Nebulizer?

[JJPlaycare]

Thank you Nannyde for stating the facts and also for standing up and educating me in what is going on and what could in turn happen! No he DOESN'T have an ASTHMA diagnosis! Although these 2 things are fairly interchangeable, I believe reactive airway disease is alot less severe than asthma. He has reactive airway disease and after re reading the doctors note with my licensor several times. It actually says he had a BOUT of reactive airway disease, which in turn tells us simply by that simple word that is what they ruled this last illness as, but he doesn't have a complete diagnosis of the condition based off of the note. I have talked about all of this with the mother and have let her know what I will be doing, what I need to do and what I still need. On the days that he has been really bad he has been sent home, simply because I didn't know what I was dealing with at the time and he shouldn't have been here in that state, asthma or not. I am in the process of educating myself about the condition at hand, honestly I believe I now know more about this condition than the mother and I am now educating her.
I live in a rural area and almost ALL of my parents work that far away. I have a few who are within 20 minutes or so, but the majority is at least 45 mins away. They send their children to daycare where they live because this is where their children will eventually be going to school, not going to school in the towns they work in. If I didn't accept children whose parents worked a distance away, I wouldn't have any children - that simply is due to the area we live. They ALL have family members in the area that can be here in a blink of an eye! That is how it works when you live in BFE!

[jojosmommy]

Like I said before, I have a child with a neb (2 children with a formal athsma dx) and have never once had any issues with getting him his TX and still running an effective daycare. Never once has this child complained about taking the meds, never once has it caused me to take time away from other kids- anymore than changing a diaper, cuddling a sad one, putting on a bandaid, wiping a nose.

I think everyone is making this out to be worse than it is. If you dont want to take the time to learn about how to properly care for this child and his RAD then give him a term notice. It's not fair to him or mom to keep going round and round about this b/c you are tied to their money. Either deal with it or lose the income and start fresh. I don't understand how people can just say its too much to care for this condition or this or this... where are these kids supposed to go?

And as someone mentioned before doctors in the ER don't just say "oh he has athsma" after seeing him 1 x. It will take the mom a while to get into her dr and complete the testing to get a formal dx. If that happens you will likely get different meds like rescue inhalers which are easier to admin and daily inhalers which can better control the issue in the first place.

[Crystal]

I haven't read all of the posts, but will share my expereince and thoughts with you.

I have had MANY children who need neb treatment over the years. Have two in care now. I think it would be unrealistic for families to not have their child in care over RAD or asthma, especially when there ARE caring providers who are willing to care for children while being sensitive to their needs and accomodating of thier condition.

You have a proper diagnosis and doctors note with the treatment plan. Make sure you also have a signed note from Mom, as well as written specifications/agreement on what to do should the child need emergency care. Clearly you cannot transport to hospital with him if you are the only provider, so get in writing that should er treatment be required you will call 911, contact mom immediately, emt will assess and transport if necessary and Mom will meet at hospital.

Every four hours AS NEEDED means use it if the child needs it.....on days when he wakes up coughing it will likely be needed every four hours. On other days, it may be every 8 hours or not at all. YOU decide when he needs it, and you WILL know if he needs it. But, you also need to get to know his triggers.....you know how he reacts to certain temperature/humidity changes, so BEFORE you go outside, give him a treatment to prevent a full blown attack. Also, have a table set up outside near an outlet if you have one, keep a bag packed with his neb and meds for taking indoors and outdoors as you go about your day and it will be readily accessible without having to take the whole group with you to medicate.

As for other parents who might ask about his cough, let them know it is non-contagious, that he has a condition that requires monitoring and neb treatments and they'll understand.

Now, I gotta go read the other posts....

[nannyde]

I don't understand how people can just say its too much to care for this condition or this or this... where are these kids supposed to go?

To you.

They are supposed to go to the one who have never once had any issues with getting him his TX and still running an effective daycare. Never once has this child complained about taking the meds, never once has it caused me to take time away from other kids- anymore than changing a diaper, cuddling a sad one, putting on a bandaid, wiping a nose.

[Crystal]

Like I said before, I have a child with a neb (2 children with a formal athsma dx) and have never once had any issues with getting him his TX and still running an effective daycare. Never once has this child complained about taking the meds, never once has it caused me to take time away from other kids- anymore than changing a diaper, cuddling a sad one, putting on a bandaid, wiping a nose.

I think everyone is making this out to be worse than it is. If you dont want to take the time to learn about how to properly care for this child and his RAD then give him a term notice. It's not fair to him or mom to keep going round and round about this b/c you are tied to their money. Either deal with it or lose the income and start fresh. I don't understand how people can just say its too much to care for this condition or this or this... where are these kids supposed to go?
.

