Okay, okay where do I begin...... Well I have a 2 year old that comes full time and he seems to have been sick since, well I don't know we'll say July! No joke! Anyway he isn't always sicker than a dog, but I don't think I have EVER seen him without some sort of symptom since July or so..... So I have sent this child home SEVERAL times! Sometimes he has a fever and gets sent home, but mainly my concern has been his cough! It is hard, tight, a HORRIBLE cough! He seems to get it everytime he seems to get sick!! Anyway his mother showed up here a week or so ago with a nebulizer and asked me if I knew how to use it! Apparently they took him to the ER and she told me that they said the area that connects like a flap or something that connects to his bronchial tubes gets inflammed due to coughing so hard! She said it isn't bronchitis or pnemonia or anything. I talked to my licensor who said nope, no nebulizer without a doctors note and it was up to me if I even wanted to do it, in which I knew! So again this week we are back to the HARSH coughing and what I have noticed with him is it seems to really hit home with a weather change! We live in MN and it seriously went from 60 to 80 and humid in 24 hours! Of course he shows up coughing his little lungs out! We went outside and the child could hardly play because he was coughing so hard, he has NO fever but does have a runny nose! I made him sit out, with some water and take a break yesterday while we were outside because I thought he was going to keel over! He is 2 doesn't understand this, starts crying which only makes it worse! He has a hoarse voice and just can't seem to kick this! Today mom shows up again with the neb, she said she will get a doctors note and email it to me today!! I am just unsure how to handle this..... I asked her what the inflammation was caused from and she says the harsh coughing and I said then what is the coughing from! Does he have asthma or allergies or what? She said he could but they don't know for sure they just told her to use the nebulizer as need be!! I told her that I needed as much information from the doctor as possible... so unsure what I will get, but what would you do in this situation!! So unless it shows up today, but not sure how it will since they haven't done any testing, but so far I guess I have to rule him as being sick and that I won't neb for a sickness! Until I get a specific signed note from the doc stating that this child has asthma and needs the neb would you keep telling them you won't neb him and that if you feel he needs to use the nebulizer than he can't be here!! I don't know what to do and I am looking for advice!!

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I have a few kids that use nebs, some own theirs and use it when they first start to get sick and others come back from the Dr and their rest at home with them. They really seem to work wonders on the kids here. I understand that you want a DR note for lisc reasons and I would require it from the DCM but other than that I don't see why you wouldn't want to use it?

MsMe

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I wouldn't feel comfortable having him in my care. It sounds like he needs one to one care.

Here are a couple of good nebulizer threads:

https://www.daycare.com/forum/showth...ight=nebulizer

https://www.daycare.com/forum/showth...ight=nebulizer

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The child may have asthma that is not very well controlled. I have never excluded a child from my dc because they needed a nebulizer ( with a drs note). I have my own children with asthma and if the school had refused to do the treatment my son would have been never been there! LOL I guess it is a personal choice and what you feel comfortable with doing.

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I guess I am going to need a note from the physician stating that this child has asthma and then I will do the neb treatments! However I do not have a noe stating that this child has asthma so am I just having to give this child a neb treatment because they are sick, then I personally am not okay with that - a cough is very contagious when it is caused from a virus and if it is bad enough to need a neb treatment in the middle of the day then I don't want him here! The problem I know I will have with the asthma part is most kids that are diagnosed with asthma aren't diagnosed until they are around 6 and this child is 2!! Is this correct or not? Have 2 year olds been specifically diagnosed with asthma??

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According to the CDC, "reports cite that asthma rates among children in North America are four times higher than they were 20 years ago."

which in itself is alarming but in this particular case, I would NOT use a nebulizer until the doctor diagnoses and prescribes it as needed for asthma. I would NOT allow this child to be in care though if he were simply sick. Waaaaay too much liability involved there...what if he does have asthma and does not have a specific health plan from his doctor and then has an attack while in your care? People die from asthma attacks and I would never want to be in that position with a child in my care.

So I think your options are; to exclude until he is well or until he has been properly diagnosed and you are given a written health plan from his doctor outlining EXACTLY what needs to be done in regards to treatment.

