Urgent Help Please - Inhaler and Nebulizer

[Baby Beluga]

I have a family who would like to bring their 4 year old to me next week while her class is on fall break (4 year old is in kindergarten). She has asthma, uses an inhaler and has a nebulizer she uses when necessary.

During our interview yesterday I told them I would need doctor documentation stating:

*Child's diagnoses
*When to use the nebulizer/inhaler
*The amount of albuterol that should be used
*What steps need to be taken after the inhaler/nebulizer is used. (IE, do I need to call mom and dad to notify them that it was needed, call 911, etc)

Mom called the pulmonologist and they said the paperwork would not be ready by tomorrow. I am requiring all paperwork no later than tomorrow evening as Monday is her first day.

Mom wants to know if she can bring just the inhaler with a note stating a doctor diagnoses, but not what steps need to be taken if she needs the inhaler. Is that sufficient for an inhaler use? I've never dealt with asthma before.

How do I handle this? To them it seems like no big deal. To me it says a lot of liability and I don't want to do something wrong. Am I over reacting?

ETA: when I say to them it seems like no big deal - they are proactive, but since this is something they are used to it seems less serious in their eyes then mine. I hope I articulated that correctly.

[LysesKids]

You are not over reacting... tell her sorry, kiddo cannot start without ALL the required paperwork; I have asthma & my inhaler doesn't always help. In my eyes, any medical issue outside the normal cold/teething etc, falls under "I need DR proof & how to handle before the child stays".

I had a Mom blow up @ me when I refused to contract her daughter (6 weeks old & heart defect). The child was on 2 different meds, one for seizures & even though I didn't have to give any of the meds, I wanted Dr's info on the conditions & how to handle any reaction to the meds mom gave... She refused to give me what I asked for (that is a huge liability in my eyes) - what if the baby had gone into a seizure on my watch, how was I to handle it? (not to mention heart issues and possible reaction to a new med). I do nothing but babies and it's not my first rodeo, but it was moms... she found a cheaper "babysitter" after I said NO

[daycare]

No way would I take the child without having the proper items needed.

what parents don't get is that to them it's no big deal, they are only dealing with one child, and not having to run a business while the ill child is having an attack.

I will only administer an emergency inhaler and only if they are having an asthma attack. If I have to administer the inhaler, they go home. I have no way of knowing that the child properly inhaled the medication and that their airway is open.

I grew up with asthma and was left at school after having an asthma attack. No one realized that I didn't get enough of the treatment to open my airway. By the time got back to my classes, the teacher said my lips were blue, face pale.Lucky for me the hospital was across the street and I got what I needed. Who knows what would have happened, I may have died if the teacher did not pick up me and run me to the hospital herself. there is a lot of this story that I am leaving now to shorten it up, but I think you get the idea of what happened to me.

I would not take any chances. I would stand your ground and say sorry, I can't take the child on without having all of the required documents.

way way too much liability to put on yourself.

[Blackcat31]

I have a family who would like to bring their 4 year old to me next week while her class is on fall break (4 year old is in kindergarten). She has asthma, uses an inhaler and has a nebulizer she uses when necessary.

During our interview yesterday I told them I would need doctor documentation stating:

*Child's diagnoses
*When to use the nebulizer/inhaler
*The amount of albuterol that should be used
*What steps need to be taken after the inhaler/nebulizer is used. (IE, do I need to call mom and dad to notify them that it was needed, call 911, etc)

Mom called the pulmonologist and they said the paperwork would not be ready by tomorrow. I am requiring all paperwork no later than tomorrow evening as Monday is her first day.

Mom wants to know if she can bring just the inhaler with a note stating a doctor diagnoses, but not what steps need to be taken if she needs the inhaler. Is that sufficient for an inhaler use? I've never dealt with asthma before.

How do I handle this? To them it seems like no big deal. To me it says a lot of liability and I don't want to do something wrong. Am I over reacting?

ETA: when I say to them it seems like no big deal - they are proactive, but since this is something they are used to it seems less serious in their eyes then mine. I hope I articulated that correctly.