I agree 100%

[JJPlaycare]

I am trying my hardest to make this all work for everyone. I haven't termed the child have I? Nor have I ignored the issue at hand have I? Simply comming on this forum asking for advice regarding this situation is educating myself. I have googled RAD to educate myself, I have contacted my licensor, I have talked to other daycare providers in my area, I have an appt set up with a public health nurse to educate me on the nebulizer, I have gotten a ER doctors note and I have requested his Ped to write me a note. these are all areas in which I am trying to get this all sorted out and educate myself. This isn't something that happens over night. Like I mentioned above, I am educating the mother now, of what exactly RAD is. We are working together and trying to figure out what is best for everyone, but mainly the child at hand. I would also like to mention, that at anytime during any of this if I thought the child was in an emergency type situation, I would know what to do. I am an adult, a mother of 3, a licensed and trained childcare provider, I also have some nursing in my background, which has all contributed to me knowing what to do when and if an emergency would ever arise. I have had this child in my care with this condition for SEVERAL months and had no neb, no diagnosis, just a lingering long lasting cough. Should he have been sent home everyday the last 6 months NO! When he has needed to be sent home or was to sick to be here I took the action and he was immediately picked up, but I would also like to point out that not any of those times did I think his life was at risk. Could it have been, possibly, but honestly emergencies can happen every minute of everyday, it is inevitable and you just need to know what and how to handle them when they arise and I am confident in myself and do know what to do in case of one. My constant phone calls at work and sending this child home in part has lead partially to his diagnosis finally. I feel relieved that we finally have a diagnosis for this lad and I am ready to move forward. I have tossed terming the child and keeping the child back and forth several times on here and I have tried to measure all of this out through all of your opinions to do what is best for everyone. I appreciate everyones opionions and the expierences you have had and I will take them with me. What I have decided at this point is to work with this child and his family and to get a plan set in stone and after I get everything I need here to use his nebulizer I will start treating him as need be. I also told the mother that if at anytime I feel that it is not working out that I will let her know and I and they will each move on in our lives to get everyone what they need and deserve. She understands this and appreciates not only me willing to try for her son, but also appreciates my honesty and trying to do what is best for not only the other children, but her son as well. Thanks

[nannyde]

I am trying my hardest to make this all work for everyone. I haven't termed the child have I? Nor have I ignored the issue at hand have I? Simply comming on this forum asking for advice regarding this situation is educating myself. I have googled RAD to educate myself, I have contacted my licensor, I have talked to other daycare providers in my area, I have an appt set up with a public health nurse to educate me on the nebulizer, I have gotten a ER doctors note and I have requested his Ped to write me a note. these are all areas in which I am trying to get this all sorted out and educate myself. This isn't something that happens over night. Like I mentioned above, I am educating the mother now, of what exactly RAD is. We are working together and trying to figure out what is best for everyone, but mainly the child at hand. I would also like to mention, that at anytime during any of this if I thought the child was in an emergency type situation, I would know what to do. I am an adult, a mother of 3, a licensed and trained childcare provider, I also have some nursing in my background, which has all contributed to me knowing what to do when and if an emergency would ever arise. I have had this child in my care with this condition for SEVERAL months and had no neb, no diagnosis, just a lingering long lasting cough. Should he have been sent home everyday the last 6 months NO! When he has needed to be sent home or was to sick to be here I took the action and he was immediately picked up, but I would also like to point out that not any of those times did I think his life was at risk. Could it have been, possibly, but honestly emergencies can happen every minute of everyday, it is inevitable and you just need to know what and how to handle them when they arise and I am confident in myself and do know what to do in case of one. My constant phone calls at work and sending this child home in part has lead partially to his diagnosis finally. I feel relieved that we finally have a diagnosis for this lad and I am ready to move forward. I have tossed terming the child and keeping the child back and forth several times on here and I have tried to measure all of this out through all of your opinions to do what is best for everyone. I appreciate everyones opionions and the expierences you have had and I will take them with me. What I have decided at this point is to work with this child and his family and to get a plan set in stone and after I get everything I need here to use his nebulizer I will start treating him as need be. I also told the mother that if at anytime I feel that it is not working out that I will let her know and I and they will each move on in our lives to get everyone what they need and deserve. She understands this and appreciates not only me willing to try for her son, but also appreciates my honesty and trying to do what is best for not only the other children, but her son as well. Thanks

THIS ABOVE

This above is the process. Think about how much TIME you have put into this already. Think about every call... every mental gymnastic... every bit of research... all the parent conferencing... consulting... calls to the parent to get the kid with "asthma" with a fever... etc etc.

And you haven't even BEGUN to deal with it.

See part of the process is that you will have input that says that it's easy peezy and never had a single problem... easy as pie. Then you have the reality. The truth is what you have already DONE. The amount of work and effort that you have had to do to manage this IS what I'm talking about.

It's a long long ride... and I've been on it with at least twenty kids in my career. It's easy to think of this in terms of the giving the nebs... but what you have described above is just as much... if not more.. of the process.