Nebulizers are easy so that part shouldn't be an issue...provided he needs one for something other than simple illness. Here are a couple really educational sites about asthma and the facts about diagnosis and treatments.

http://www.aafa.org/display.cfm?id=4
http://www.fda.gov/ForConsumers/ByAu.../ucm118497.htm

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I'm going to assume the difference between you and an elementary school is that the school has a knowledgeable nurse on staff and you don't?
I had a situation like this at the start of the year. The family showed up with it and no answers why.
I have no medical background so I said sorry I dont feel comfortable giving this, you are welcome to do it. I also told them that I would need still need a doctors note stating reason for neb and any special side effects that conside with the medication he's been given.
I made a mistake and let the baby come one more day without doc note because they said they has an appt the following day. Well that day before his appt he had a seizure. He had a reaction from the medication

Again having no medical background or info from the doctor there was not much I could do.

My advice to you is don't do it, doctors note or not. If the Childs health is that unstable he needs one on one care else where.

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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.....

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I say YES! it is enough to send him home because of his history with these symptoms. I would be super uncomfortable with providing care for him when you know it is more than just a cold. I would tell mom, I am sorry but it is just too much of a liability to have him stay without him having a doctors visit stating he does or does not have asthma or some other respitory illness.

I would probably keep the child IF he didn't have the history of being so sick as you stated in your original post. But since he has had a history of this, it is telling me something is wong.....and not knowing is as dangerous as ignoring IMHO. Good luck and don't feel bad...you are advocating for this child. What you described is not normal.....

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I've used nebulizers on many occasions with different children for different reasons. Some chronic and some acute (but no longer need to be excluded). It is really easy, and ime, the other kids find it fascinating, so I have never had a supervision issue surrounding it.

I do require a physician's note and since I am licensed I have to take a medication administration class each year.




***I say this very gently...your posts are really difficult to read with all the exclamation points. I don't know if anyone else feels this way, but I have a hard time.

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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

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Yes, children under the age of 6 are diagnosed and treated for asthma. It sounds like this child needs a good checkup from his dr to get at the root of his coughing.

I would tell the parent that you have to have a note from his dr before giving him the inhaled medications.

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I am in MN also and have a severe athsmatic here in care also. He uses his neb here regularly. I have dr note and follow the guidelines for how/when to use it. He also has other inhalers.

He has been taken by ambulance from school to ER two times in the last year b/c of athsma sx.

The weather here is always the contributing factor and as you mentioned huge changes here in spring and fall make the coughing terrible.

He too was always sick prior to the neb treatments.

I would get tough on the mom and say he can not come UNTIL you have a doctors note and a written plan for managing his athsma at daycare. For example, if the child in my care can not function normally (take walks etc) then he needs to go home. She also knows I do one call to mom, one to dad and if he needs to be picked up immediately I will not hesitate to call the ambulance.

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Because you're in MN, you need to have a medication administration form filled out by the parent as the albuterol (or whatever else??) used in the nebulizer is a prescription medication.

My daughter is 2 also and can hold the air mask near her face on her own. 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.

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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?

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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/rea...isease/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.

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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....

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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.

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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.

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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.

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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....

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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!!!

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

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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?

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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

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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?

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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.

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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.

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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.

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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?

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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.

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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?

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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?

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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. 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....

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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.

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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!!!

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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.

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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.

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

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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.

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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.

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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).

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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

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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.

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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?

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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!

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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.

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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....

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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.

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I agree 100%

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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

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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.

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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.

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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.

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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.

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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.

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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.

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

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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.

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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.

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Yes this is an important part. There's little help out there to evaluate whether a child is truly disabled and if the disability laws apply. The natural inclination of parents, licensors, and doctors is that we just DO. That's an easy leap to make because it means someone ELSE has to take it on.

Once the same child is presented to the government for disability checks and insurance then all of a sudden it's a BIG long process. When presenting this child to the school system it's a big long process.

VERY often the COST of the child's care is actually HIGHER for the provider than the cost would be to a school or the governement when you look at her small income and her small population.

In this case the child has just seen an ER doctor in a crisis care unit for this diagnosis. That single trip to the ER would NEVER qualify the child to receive special needs services in a school setting or to receive cash and insurance subisidy for disabled children.

We are not required to assume this child qualifies as a disabled child and provide free medical care and medical services (consultation, training, conferencing) for the child. It may be that he is simply temporarily acutely ill at this time and this is something the parents need to completely manage as all parents have to do. It may not have anything whatsoever to do with a disability or child care.

The provider has to decide this for herself. If his care is not related at all to the disability act she has the right to refuse to provide services at times when the child needs the service. If his care IS covered by the disability act then she has to decide if the services he needs can be supported by her client base as not to substantially alter her program and pose an undo burden on her and her family.

