DCM kept DCG (1) home today because she had a bad cough over the weekend. DCM took her to the doc who prescribed nebulizer treatments for her 3 times per day (the doctor prescribed this last time DCG had a persistent) cough as well. Well DCM texted me asking about the required paperwork for giving her the med. and my response was that if the doctor prescribed the nebulizer as PRN or "as needed" then I would be giving it to her only if she showed certain syptoms such as wheezing, coughing, etc. BUT that is the doctor prescribed it for 3 times a day she didn't really need to have it at daycare as they could administer it in the am, when she got picked up, and before bed.

Is this wrong of me? I will give meds when necessary (for allergic reactions, nebulizer treatments and inhalators for asthma, Tylenol or Motrin to prevent febrile seizures, etc). granted I have all of the proper paperwork. However, I see giving meds as a HUGE responsibility and if they can be administered at home, by the parent, they should be.

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I agree that meds should always be given at home if possible, but I think with a nebulizer prescribed "as needed" would mean that the child has to have the nebulizer available to her in case it is needed...kwim?

It isn't like an antibiotic where you just do it 3x's a day. Sometimes those 3x's are really close to each other....just depends on the child and the illness and the need.

I have several kids like that but they have asthma and I keep a neb here. In cases of kids who are prescribed nebulizer treatments due to a cough/cold or respiratory illness, I would exclude since I would not want to do nebs for something like that.

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I definitely agree! Is the doc thinking she has asthma? That would be different.
My daughter is prescribed nebulizer treatments, hers is every 4 hours if needed

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Usually (from my experience with asthma) nebulizers are used as regular breathing treatments and inhalers are used more on an 'as needed' medication. I used to always have to do my breathing treatments when I got home from school and would use my rescue inhalers for when I was wheezing between treatments.

I'm not sure if the girl has asthma or not (because you said it was for a cough) but with asthma even when it seems "under control" it can still cause lung damage if there isn't a regular treatment to keep the airways from inflaming. http://www.webmd.com/asthma/features...rmanent-damage

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Right - this is what I am saying. It wasn't prescribed "as needed." That I have no problem with. It was prescribed as 3 times per day which I feel can and should be given at home.

DCG hasn't been diagnosed with asthma. This is the second time she has been prescribed nebulizer treatments for a persistent cough though.

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If it wasn't prescribed "as needed" then I agree. The 3x daily medication treatments need to be done at home.

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I am having an issue with medication right now. The DCPs want me to give it to DCK twice per day. Well that is not what the label says, it says as needed. So if I do not hear wheezing, coughing or labored breathing I am not administering it.

It’s a longer story but I am not going to vent to day.

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I have two on nebs right now.... One is every six hours... And he other has two different nebs... One is twice a day mixed with the second one and hen the second one is in between PRN every four... So needless to say I have a new machine going all day... And this morning had both going at the same time lol.

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3x a day one really needs to be during the day unless the child is picked up by 3. 5:30 and 8 are too close together in the evening. And the child is running and playing and needs to be able to breathe and not be coughing.

If there has to be 4 hours minimum between treatments and they pick up at 5. home at 5:30 they will have to delay bedtime until after treatment 930plua treatment TIME SO child will be up past 10 every night just to have treatments.

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Exactly why I quit giving them.

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The parents could give the treatment to the child late at night when the child is sleeping , no need to wake her up just hold the mouthpiece up to her nose . My dd had to have treatments around the clock and this what we were told to do for her .

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That's ok by me. I don't have a problem with parents managing all the treatments. It will be easier for the parents and kid if done during daycare. It won't be easier for me.

Better to have the give and take be with the parents, chikd, and their family time than with a provider who has a group of kids by herself.

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oh nebs... I have a bad taste in mouth from doing nebs. I've had the parents that weren't even prescribed them for their dcks but they have them on hand from a previous illness, so they'd show up with the machine and expect me to give them nebs 3 times a day. On top of other children actually being PRESCRIBED a neb several times a day. I was giving neb treatments constantly ALL. DAY. LONG!! It was after this, I adopted a NO MED policy. If the child needs meds, a parent or relative needs to come in and give them. It's amazing how the kids don't need the nebs now that I'm not the one administering them....