She can have her Dr e-mail you the instructions/management plan.

Last resort; have mom give permission for you to speak to Dr or Dr's nurse. Get official paperwork by Tues... and you're covered for Monday.

I wouldn't have issues accepting either solution for a day or two. A week, no way but a day or two... meh

[Baby Beluga]

Daycare, I am glad you're teacher was observant enough to get you to a hospital!

I spoke with mom - the inhaler and nebulizer are the same medicine (I did not previously know this) The inhaler is at school because there is not enough room for the school to store a nebulizer. They wanted to bring the nebulizer here so they didn't have to remove the inhaler from school.

Mom said the inhaler has the perscription from the doc o the box, as well as a written letter from the doc stating that the child is to use the inhaler for asthma and the dosage. Mom wrote on an additional sheet what symptoms to look out for and what steps need to be taken if the inhaler is used.

Liability wise - it seems she has what is needed for the inhaler, yes? Or no?

I didn't even think about sending home if the inhaler is used - thank you for mentioning that daycare. It is something I plan to implement whether it is in mom's instructions or not. From what she said over the phone if the inhaler is to be used I am to call mom/dad first unless X symptoms are present, then I am to call 911 first then mom/dad - which I think is pretty standard?

[Blackcat31]

Daycare, I am glad you're teacher was observant enough to get you to a hospital!

I spoke with mom - the inhaler and nebulizer are the same medicine (I did not previously know this) The inhaler is at school because there is not enough room for the school to store a nebulizer. They wanted to bring the nebulizer here so they didn't have to remove the inhaler from school.

Mom said the inhaler has the perscription from the doc o the box, as well as a written letter from the doc stating that the child is to use the inhaler for asthma and the dosage. Mom wrote on an additional sheet what symptoms to look out for and what steps need to be taken if the inhaler is used.

Liability wise - it seems she has what is needed for the inhaler, yes? Or no?

I didn't even think about sending home if the inhaler is used - thank you for mentioning that daycare. It is something I plan to implement whether it is in mom's instructions or not. From what she said over the phone if the inhaler is to be used I am to call mom/dad first unless X symptoms are present, then I am to call 911 first then mom/dad - which I think is pretty standard?

Personally, I think you're good.

[childcaremom]

Is the inhaler something that she uses often? Regularly? Or is it a sometimes occurence?

I would want, on hand, her inhaler and meds, a list of symptoms that may be present if the inhaler is required, along with the original packaging. Does dcg have a spacer? I would want to ensure that it is on hand, as well. I would also want to have a list of possible triggers for an asthma attack.

I would require dcm show me how it is administered (I am familiar with asthma but would still require this). I would also ask how dcg handles the treatments. "Show me how you do them" I would want to see this.

I would ensure that I had a list of contact methods for each parent and emergency contacts.

I like daycare's policy of only administering it in an emergency and once administered, calling for pick up. I would make sure that dcm understood that if the inhaler was used, I would be calling for immediate pick up and/or calling 911 if necessary.

2 of my own children have asthma. I have in their treatment plan that if it is administered to them at school, I am to be notified and I will come right away. So it is not out of the ordinary to require that, imho.

[Baby Beluga]

Is the inhaler something that she uses often? Regularly? Or is it a sometimes occurence?

I would want, on hand, her inhaler and meds, a list of symptoms that may be present if the inhaler is required, along with the original packaging. Does dcg have a spacer? I would want to ensure that it is on hand, as well. I would also want to have a list of possible triggers for an asthma attack.

I would require dcm show me how it is administered (I am familiar with asthma but would still require this). I would also ask how dcg handles the treatments. "Show me how you do them" I would want to see this.

I would ensure that I had a list of contact methods for each parent and emergency contacts.

I like daycare's policy of only administering it in an emergency and once administered, calling for pick up. I would make sure that dcm understood that if the inhaler was used, I would be calling for immediate pick up and/or calling 911 if necessary.