When you look at it in totality you have to consider "am I being fairly compensated" for THIS amount of work (what you describe above)?" If you are not then you will find over time that it becomes unmanagable. The day it dawns on you that the bottom line is you are taking care of a sick kid in well child day care... with well child pay... THEN you have to decide concretely what you will and won't do.

[Crystal]

THIS ABOVE

This above is the process. Think about how much TIME you have put into this already. Think about every call... every mental gymnastic... every bit of research... all the parent conferencing... consulting... calls to the parent to get the kid with "asthma" with a fever... etc etc.

And you haven't even BEGUN to deal with it.

See part of the process is that you will have input that says that it's easy peezy and never had a single problem... easy as pie. Then you have the reality. The truth is what you have already DONE. The amount of work and effort that you have had to do to manage this IS what I'm talking about.

It's a long long ride... and I've been on it with at least twenty kids in my career. It's easy to think of this in terms of the giving the nebs... but what you have described above is just as much... if not more.. of the process.

When you look at it in totality you have to consider "am I being fairly compensated" for THIS amount of work (what you describe above)?" If you are not then you will find over time that it becomes unmanagable. The day it dawns on you that the bottom line is you are taking care of a sick kid in well child day care... with well child pay... THEN you have to decide concretely what you will and won't do.

FTR, I never said it is "easy", it's just not as difficult as many like to portray.

And, re. COMPENSATION, not ALL providers put more money above meeting the needs of the children....some of us are willing to do more without more compensation because we love the kids we work with. Not EVERYTHING is or should be about the money.

[Crystal]

JJplaycare, I'd like to say that I applaud your efforts to meet the needs of this child and family. Not all providers would do the same.

[nannyde]

FTR, I never said it is "easy", it's just not as difficult as many like to portray.

And, re. COMPENSATION, not ALL providers put more money above meeting the needs of the children....some of us are willing to do more without more compensation because we love the kids we work with. Not EVERYTHING is or should be about the money.

Oh I wasn't referring to you... just that the scheme of the viewpoint is from "easy peezy" to my take on it. Very broad range of experience which I'm sure has to do with the level of care needed for the kids in your "practice" or experience.

I truly wasn't referring to you or anyone in this thread. I've had this discussion so many times before. I'm saying generically speaking she will see all ends of the spectrum of how providers view this.

And money... yes some decide that they won't worry about the money or time (which is money). The day I realized it WAS about money for me was when I paid a hundred bucks to a staff assistant DIRECTLY due to the neb treatments of our current group. That in ONE day.

When you are actually PAYING someone else it's not funny money... it's real money. The care of kids with breathing issues can get really expensive to a small business.

[nannyde]

And, re. COMPENSATION, not ALL providers put more money above meeting the needs of the children....some of us are willing to do more without more compensation because we love the kids we work with. Not EVERYTHING is or should be about the money.

Oh and they aren't mutually exclusive concepts. You can LOVE the kids you work with and understand fully that there are aspects of their care that ARE about money.

Heck I love my kid but he isn't cheap. ::

[Live and Learn]

I haven't read the entire thread so forgive me if this has already been said.

I would not provide nebulizer treatments. I am not qualified and it could be a legal liability.

When I get these special requests from parents I ask myself "What if I had to do this or something similar for each of my dc kids every four hours? Could I manage that? Would I want to?"

I provide care to children who are well and this child is not. Bottom line.

There are many circumstances were it is so important that a parent stay home with their own child and this is one of those circumstances. At the very least the child should have a nanny or some other one on one care.

Good luck.

[Live and Learn]

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.

This is my policy too and I think it applies to this circumstance.

[Crystal]

I haven't read the entire thread so forgive me if this has already been said.

I would not provide nebulizer treatments. I am not qualified and it could be a legal liability.

When I get these special requests from parents I ask myself "What if I had to do this or something similar for each of my dc kids every four hours? Could I manage that? Would I want to?"

I provide care to children who are well and this child is not. Bottom line.

There are many circumstances were it is so important that a parent stay home with their own child and this is one of those circumstances. At the very least the child should have a nanny or some other one on one care.
Good luck.

See, that isn't realistic. I don't know anyone who can afford to not have an income because their child has a special need, unless Dad is making bank.

I do think it is important for the provider to be realistic about wether or not they can handle such special needs, and for most I'd say it would be manageable. However, I do find it commendable when a provider is willing to admit that they cannot meet those needs and bows out.

[Live and Learn]

Crystal,

This child does not have a special need in the legal "disabilities" sense.

He is not WELL enough to participate fully in the daycare setting.

I provide care to well children only.

Just because a family shows up on my daycare's doorstep with breathing issues doesn't mean I should be expected to
take them into my care.

....and just for the record I have two children in my daycare with ACTUAL special needs. Nothing that prevents them from
BREATHING though.

In my own circle of friends and neighbors I would say the vast majority of families have one parent who stays home with their own children.....at least until junior high.