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**Bingo**. About a month ago, my favorite daycare client brought me a nebulizer for her 13 month old. She said it was prescribed for 4x a day. I was a little shocked when she said that DCG needed 2 treatments here, because to me 1 seemed sufficient, if you do one in the morning, one after pickup, and one before bed at home. I have given breathing treatments before, so I really didn't think to much of it. The first one was to be given around noon, so as we are getting the kids done with lunch, and DCG is in a bucket seat at the table, we plug the machine in and put it on her. The noise freaks the other children out, and the mask s cares her to death. Turned it on for 3 minutes, and we were don't. Told DCM it was a disaster.

Turns out DCM was holding the mask up close to her face without actually putting it on her. Super easy for someone with 12 other kids to care for to dedicate a solid 25 minutes to only one child. Leaving the other person with 11 kids to care for. Sorry, not going to happen.

My assistant told us that at the center she used to work at, their policy was if the child was old enough to hold it themselves/wear the mask without fidgeting with it, then it was okay. I think that is going to be our new policy, or to not do them at all.

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I don't mind so much... But when they are PRN and my asthmatic dck is wheezing... They get them here... I'm not making them wait 8 hours until they get home to get them...

As a mom of an asthmatic and an asthmatic myself.... I'd be livid if a provider agreed to do the nebs then decided oh never mind they can just wait hours until they get home.

Now, if a provider didn't do nebs or meds at all, then I would have never sent my asthmatic child there to begin with....

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I have to agree, I just wouldn't take my child to a daycare not willing to treat my child's illness. Would you same non-med people not accept a child with diabetes because of dealing with meds? To me it's no different. Life saving meds.
My children never needed one at daycare but there were many times they needed them every 3hrs. If it's for asthma that's different than illness. My son has had it for asthma, typically from having pneumonia. If the child doesn't have asthma yet is sick enough to "need" the neb every 3hrs around the clock, from my experience, they'd be sick enough to be home sick. For children with true asthma (which my son has) he has had inhalers for several years, one daily and one as needed. Our old Ped pushed inhalers as early as 3 where our long term Ped said whatever works best and if a child is sick in the office they give a neb right away for immediate treatment.
Are inhalers possible for some of you? I found it much easier with my youngest son as well. He's a fighter and fights me the whole time.

Personally I've had 2 boys need them over the years and we have a special neb form for parents to sign.

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Yup the day my assistant did 20 in one.day I said no more. They have become the new cold medicine and are the gateway to sending sick kids into daycare.

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Yep, I have the dr sign a treatment plan form... Even the schools do it... That basically stays on file for one year.... Not to mention my med policy says original container and meds have to be prescribed not from an old illness. I think providers that have med policies need to follow them and not get upset when they allow providers to step all over them by bringing old meds etc.

Inhalers are great for long term control but when it flares up, which is often here in the Deep South, nebs are sometimes necessary and yes, are life saving and/or life preserving.

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Things like insulin and occasional breathing treatments and epi-pens are definitely in a different category than Tylenol and once a day meds parents don't feel like giving and meds that could (and should) be given at home. If those things need taken care of at daycare, they need taken care of at daycare.

Now, if the child is sick enough that they are needing a breathing treatment several times during the daycare day, they are too sick to be here. If a parent dropped their child off with the neb stuff and said, here he might need this, I'd send parent right back out the door because I've never done one and might not feel comfortable without at least a few minutes of "training". Same with diabetes--I'd need training to deal with the child's situation because I never have.

But those sorts of meds are the only ones I'd ever consider. Something that is "emergent" during the daycare day rather than expected.