2 of my own children have asthma. I have in their treatment plan that if it is administered to them at school, I am to be notified and I will come right away. So it is not out of the ordinary to require that, imho.

Thank you (and everyone else) for helping me with this!

Mom, dad and child are swinging by later to bring inhaler, paperwork and to show me how to use the inhaler.

The inhaler is a sometimes thing. She uses it only when she has symptoms. They give her meds at home in a nebulizer each night which mom said has controlled her asthma. She said she has yet to use the inhaler at school and she started mid August.

Mom said the child handles the treatments well. If she has symptoms, she gets two puffs - each puff she has to take 6 breaths. So one puff, we count six breaths, then second puff we count 6 breaths. Mom did not call it a spacer, but she did say there was a type of chamber that the inhaler goes into that shows her breaths - I am assuming it is a spacer? I do know that the inhaler is in the original box with the script from the doc on the box.

[childcaremom]

Yes. It's an aero chamber. On ours there is a flap that makes it easy to count the breaths.

[KSDC]

I'd check with your state's regulations. I have to have a specific form filled out to administer any medications in daycare.

[daycare]

Thank you (and everyone else) for helping me with this!

Mom, dad and child are swinging by later to bring inhaler, paperwork and to show me how to use the inhaler.

The inhaler is a sometimes thing. She uses it only when she has symptoms. They give her meds at home in a nebulizer each night which mom said has controlled her asthma. She said she has yet to use the inhaler at school and she started mid August.

Mom said the child handles the treatments well. If she has symptoms, she gets two puffs - each puff she has to take 6 breaths. So one puff, we count six breaths, then second puff we count 6 breaths. Mom did not call it a spacer, but she did say there was a type of chamber that the inhaler goes into that shows her breaths - I am assuming it is a spacer? I do know that the inhaler is in the original box with the script from the doc on the box.

Is the name of the medication you will give called albuterol? If so, this is only to be given when having an asthma attack. If I were you I would administer it and send the child home. But that's just me

[Baby Beluga]

Is the name of the medication you will give called albuterol? If so, this is only to be given when having an asthma attack. If I were you I would administer it and send the child home. But that's just me

Yes, this is the med.

The parents came on Friday, demonstrated how the child used the inhaler (childcaremom - you were right it is an airo chamber) and gave me documents/prescription from the pulmonologist. The inhaler is used only in the event in an attack, and I did discuss with the parents that the child would be sent home if she has an attack. Obviously if the inhaler didn't work 911 would be called - but if it calmed the attack, I still made it clear that child would be sent home for the day.

I found it interesting though that the teacher didn't have or request all the documents I did. From the way mom spoke, I seemed to be more thorough then the school. That was scary to me. This child's school is a charter school therefore there is no school nurse. This means the teachers themselves carry medications and handle things like asthma attacks.

[mommyneedsadayoff]

Yes, this is the med.

The parents came on Friday, demonstrated how the child used the inhaler (childcaremom - you were right it is an airo chamber) and gave me documents/prescription from the pulmonologist. The inhaler is used only in the event in an attack, and I did discuss with the parents that the child would be sent home if she has an attack. Obviously if the inhaler didn't work 911 would be called - but if it calmed the attack, I still made it clear that child would be sent home for the day.

I found it interesting though that the teacher didn't have or request all the documents I did. From the way mom spoke, I seemed to be more thorough then the school. That was scary to me. This child's school is a charter school therefore there is no school nurse. This means the teachers themselves carry medications and handle things like asthma attacks.

I'm not sure, but I imagine the liability is spread out to the school, versus just you being liable when it comes to daycare, so maybe that is why they were not as thorough with everything.

[Blackcat31]

I'm not sure, but I imagine the liability is spread out to the school, versus just you being liable when it comes to daycare, so maybe that is why they were not as thorough with everything.

When you are the only one accountable it makes a big difference.

[Baby Beluga]

I'm not sure, but I imagine the liability is spread out to the school, versus just you being liable when it comes to daycare, so maybe that is why they were not as thorough with everything.

When you are the only one accountable it makes a big difference.

This is very true