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Hmm, Should I Be Concerned?


Cait
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I have a child who started at Preschool in September. On her booking form it says she has occasional night-time asthma and when I queried it with Mum I was assured that it was very rare and only was a cough at night sometimes.

 

Now, in late October Mum came in and spoke to our youngest member of staff and said that the child is hypoglycaemic and here's a tube of stuff to squirt into her mouth if she needs it. Mum then left quite quickly and my member of staff brought the tube of 'stuff' over to me asking what she should do with it. I explained that Mum should have brought it to me really, as I'd need to complete a medication form and get a signature before we administered it. I telephoned Mum and explained this and got a verbal permission to administer if necessary, on the understanding that she would sign the paperwork when she collected the child. She signed it the next morning and I asked for the medication to be handed over so I could lock it in the cupboard and Mum said 'oh she hasn't got it today, just give her a spoonful of jam if she goes floppy'. I explained that we didn't have any jam at Preschool but we could give sugar, and she agreed to this and signed the paper to say that we should do this in the eventuality that there was no medicine available. I asked if she would bring the box in the next time so that I could see the prescription sticker and make a note of it. She said she would, but we've never seen the medicine again.

 

Now last month, Mum said that the child has bad asthma, and her inhaler was in her bag. This was again said to the youngest staff member who was by the door, helping another child with footwear. She directed Mum to me, but she was dashing and said 'It's ok, she knows about it, it's on child's form'. Now, yes, I did 'know' but hadn't any care plan for it because it's 'rare, night-time cough' only. I took the inhaler out of child's bag and it has no prescription label, no cap and the use by date is almost up. Luckily, we didn't need it, and at the end of the day I brought out all the care plan paperwork for Mum to complete with me. I asked for an inhaler and spacer to be kept in Preschool, with the box so that we could see the prescription label. We've never seen the inhaler again.

 

Mum has today brought in a bottle of Asda cough medicine - and gave it to usual staff member who gave it back to Mum and asked her to take it to me. I whipped out a load of forms for permission signatures, which she happily gave. I asked if it was on the recommendation of doctor and she said that it wasn't.

 

Soooooo, does anyone else feel uneasy about this, or am I picking up concerns without foundation?

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yep sounds a bit odd to me...i'm afraid i now suggest that i will not accept the child back in to the setting until i have the medicine from the doctor with the right prescription label etc and care plans done...i have had to carry this threat out once ...only for a day though then everything was handed to me perfectly!! :o

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I have a child who started at Preschool in September. On her booking form it says she has occasional night-time asthma and when I queried it with Mum I was assured that it was very rare and only was a cough at night sometimes.

 

Now, in late October Mum came in and spoke to our youngest member of staff and said that the child is hypoglycaemic and here's a tube of stuff to squirt into her mouth if she needs it. Mum then left quite quickly and my member of staff brought the tube of 'stuff' over to me asking what she should do with it. I explained that Mum should have brought it to me really, as I'd need to complete a medication form and get a signature before we administered it. I telephoned Mum and explained this and got a verbal permission to administer if necessary, on the understanding that she would sign the paperwork when she collected the child. She signed it the next morning and I asked for the medication to be handed over so I could lock it in the cupboard and Mum said 'oh she hasn't got it today, just give her a spoonful of jam if she goes floppy'. I explained that we didn't have any jam at Preschool but we could give sugar, and she agreed to this and signed the paper to say that we should do this in the eventuality that there was no medicine available. I asked if she would bring the box in the next time so that I could see the prescription sticker and make a note of it. She said she would, but we've never seen the medicine again.

 

Now last month, Mum said that the child has bad asthma, and her inhaler was in her bag. This was again said to the youngest staff member who was by the door, helping another child with footwear. She directed Mum to me, but she was dashing and said 'It's ok, she knows about it, it's on child's form'. Now, yes, I did 'know' but hadn't any care plan for it because it's 'rare, night-time cough' only. I took the inhaler out of child's bag and it has no prescription label, no cap and the use by date is almost up. Luckily, we didn't need it, and at the end of the day I brought out all the care plan paperwork for Mum to complete with me. I asked for an inhaler and spacer to be kept in Preschool, with the box so that we could see the prescription label. We've never seen the inhaler again.

