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Old 08-30-2013, 05:48 PM
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Default DCK With Open Wound - WWYD?

Long post - sorry!

So I had my first conflict today with a mom that I really like and it's left me feeling a little unsure about whether I handled the situation well.

dck (14 months) has had some kind of infected abcess on his neck for several weeks. It went undiagnosed and untreated for a long time (docs said it would go away on its own) and gradually grew larger and more infected.

dck had missed 1 afternoon of dc a few weeks ago when I called dcd to let him know this lump had appeared and maybe they should check it out.

dck had to be admitted to hospital this week to have it surgically removed. He missed another two days while in hospital and then was back in dc the day after being discharged. They have a drs note saying he is well enough to return.

Yesterday I admitted him. He had a bandage wrapped around the wound and it looked scabby and seemed to be healing well. Today, he kept tugging on the bandage, managed to pull off the scab and has an open wound about 1" long.

So, I called dad and asked that he be taken home as he seemed uncomfortable and is walking round with a seeping, open wound. Mom came to pick him up over 3 hours after I called and was visibly mad at me.

She said she is in danger of losing her job if she takes more time off and that its unreasonable to send a child home just because he is tugging on his bandage. I stood my ground and said he has also been unable to sleep or eat (very unlike dck) and that I wasn't comfortable having a non verbal child walking around with an open wound. She took him home but was clearly not happy to do so.

Would you have done the same thing? Are there any rules about open wounds in daycare situations? I hate conflict and always come out thinking I did the wrong thing

Thank you for 'listening'
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Old 08-30-2013, 06:20 PM
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I absolutely would have sent him home. It is unsafe and unsanitary to have an open seeping wound in a group setting. Period.
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Old 08-30-2013, 06:25 PM
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Absolutely you should have sent him home. That is so unsanitary and so dangerous--for the other kids AND for him. His parents need to realize that walking around with a gaping open wound could easily get infected and he could get very sick. You should follow up with the mom and say that in order to be admitted back into your care, he needs to have to have the wound bandaged in a way so that he can't remove it.
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Old 08-30-2013, 06:34 PM
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I feel you definitely had the right to send him home. I personally probably would have just rebandaged the wound.
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Old 08-30-2013, 06:51 PM
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I feel you definitely had the right to send him home. I personally probably would have just rebandaged the wound.

I had initially offered to redress any wounds when she mentioned he was returning after surgery but dcm specifically asked me not to do this as the doc said it would heal quicker if left exposed. Kind of felt like a no win situation
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Old 08-30-2013, 06:55 PM
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I would have sent home as well. No open wounds of any kind. Especially if they are oozing.

Don't feel bad. It's not your fault that DCM has issues with her work. Her problem not yours. I would have told DCM then you need to arrange back up care, because what would you do if that wound got infected and he ended up in the hospital? Is she not going to go because she has no more time off?

Of course not. I believe it is against the law for her employer to let her go because She needs to care for a sick child.

I would send her a text later tonight checking on dcb...
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Old 08-30-2013, 06:57 PM
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Quote:
Originally Posted by Stepping View Post
I had initially offered to redress any wounds when she mentioned he was returning after surgery but dcm specifically asked me not to do this as the doc said it would heal quicker if left exposed. Kind of felt like a no win situation
Where do they go to the doctors? Lol
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Old 08-30-2013, 07:07 PM
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I feel you definitely had the right to send him home. I personally probably would have just rebandaged the wound.
that's what I would have done if the child had a dr's note
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Old 08-30-2013, 07:09 PM
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Originally Posted by Stepping View Post
I had initially offered to redress any wounds when she mentioned he was returning after surgery but dcm specifically asked me not to do this as the doc said it would heal quicker if left exposed. Kind of felt like a no win situation
in that case I would have sent him home, what kind of dr gives ok to take back to daycare under those conditions?
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Old 08-30-2013, 07:27 PM
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If I was told it couldn't be recovered (tho I wonder why it could be covered originally and not re-covered ) I would have sent him home. That isn't safe for anyone. I would text or call dcm and see how he is doing and ask if she would agree to a covering while in care. I would then ask that she supply back ups. I would make sure she understood it must be covered in daycare.
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Old 08-30-2013, 07:53 PM
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I would not offer to re wrap it. I don't have a medical background so I would not be comfortable in doing so. I tell parents. If its more than soap, water and a standard size bandaid I send home.

