical disabilities, chronic medical illnesses, or behavioral problems will be considered for enrollment based on the ability of the day care to provide excellent care to the child and existing children in the day care. We receive many requests to consider special needs children but usually have only one slot available. We currently have that slot filled and will not be considering additional special needs children at this time unless the child has a parent funded or State funded assistant present during day care hours.

[MarinaVanessa]

If you personally do not feel comfortable giving the nebulizer treatments yourself you could always tell the parents the way you feel but offer to allow them to come to DC every four hours (or whatever the treatment times are) so that they can give the treatments themselves.

What I see is that you are asking questions about things that you are not comfortable with (coughing child, how to talk to family, treatments, plan from a doctor etc) and are still not comfortable with the situation even after all of the comments and suggestions. Maybe we are not addressing your concerns properly? What exactly are you still not comfortable with?

[nannyde]

If you personally do not feel comfortable giving the nebulizer treatments yourself you could always tell the parents the way you feel but offer to allow them to come to DC every four hours (or whatever the treatment times are) so that they can give the treatments themselves.

What I see is that you are asking questions about things that you are not comfortable with (coughing child, how to talk to family, treatments, plan from a doctor etc) and are still not comfortable with the situation even after all of the comments and suggestions. Maybe we are not addressing your concerns properly? What exactly are you still not comfortable with?

She's got a kid that is actually a sick kid... one that shouldn't be in child care.... one that shouldn't be an hour and a half away from a parent... one that has a diagnosis that is vauge and a treatment that takes a LOT of man hours to manage.... and the risk that he'll go south in a flick of a switch and she'll have to deal while she's trying to take care of the other kids.

She's concerned because she really doesn't understand what the vague diagnosis really means and what she DOES know (treatments every four hours) is just one piece of making him live and livable in a nine/ten hour day.

She's concerned because she knows how often this kid is sick and how long he stays sick and how the others around him get sick at the same time when he's sick. Now he has a diagnosis that will be THE reason he is sick even when he's actually got something contagious... but by the time she KNOWS that it will be too late. And that scenario will happen over and over and over again.

She knows that the constant sickness, coughing, barking, and noise is so disconcerting and stressful. She's worried that her other clients will be as lost as she is trying to decide if it's too much and when it possibly can affect their life.

She's concerned that when she does HIS best interest no one else's interest will be met.

How am I doin OP?

[JJPlaycare]

Wish there was a "like" button on this forum? LOL You guys are being very helpful, I guess I am blabbing on and on and trying to sort things out in my head, but doing so on this forum and trying to figure out what the best plan of action would be without upsetting ANYONE hahaha easier said than done!! I REALLY do not understand this condition I guess. :confused: What Nannyde has described above is correct. I feel like from here on out with this RAD situation, I feel like his parents will just think it is okay for him to come no matter what he has because he has this condition and I somehow need to let them know that, that will not be the case! I honestly believe that they (his parents) do not think he is contagious, she told me herself in which isn't true! I need to tell her indeed probably no other childs airways will restrict because they do not have that condition, but there is something causing that to happen to him and more than likely it is a virus which in turn is contagious! I get that RAD can happen for several different reasons and I see that his is usually weather change which really brings it out, but I do believe that he has suffered from several viruses and believe that really that is the underlying cause to inflame the RAD situation. Which in turn is contagious, does every illness/virus have to stay out of care no. However I will try to make this my last question on here; I think this is the scenerio I am seeing over and over here! He picks up a virus, here, there, wherever, the other kids are affected by this virus, started it or whatever, it happens, there will forever be illness in kids, its inevitable. However the other kids stay home a day or two, get well and come back! I send him home with a fever, he stays out until his fever is gone and then comes back and still has this huge cough, which I believe, but correct me if I am wrong is still contagious. He is back and in good spirits, no fever but still a lingering cough, how am I to keep this cycle to a minimum and reduce or even end the spread? If I tell them he can't return until his symptoms are gone, this child will NEVER be in childcare....... I love this child, love this family, don't want them to loose this for these reasons, but also for the fact that he is income in my pocket, and that is what I am tossing back and forth and I don't know I will hush now and deal with it in my own head! I appreciate all of your advice and will take it with me and somehow figure this all out and will make someone upset in the end I am sure and maybe I just have to look at it as majority rules I don't know! Thanks again....:confused:

[nannyde]