 

Mum has today brought in a bottle of Asda cough medicine - and gave it to usual staff member who gave it back to Mum and asked her to take it to me. I whipped out a load of forms for permission signatures, which she happily gave. I asked if it was on the recommendation of doctor and she said that it wasn't.

 

Soooooo, does anyone else feel uneasy about this, or am I picking up concerns without foundation?

I think I would too be feeling uneasy regarding this situation , erractic behaviour from parent regarding medication, most over anxious parents would make a big deal and be very thorough with regards to medication, wanting every form filled ,checked etc

Personally I would not be administering any non prescribed medication during preschool hours as there would be no reason to administer, this should be done at home, secondly referring to verbal permission given over phone , I would be vey careful as you are putting yourself at risk , parent could deny having given permission and it could leave you wide open in terms of any comebacks.

From what you have said I would speak to health visitor or take the opportunity to request a proper scheduled time to sit down with mum to discuss medical concerns of child. it is very abnormal for a child to need treatment for hypoglacema and then to suddenly not , why does mum keep approaching younger member of staff ??

i would also list , date all concerns in incident book

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I think you're right to be concerned Cait. Even someone like me with a somewhat chaotic parenting style wouldn't rack up that many incidences of this kind in four months.

 

Do you have any other concerns about the child at all?

 

Our policy said we wouldn't administer any drug without it being in its original packaging with the pharamacists's label showing dosage instructions, and I'd expect to see some kind of letter/advice from a GP or hospital consultant before I'd be happy to give a spoonful of jam or sugar to a child, and I'd want to know the exact circumstances when this kind of intervention as needed.

 

Having the parent's signature without this advice from a healthcare professional wouldn't have been enough for me. Certainly the cough mixture would have been a no-no. Does that make me a bad person?

 

I'm not sure where you go from here - but maybe a reminder of what your policy says and a general chat about what has happened so far might help clear the air and give you a bit more information about the family?

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Gosh, I'm an erratic parent too, but nothing like that.

Like everyone else has said Cait, it does sound a little odd, maybe not all the problems but the lack of concern by mom that you've documented everything is strange, I was always anxious people would forget Rich needed an inhaler sometimes, his was usually at the bottom of his bag covered in fluff (I know thats terrible) but it had the lid because we used the easibreath ones.

Maybe she is just a very busy mom and presumes you are trained in recognising problems.

 

Edited to say I've just had a quick read about hypoglycaemic, I dont think I'd feel qualified to give a spoonful of jam and then presumably wait for the floppiness to go. You wont know if her blood levels have risen to the correct level, you'd need to call an ambulance.

I've just been hit by a thought, its a very vague memory from years ago of someone I knew or knew through someone who was giving their child other peoples meds. I cant remember anything else about it but I'm sure t wasnt a dream :o

Edited by Rea
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I can see how you got dragged into this detriorating situation Cait - but now as you already suspect you have to act to protect child and yourself.

 

This parent must make time to sit down with you and explain herself, is she a working parent who cannot afford to take any time off and just tries it on with you?

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YES - to all of the above!!!! I should add that I wouldn't actually have administered anything on a verbal say-so like that, but would have phoned for Mum to come and do it if it was needed.

 

Our policy does say that we must see the original packaging - which is why I keep asking for it, and then we never see the medicine again!

 

And Maz - no, I don't intend to give her the cough medicine - I'm sure that would be a total waste of time. If the child's coughing that much we're phoning Mum to take her home.

 

As regards other concerns, she's not particularly clean. When she goes to the toilet - which she does, A LOT - she often dribbles a bit on her pants, so Mum is providing panty liners for her. I have NEVER had this before - does anyone else?

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I would feel concerned,

 

hypoglycaemia seems and odd thing to say a child has, if diabetic then I can understand and if not getting regular snacks it can be an issue for some but not something I would expect to see a child have without some medical confirmation or details on how to treat correctly if needed..