This parent send her kid back a day after surgery ? Ugh poor kid
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Old 08-30-2013, 08:07 PM
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Thanks for the feedback everyone. It really helps to hear other's input. He is a lovely little guy and I hated to send him home but it felt like the right thing to do at the time. I plan on messaging mom later to check up on him and discuss the bandage situation.

They are sending mixed messages as dad said the infection is still present (he's on antibiotics) but mom said it isn't. The wound had a covering but it was very loose and not taped, when I offered to tape it , that's when mom said it was to be kept loose. I think I will just make it clear that he can come back as long as the bandage is secure and I can redress it if it does come loose again.

Thanks again
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Old 08-31-2013, 07:43 PM
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Did they say what it was ? it sounds like MRSA but I would assume the dr would have said that. but privacy maybe he couldn't but yes an oozing wound needs to be lightly covered and possibly seen by the dr if it is oozing
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Old 08-31-2013, 07:45 PM
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Quote:
Originally Posted by JoseyJo View Post
I absolutely would have sent him home. It is unsafe and unsanitary to have an open seeping wound in a group setting. Period.
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Old 08-31-2013, 11:06 PM
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Originally Posted by itlw8 View Post
Did they say what it was ? it sounds like MRSA but I would assume the dr would have said that. but privacy maybe he couldn't but yes an oozing wound needs to be lightly covered and possibly seen by the dr if it is oozing
They said it was an 'atypical mycobacterial infection'. Mom initially said it had to be just loosely covered as you say, but then said she would bring him with a secure dressing if that's necessary. If its meant to be exposed will it do him harm to have it completely covered?

I did message mom and dad but haven't heard back from them
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Old 09-01-2013, 05:41 AM
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first you did great!

second, why is it the minute we need the parents to do something, they throw the "i'm going to to lose my job" card. drives me nuts.

I would require the wound to be dressed during daycare hours, at home if mom wants to keep it open then she can on her own time.
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Old 09-01-2013, 05:54 AM
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Originally Posted by countrymom View Post
first you did great!

second, why is it the minute we need the parents to do something, they throw the "i'm going to to lose my job" card. drives me nuts.

I would require the wound to be dressed during daycare hours, at home if mom wants to keep it open then she can on her own time.

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Old 09-01-2013, 08:23 AM
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Quote:
Originally Posted by Stepping View Post
If its meant to be exposed will it do him harm to have it completely covered?
This is a question they need to ask the dr- BEFORE he comes back. If the dr says it needs to be loosely covered then the child needs to be excluded from daycare until the wound is either not open/seeping OR until it can be securely covered.

Just keep in your mind that this child's wellbeing should be his parent's primary concern (yes, above their jobs and anything else). Act as if it is. Don't allow the parent's to force you to do something that is against the child's best interests (ie securely wrap a wound that should be left unwrapped, have a child in daycare that should be home, etc). If they want to go against his best interests that's on them and their Karma, don't let them put in on yours. (Just my 2 cents!)
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Old 09-01-2013, 08:48 AM
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Originally Posted by Stepping View Post
dck had to be admitted to hospital this week to have it surgically removed. He missed another two days while in hospital and then was back in dc the day after being discharged. They have a drs note saying he is well enough to return.
Just because the doctor says the child is well enough to return to care does NOT mean you HAVE to accept him back...especially if there are special circumstances such as the child not leaving the wound alone and the fact that you may not be equipped to care for him (NOT saying you aren't) I am saying YOU should have the right to not accept him if you do not feel comfortable dealing with the situation.