Wish there was a "like" button on this forum? LOL You guys are being very helpful, I guess I am blabbing on and on and trying to sort things out in my head, but doing so on this forum and trying to figure out what the best plan of action would be without upsetting ANYONE hahaha easier said than done!! I REALLY do not understand this condition I guess. :confused: What Nannyde has described above is correct. I feel like from here on out with this RAD situation, I feel like his parents will just think it is okay for him to come no matter what he has because he has this condition and I somehow need to let them know that, that will not be the case! I honestly believe that they (his parents) do not think he is contagious, she told me herself in which isn't true! I need to tell her indeed probably no other childs airways will restrict because they do not have that condition, but there is something causing that to happen to him and more than likely it is a virus which in turn is contagious! I get that RAD can happen for several different reasons and I see that his is usually weather change which really brings it out, but I do believe that he has suffered from several viruses and believe that really that is the underlying cause to inflame the RAD situation. Which in turn is contagious, does every illness/virus have to stay out of care no. However I will try to make this my last question on here; I think this is the scenerio I am seeing over and over here! He picks up a virus, here, there, wherever, the other kids are affected by this virus, started it or whatever, it happens, there will forever be illness in kids, its inevitable. However the other kids stay home a day or two, get well and come back! I send him home with a fever, he stays out until his fever is gone and then comes back and still has this huge cough, which I believe, but correct me if I am wrong is still contagious. He is back and in good spirits, no fever but still a lingering cough, how am I to keep this cycle to a minimum and reduce or even end the spread? If I tell them he can't return until his symptoms are gone, this child will NEVER be in childcare....... I love this child, love this family, don't want them to loose this for these reasons, but also for the fact that he is income in my pocket, and that is what I am tossing back and forth and I don't know I will hush now and deal with it in my own head! I appreciate all of your advice and will take it with me and somehow figure this all out and will make someone upset in the end I am sure and maybe I just have to look at it as majority rules I don't know! Thanks again....:confused:

Woops I missed: "and she wants the money"

Welcome to the roller coaster of "asthma" and "RAD.

It took me a long time to get to where I am now but I settled on "no nebs". For me, it's just not worth the money. The cost of managing it in my setting is just too high. When I say "it" I'm not talking about JUST the treatment... it's all the other things you have posted about.

You have to know when you are in over your head... and for me... this is one of my lines. I came to the conclusion that I have to have kids here every day that can breathe well in order for me to be happy and do a good job. I've done MANY MANY years of managing kids who don't and I've done my part. It's time to have a break and enjoy my career and make it thru the next decade with my nerves intact.

[GG~DAYCARE]

A cold shouldn't exclude a child from day care. This child just happens to get sicker than most and will take longer to recover. His contagious period is no different than any other child in dc. I am not trying to argue this but he has a condition that is NO WORSE that the common cold. I have 5 children suffer through RAD as little ones and it was almost awlays another kid in my care who got them sick.
Reactive airway disease= airway reacts to a virus or bacterial infection. Whether that be a common cold or bronchitis

I really think it comes down to...do you want to give him his treatments or not? If you don't feel comfortable I would talk to the parents and go from there. With the distance it doesn't seem like they can come to do the treatments from work. This is not going to be a one time occurance. Everytime he gets a cold he will more than likely need the nebulizer.
I think you will make what ever decision is right for you and be confident in your decision!!!

[nannyde]

A cold shouldn't exclude a child from day care. This child just happens to get sicker than most and will take longer to recover. His contagious period is no different than any other child in dc. I am not trying to argue this but he has a condition that is NO WORSE that the common cold. I have 5 children suffer through RAD as little ones and it was almost awlays another kid in my care who got them sick.
Reactive airway disease= airway reacts to a virus or bacterial infection. Whether that be a common cold or bronchitis

I really think it comes down to...do you want to give him his treatments or not? If you don't feel comfortable I would talk to the parents and go from there. With the distance it doesn't seem like they can come to do the treatments from work. This is not going to be a one time occurance. Everytime he gets a cold he will more than likely need the nebulizer.
I think you will make what ever decision is right for you and be confident in your decision!!!

With the distance it doesn't seem like they can come to do the treatments from work.

The distance thing alone would do me in. Being that far away from a kid who has had such a long history of continuous illness? NO WAY

I need my parents to get here in a jif if need be. If they can't then I can't take the kid. Too risky for me.