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Just adding my 2 cents.. I Have a child that requires a neb treatment 3x a day.its NOT that hard nor does it take upmorw of my time. I don't charge more either.not everything needs a dollar sign attached. Kiddos for educating yourself . U will find its not a a big a deal as some think it is.

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The disabilty act is irrelevant to me, because I wouldn't keep him because of that, I'd keep him because I loved him. But, I consider any need that requires additional care/services a special need. A child doesn't have to have a major disabilty to have a special need.

I agree, you shouldn't be "expected" to care for him. It certainly is your right not to care for him.

In case you did not notice, I was not in any way being offensive to you or defensive of what you said. In fact, I stated "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.

That's great that the "vast majority" of YOUR "circle of friends" has a parent who is able to stay home with them.....but that's not reality for all families and would certainly cause a major issue for providers if it were true for all families.

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I'd like to add that, if the child's condition is managed, he WILL be well enough to fully particpate. Not sure WHY that keeps getting mentioned. Clearly he is not well enough NOW, but since he now has a diagnosis and a treatment plan, he WILL be able to particpate.

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I never said I COULDN'T handle the nebulizer treatments.......

I said I WOULDN'T.

I provide care to well children.

When the parents and doctors stabilize his health and he is well ......he would be welcome back into my care.

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That's kind of a hit or miss deal.

There's a lot of kids who are just sickly, poorly fed, poorly cared for, in smoke environments, have no schedule.... and they end up sick all the time.

The nebulizer treats one of the aspects of their constant illness but every respiratory illness they get can easily get blamed on their "ashtma".

Then you have to tell the diffrence when the parents use the fact that the kid CAN have treatments in your house as the THING to do. It's a get out of jail free card to get kids into day care when they actually SICK.

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Exactly.

A bit like when a parent says that their child "just has allergies."

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My 2 year old has bronchial asthma-which flairs up when he gets a cold. He didn't have this problem till we enrolled him in Daycare last year. Literally about month into daycare he was always getting very sick, he contracted Mono and was out of school for quite some time. Following Mono he started developing lung problems-wheezing, coughing, shortness of breath. I myself have had asthma my entire life and now that I am in my 30's luckily it's controlled with an inhaler called Advair Diskus. Controlled means no asthma related symptoms such as the wheezing, coughing and shortness of breath.

So with all that being said, my 2 year old is now using a nebulizer to treat his bronchial asthma and thank God for us his daycare is very well trained and certified in these types of situations because if they weren't my son would not be attending this daycare at all. In my own opinion a daycare should have the common knowledge about these types of conditions and also accept a doctors note to treat a child with a health condition. It's against the law to discriminate!

I would hope that every parent just like myself wouldn't bring their child to a daycare that doesn't know how to handle situations when it comes to children and specifically situations like this one. Daycare's are caring for other peoples children, they really should be trained and skilled in all areas.

I personally think you need more education and training, with proper training you will feel more comfortable and most importantly confident in handling a situation such as this. I'm not trying to be rude but we are talking about children, they are most important and especially with all the horror stories you hear on the news these days, it's always good to have proper training and enough staff to cover when working with kids.

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It's against the law to discriminate!
True BUT there is more to it than just a few words.
First the child must actually qualify under the disability act.
Secondly, the provider must have the means to support the services offered to the child meaning she must have a client base that she can spread the cost of the child's care to. In home child care the client base is so small that often this type of service can "substantially alter" the program because the time to manage ALL aspects of the service become so high that there is no way to receive compensation for the service. Providers aren't expected to do it for free.

Last winter I worked with a Center who was being hit very very hard with the "asthma" and "reactive airway disease" treatments. Working closely with the ADA it was a matter of showing that the center actually could NOT support the cost of the nebulizer treatments to the number of clients requesting them daily and numerous times a day. It took supplying some financial documents, time studies, and staffing information but it was possible to show that they litterally couldn't afford the service. They were able to institute a medication administration fee for all but one of the children who received the treatments before working with the ADA.


You are right that training is important BUT I'm a RN and I don't feel comfortable doing these treatments in my setting. The level of responsibility for me is SO much higher than that of a parent or a non licenensed person. It adds a BIG layer of assesment, documentation, and evaluation that most providers do not have. Putting medication directly into a child's lungs is SERIOIUS business in my book. I've seen with my own two eyes a very serious reaction to the medication and it scared the bejeezus out of me.

In the end, education or not... the child needs to be in a place where the provider feels 100 percent comfortable doing the entire process and is being paid accordingly to provide the service. There are a number of providers on this board who would readily work with your child and provide the service. You just have to make sure he is in THAT place.

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