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This was kind of my original point/question. I DO give meds (and have had the extensive training my state requires for us to be able to do so) if they are something the child needs for everyday wellness. My questions was if a med is NOT an "as needed" medicine but one to be gives X number of times per day. I do NOT mean that I wouldn't give a nebulizer treatment for emerging symptoms of difficulty breathing/wheezing, etc....I am saying that if the med is something that is prescribed to be given on a schedule than the parent should probably fit it into their schedule and not plan to have treatments be given at day care. Obviously, if a child needed a medicine and I had all of the appropriate paperwork, etc. I would administer it.

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But breathing treatments aren't like antibiotics where you just need a steady dose in your system per day, whether that's at 2pm or 5pm. Some meds really do need to be taken every so many hours to be effective, even though many parents don't follow that to a T. The meds like Albuterol/Xopenex are fast acting and if the child is continually coughing and wheezing then that 2nd time needs to be at daycare. Plus, it not recommended to give steroid at 5 and 8pm. They can have a stimulant effect and prevent child from getting the sleep they need. Like someone else posted, if they need them around the clock it's almost better to wait til they're asleep and give the night treatment. My kids rarely needed to have one in the middle of the night but my friend's son did. It was every 3hrs or admitted to the hospital and she didn't have insurance so they did them every 3hrs around the clock for 2 days and it helped a lot by the 3rd day so they could move to 4hrs and not at night.
This is where it comes down to why they're getting the treatments. Are they sick? Is it asthma? Is the asthma aggravated by a current illness? If the child is coughing to the point of needing a neb mid day and NOT related to an ongoing asthma diagnosis I would say they should be home until they don't need mid day treatments or can use inhalers. It really just depends on the reason why and how long. And I would request a note from the doctor with their rec's. The Rx is often written in a generic "3x daily" but really that means every 8hrs. So 6am, 2pm and 8pm NOT 6am, 5pm and 9pm. That leaves too long of a span between 6am and 5pm and too close together at 5pm and 9pm. Mine all say every 4hrs as needed on the Rx.

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If the doc wanted it administered "every 8 hours" then it would be on the prescription. And if there couldn't be a certain amount of hours between treatments then it would be written "3x daily not to exceed 8 hours between treatments". The parents can go to work a little later or pick up earlier in order to administer at home.

Also, if the doc wanted this child to receive a treatment when they show symptoms (cough, wheeze, etc.) it would be written "as needed".

But the prescription wasn't written either of those ways so OP is free to say none of those treatments are happening here if that's what she wants to do.

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My point is that going by what's written on a box isn't always the best idea, sometimes the dr tells ME one thing but I've had something totally different on our Rx and called for clarification. Some of the new computer systems just have a box you click for what you want on the Rx, nothing hand written anymore. Or someone at the front desk calls in the Rx and perhaps makes an error. That's why it's important to have a dr's note WITH the Rx you're giving. I'm not arguing that she should or shouldn't, she can do whatever she wants. I'm just relaying MY experience with nebs and what I've dealt with not only with MY children but daycare children as well. I could probably find 3 different boxes with 3 different instructions on them in my closet right now. If something says 3 times a day then really you can give it all within an hour right? As long as it's 3 doses. Of course not! You're supposed to space those out. If the child isn't showing symptoms at daycare then NO, don't give it. Especially if it's an old Rx from a previous illness which I've read posts about several times. That's how my dr does it, he doesn't give me a new Rx if I still have some in the box from our last go round which is why I was recommending a dr's note as well. Not many meds work that way and a provider can see an Rx from 3 months ago and not realize it's a standing order kind of thing. But of course, OP can do whatever she wants to do, it's her daycare!

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As a provider though, I would ONLY adhere to what is written on the prescription. I don't care if the parent tells me to give the meds on a silver spoon while in the kitchen only. If the doctor didn't explicitly write that on the prescription then it isn't part of the directions...kwim?

As a parent YOU can do things however you want...YOU know your Dr and whether or not to second guess or question him.

NONE of that is applicable to the provider (OP).