[MarinaVanessa]

I totally get that the OP is mulling over everything in her head and that's why we keep going in circles but there comes a time when you really have to make a choice KWIM? I understand that you don't want to lose them as a client, I understand that you don't want to peeve anyone off, I understand that she needs an income but this is where you have to stop and think about how it will effect your business. What are YOU willing to deal with? What is better for YOUR business? Are other families sharing concerns with their children getting sick? Could there be issues in the future? Could the child potentially be at a greater risk being in your group? Are you prepared with a clear plan of what you will have to do in the case that the child becomes very I'll and needs immediate medical attention?

I know that if I were put in this situation I would not accept this diagnosis of "we don't really know what he has so were callin it this". I would need to have a DR's recommendation, a plan of action from the parent, parents willing to give the child the nebulaizer treatment themselves (I don't even give my own kids over the counter medications for crying out loud) and you can bet your bottom dollar that I would still call my own pediatritan and probably even licensing and the health department for their recommendations (maybe even my liability insurance) and THEN and only then would I think about what I everything and base MY decision off of that. Yes the child gets sick more often than other kids and perhaps this is just a minor illness that this child just so happens to have an exaggerated reaction over but there is still that risk that the child could potentially be in a medical emergency. It all depends on what each provider is willing to be liable for and what they are able to take on personally.

[GG~DAYCARE]

With the distance it doesn't seem like they can come to do the treatments from work.

The distance thing alone would do me in. Being that far away from a kid who has had such a long history of continuous illness? NO WAY

I need my parents to get here in a jif if need be. If they can't then I can't take the kid. Too risky for me.

I have to agree with you there! All my parents are within 15 minutes of my house.

[nannyde]

I totally get that the OP is mulling over everything in her head and that's why we keep going in circles but there comes a time when you really have to make a choice KWIM? I understand that you don't want to lose them as a client, I understand that you don't want to peeve anyone off, I understand that she needs an income but this is where you have to stop and think about how it will effect your business. What are YOU willing to deal with? What is better for YOUR business? Are other families sharing concerns with their children getting sick? Could there be issues in the future? Could the child potentially be at a greater risk being in your group? Are you prepared with a clear plan of what you will have to do in the case that the child becomes very I'll and needs immediate medical attention?

I know that if I were put in this situation I would not accept this diagnosis of "we don't really know what he has so were callin it this". I would need to have a DR's recommendation, a plan of action from the parent, parents willing to give the child the nebulaizer treatment themselves (I don't even give my own kids over the counter medications for crying out loud) and you can bet your bottom dollar that I would still call my own pediatritan and probably even licensing and the health department for their recommendations (maybe even my liability insurance) and THEN and only then would I think about what I everything and base MY decision off of that. Yes the child gets sick more often than other kids and perhaps this is just a minor illness that this child just so happens to have an exaggerated reaction over but there is still that risk that the child could potentially be in a medical emergency. It all depends on what each provider is willing to be liable for and what they are able to take on personally.

This is a great post.

This IS the process... and we all have to go thru it as we go along doing day care.

I've been on the ride too many times and really not managed it well. I made so many judgement mistakes... ones that kept the kid alive but stressed me and my staff assistant out... ones that directly affected the ability to take care of the other kids... that pulled away from the other kids... and added SO much more work to our day.

I tried to make it work and it just doesn't for ME. I had to make a concrete decision and stick to it. Now... I don't provide services to kids who need nebs because I know I can't manage it.

[JJPlaycare]

Talked to my licensor, having a public health nurse come out and train me on the machine, have a doctors note, but getting a better doctors note a more precise plan of action which also includes the risk factors of the medication and also the risk factors of when he doesn't recieve the medication! I am getting specific details of when he is in need of the meds and so on..... I am going to try this, but at any point if I feel it isn't working then I will take immediate attention and do what needs to be done for the best of everyone! I guess I have to experience it myself and see if this is something I can handle just as you have done. If it becomes to stressful or supervision becomes an issue than I will need to terminate this child so he can have the care he needs and for the care all of the other children deserve here! Mom works an hour away, but they have several family members that are nearby, as in, in my neighborhood or work within 10-15 mins of where I live. I appreciate all of your advise and trust me I completely understand where each of you is comming from. Licensing however says I should go through the training and not just disregard the situation to avoid discrimination issues as we as licensed providers have to do what the doctor orders and can't throw it out the window.