Quote:
Originally Posted by Stepping View Post
So, I called dad and asked that he be taken home as he seemed uncomfortable and is walking round with a seeping, open wound. Mom came to pick him up over 3 hours after I called and was visibly mad at me.
Wow! I would have been livid!! I require parents to come for their child within 30 minutes after I call. I would have termed a parent who didn't show up for 3 hours. That is rude and disrespectful.

Quote:
Originally Posted by Stepping View Post
She said she is in danger of losing her job if she takes more time off and that its unreasonable to send a child home just because he is tugging on his bandage. I stood my ground and said he has also been unable to sleep or eat (very unlike dck) and that I wasn't comfortable having a non verbal child walking around with an open wound. She took him home but was clearly not happy to do so.
She is a parent FIRST and if she is in danger of losing her job, it has NOTHING to do with you but has to do with the fact that she ahs a child who NEEDS her (or dad). YOU have no bearing on her job retention or loss.

I am so tired of parents who try using that excuse. The child is the family's responsibility in this situation NOT yours.

OP~ I hope things work out for you in this situation but honestly unless these parents start respecting your position in this situation and stop pushing this off on you, I don't see this situation working out well.

Last edited by Blackcat31; 09-02-2013 at 11:51 AM.
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Old 09-01-2013, 08:00 PM
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Originally Posted by Stepping View Post

Would you have done the same thing? Are there any rules about open wounds in daycare situations? I hate conflict and always come out thinking I did the wrong thing
I never thought about putting that as an exclusion rule, but now I will!

If it's an open wound (especially if caused by an abscess) its susceptible to infection, which means a liability. I would at least require that it be bandaged (if possible) and that not only have a doctors note but a list of care instructions to avoid infection before considering letting him back in; I would continue with exclude if the care instructions affect his ability to participate in regular daycare activities (which is in most dc/school exclusion policies) or if it affects your ability to care for the other DCKs.
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Old 09-02-2013, 11:19 AM
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Thank you every one so much for your support and advice. I'm so glad I found this forum!

I plan to call DcFS tomorrow to double check the open wound situation and will readmit him as long as his wound is either securely covered or no longer oozing and as long as the little guy seems well enough to participate.

I find most parents just don't get the idea that a child has to be well enough to participate in group care!

I've been open a year on Wednesday so I'm planning on rewriting my policies to include something about this. Does anyone have an example statement for how to word this?
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Old 09-02-2013, 02:01 PM
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Originally Posted by Stepping View Post
Thank you every one so much for your support and advice. I'm so glad I found this forum!

I plan to call DcFS tomorrow to double check the open wound situation and will readmit him as long as his wound is either securely covered or no longer oozing and as long as the little guy seems well enough to participate.

I find most parents just don't get the idea that a child has to be well enough to participate in group care!

I've been open a year on Wednesday so I'm planning on rewriting my policies to include something about this. Does anyone have an example statement for how to word this?
"Children with open wounds that are not treated or under doctors care will not be eligible to attend the child care program until the child has seen a doctor or said wound has healed on its own. I may decide to allow a child with an open wound to attend regular care if wound is being treated, bandaged (if possible), and if there is a doctor's note stating that the child's wound will not affect the child's participation in regular daycare activities. While I will ask for a doctors note in such a case, as with all health/safety conditions, I will always have the final say if the child will be readmitted into my child care home.

In all health and safety issues, regardless of a doctor's note, if I have reason to believe
  • the child will not be able to fully participate in regular daycare activities
  • the condition affects the health/safety of that child/other children/other daycare families/myself/my family/my assistants/my pets
  • or that the child's condition will affect my ability to care for the other children in care
I will not allow said child to attend until further notice."

Last edited by Starburst; 09-02-2013 at 02:12 PM. Reason: grammar
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Old 09-02-2013, 07:22 PM
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You were right for sending home.
I would not wrap, rewrap, or apply any meds of any kind to the wound.
Just because the Dr. feels comfortable allowing him back to daycare, does not mean you feel comfortable with having him back. You control your daycare, not their Dr.
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Old 09-02-2013, 08:15 PM
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Their child's injury is NOT your problem. Shame on her for making you feel guilty. This is THEIR child and it is their responsibility to take care of them when they are ill.
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