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I never said to do what the parents say to do especially if its against the Rx? I said to have a dr's note WITH the Rx. If the Rx says 3x a day and the note from the dr says every 8 hrs that's the same thing! I don't know what it is that I'm not getting clear here. I'm not suggesting she do anything outside of what the Rx or dr says?? I'm saying it's wise to CLARIFY what 3x a day means when it comes to inhaled steroids. But if a child is sick and needs nebs every 3hrs that's a reason for them not to come.

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I'm not sure either because your other post said

and my reply was that the OP needs to only go by what is written.

She doesn't need to clarify anything with the Dr or anything else... I don't have any idea what you are getting at with the 3 doses spaced out over the day and whether or not it's safe to give steroids at certain times... I would think that would fall under parental responsibility

I lost the point of your message in all that other info because I didn't think any of the other info had anything to do with this provider's situation.

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I get what yu are saying....

First of all antibiotics and nebs are DEFINATELY different like you are saying...

As a matter of fact, my family dr doesn't even encourage doing 3 times a day on antibiotics at like 6, 5 pm and 9 pm... They want them done either with meals only... Or at 0600, 200 pm and at bedtime etc. And that's what they write on those RX also... And on he 4 time a day ones they specifically write 0600, 1200, etc... The twice a day ones are the only ones hat wouldn't be given at a traditional daycare....

As far as nebs... The steroid ones are usually written am and pm twice a day so those could be given at home.. But the every four hour ones would be like every 4 hours literally.

And my daughter needs nebs still at 11 years old as do I, and sometimes she isn't sick excludable... Just needs them.... Even though she also uses a traditional preventative inhaler...

I guess every situation is different and each provider has to do what's best for them...

In my case, I go by the RX only and he dr note has to match.... It's he parents job to be sure they do or call the dr to fax me clarification...

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OP have you spoke with mom about this? Is she willing to do the treatments at home?

If she says it must be done at specific times maybe she could ask the Dr to write a note specifying that administering during daycare is necessary to clear up confusion?

My state (and probably every state) mandates that prescription instructions be followed. I would do as prescribed

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I was responding to another person's reply, not the OP in your 2nd quote. She was questioning the concept of 3x a day vs every 8hrs.

I swear, this board can get so catty sometimes over such lame things. I never said to go against a dr's note, I'm merely speaking as the mother of an asthmatic. I've had different drs do different things, it can be confusing when a provider has to be in the middle. Of course the parents are ultimately responsible. The OP was asking about giving meds mid day that aren't written "as needed" but just 3x a day. I get the problem here. That's why I've suggested getting a drs note for clarification when giving Rx meds, especially for something that could have a standing order like neb meds as opposed to something given for a specific ailment like antibiotics that you won't have extras of. I always have extra neb meds here. I never have extra antibiotics.

Bottom line, if you're confused... Ask for a drs note!!!

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By "this board" are you meaning anyone who questions or misunderstands you (or your point) or is this comment directed solely at me?...

YOU are the one who added a ton of other info that made your point confusing to me so I was commenting/replying to what I perceived your words to mean.

If none of what I said made sense, I would hope someone would ask me to further clarify instead of just implying that I was being catty about something you consider lame.





OP, I truly hope you were able to work this out with your daycare family.

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The problem with the doctor's note vs. what the prescription states is that my licensor isn't going to give a rat's patootie what the doctor's note says. Whatever the prescription says has to be followed.

And I didn't think anyone was being catty, but seriously when it sounds like a provider is suggesting to go against what a prescription says and to follow a doctor's note instead we're going to ask questions and request that you confirm that that's what they just suggested, kwim?

To me, your posts sounded like you were suggesting to go off of what the parents and doctors say to do rather than what the prescription says. As a parent, yeah sure do whatever you want, but as a provider that's a no no. You're setting yourself up for problems and taking on a whole lot of liability if you don't follow the prescription to the T. If the doctor doesn't write the prescription exactly how it needs to be taken (because they used a computer, for example) then the parent needs to make sure that the doctor figures out a way to write it properly.

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