[nannyde]

Talked to my licensor, having a public health nurse come out and train me on the machine, have a doctors note, but getting a better doctors note a more precise plan of action which also includes the risk factors of the medication and also the risk factors of when he doesn't recieve the medication! I am getting specific details of when he is in need of the meds and so on..... I am going to try this, but at any point if I feel it isn't working then I will take immediate attention and do what needs to be done for the best of everyone! I guess I have to experience it myself and see if this is something I can handle just as you have done. If it becomes to stressful or supervision becomes an issue than I will need to terminate this child so he can have the care he needs and for the care all of the other children deserve here! Mom works an hour away, but they have several family members that are nearby, as in, in my neighborhood or work within 10-15 mins of where I live. I appreciate all of your advise and trust me I completely understand where each of you is comming from. Licensing however says I should go through the training and not just disregard the situation to avoid discrimination issues as we as licensed providers have to do what the doctor orders and can't throw it out the window.

Part of the process is understanding that the "state" or "licensor" often don't really understand the disability act and discrimination. Often it is YOU JUST DO. If a dr says it ... you do. If the parent claims it... you do. It's for the babies... you do.

It doesn't take long before "you do" consumes you.

(One thing I will pass on for sure is if they come in and say that the kid had the treatment in the middle of the night and it's due now or near now... you will have a pretty good idea that they aren't doing it at all at home. Once the kid starts crying over having to do it at home you can EASILY get into a deal where you are doing THREE of them a day. The parent says "I couldn't do it before we left home.. it was too early... not four hours... the four hours will be in fifteen minutes. So you will HAVE to do it right when he arrives... at nap... and four hours later. In an eight hour day you can be expected to DO it three times. Then they start adding a second one (steroid usually) and then that can't be given together... then you have five/six of them. It can get very time consuming pretty quickly so proceed with caution).

[jen2651]

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

Yikes! I do this all the time (great, there I go again). And I have a really big problem with run on sentences connected with 3 periods, and parenthesis...I'm a big, hot, writing mess! - oh, man

[Unregistered]

As others have said this child's asthma is not controlled.

That being said, an asthmatic child on a nebulizer can be properly treated and participate in day care. HOWEVER.. I can't believe the parents are leaving him so far away, with someone who isn't sure what they're dealing with. I have a severe asthmatic, he did not stay with anyone who didn't know HIM and the signs that he was headed for trouble. I would not have been an hour and half away from him. I would not have left him with someone unfamiliar with what he needed, or for that matter someone who had however many other kids to worry about. (Meaning, his needs were too much of an inconvenience. I understood that, hell, I lived with it.. but he wouldn't have been left with someone with a full dayhome.) He had two attacks that could have been fatal. Once when he was with a provider who sloughed off (ignored) what needed to be done.. or didn't have time or couldn't be bothered or whatever. She didn't want to deal with it and didn't pay attention when I explained things but she wanted the money basically. The other one was when he was with ME.. when I knew what I was dealing with. He went from "OK" to being admitted and in an oxygen tent very quickly.

If, after the information you gather you are not 100% sure about this child then tell his parents that and let everyone move on.

[nannyde]

As others have said this child's asthma is not controlled.

That being said, an asthmatic child on a nebulizer can be properly treated and participate in day care. HOWEVER.. I can't believe the parents are leaving him so far away, with someone who isn't sure what they're dealing with. I have a severe asthmatic, he did not stay with anyone who didn't know HIM and the signs that he was headed for trouble. I would not have been an hour and half away from him. I would not have left him with someone unfamiliar with what he needed, or for that matter someone who had however many other kids to worry about. (Meaning, his needs were too much of an inconvenience. I understood that, hell, I lived with it.. but he wouldn't have been left with someone with a full dayhome.) He had two attacks that could have been fatal. Once when he was with a provider who sloughed off (ignored) what needed to be done.. or didn't have time or couldn't be bothered or whatever. She didn't want to deal with it and didn't pay attention when I explained things but she wanted the money basically. The other one was when he was with ME.. when I knew what I was dealing with. He went from "OK" to being admitted and in an oxygen tent very quickly.

If, after the information you gather you are not 100% sure about this child then tell his parents that and let everyone move on.

Just to clarify. This kid doesn't have an asthma diagnosis. Just reactive airway disease.

Your story is VERY good. It shows a real life example of how a child with breathing issues MUST be with people who really feel comfortable with it AND have the paid TIME to do ALL the things that come along with managing it.

You said "She didn't want to deal with it and didn't pay attention when I explained things but she wanted the money basically."

Was she being paid a salary for managing his asthma beyond her regular pay for regular care? Was he enrolled as special needs at a special needs rate?