 

asthma can be fatal if not treated correctly..and if she has this no matter how slight should have a care plan and the appropriate medication available, which she obviously has as she has brought it in .. and I really despair qt parents and people who have inhalers without covers - they are inhaled, what if something was inside and was inhaled when using the thing! ( as a nurse in a&e I once say a patent come in who had inhaled a small screw this way, had unshielded inhaler in pocket, and used it , screw ended up in lungs and surgery was needed for removal.. not good)

 

Some asthmas are only present during illness or colds, my son was one who only had it in summer , pollens kicked it off so never needed any treatment in cold like most but always carried an inhaler.

 

As to the cough medication, think I would ask her to be given before and after session - any reason to give more often I would query.

 

May be a parent who doesn't see the need to make it 'formal' and cannot understand the issues there may be with giving medication, or a bit like me cope with them all and cannot see the fuss.. when dealing with things I just get on with it and often wonder why others don't, but then with my child I knew what to do and when.. assuming everyone else does too is the issue, or then they could be just not acknowledging the fact that others need more info.

 

Could also be embarrassment, that their child had these conditions but she did not fully declare on the form the extent, thinking you may not take the child if they did.. I had several parents like that who once I had a meeting with did open up more and would then come to me not the junior staff as a way to side step me as they had in the past.

 

maybe time for that chat...

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My typing was so slow.. watching that programme on TV about 'My child's not perfect' at same time...

 

Not had the same issues with a child who 'dribbles' but this could be a lack of bladder control and a medical issue or an infection can cause this, lots of feeling the need to go and not emptying bladder fully.... but then this can also be caused by a child being asked to go 'just in case' as we are going out... the bladder does not then develop the need to control holding larger volumes of fluid, so remains small with a lower capacity , hence the frequent need to go... moral is NEVER teach your child to go just in vase and allow them to develop full bladders.

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I wouldn't imagine for a minute you'd do anything against your policy Cait - far too experienced for that. But as Panders said, it is easy to see how you've got to this stage.

 

From what everyone is saying here, I think you need to follow your instincts because they are usually right. There could be 101 things going on for mum and she just might not understand why your policies and procedures are so vital. If you have a chat and this odd behaviour doesn't stop then you might need use your LSCB procedures to get some advice on a no-name basis. Better to raise the issue and be told that there isn't anything to worry about than not to do something but find out later it was an indicator of something more serious underlying the situation.

 

Good luck!

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Until your last post Cait I wasn't very concerned as we've had situations like this before. They tended to be working parents who had enough IT skills to Google every symptom their children presented with but not time to go to the doctors. Not that I'm condoning that at all. Like you we documented every prescribed medication and I refused to accept any medication without a prescription label, especially after our local chemist became able to recommend things and give it on prescription - no excuses then. The children in question tended to be the healthiest specimens I'd ever seen and the parents a bit over anxious. I just stuck to our policy and explained clearly. It also helped that I also had asthma (still do actually if I'm being precise!) and I could demonstrate the incorrect way to store my inhaler as it was always in my apron pocket covered in fluff!

 

But your last post gives me more concern and makes me think that maybe there is more going on. I've never heard of using liners for young children and the generally unclean is worrying for me too. I'd be looking to follow this a little further.

 

edited to say my typing is even slower! I refer not to your last post now obviously!

Edited by Guest
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The constant 'going' is to do with her hypoglycaemia apparently. She just jumps off the loo too soon because she doesn't want to miss anything going on in the main room

 

Then that would worry me.. as it is a sign of diabetes , and would want parent to give me more information..

 

 

Toilet every time Inge :o

 

 

Just shows I am engrossed in that programme.. ..

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When we had a child with diabetes, we had a diabetic nurse come to our setting to train staff in her care. When she had symptoms of either low or high blood sugar levels we would check her blood sugar levels, to obtain an accurate, factual record, then act according to the child's health care plan. So what I'm trying to say is in the absence of this in this case I think there is cause for concern.

 

Do you have access to a child protection advisor in your area to talk things through with?

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I too think you are right to have become a little concerned. As someone else said, I think I would be recording all of these incidences, as well as making an appointment with mum to record with her the child's health needs. I'm sure it's very unlikely, but there's always the possibility that this could be a child protection issue of 'Fabricated Induced Illness' (FII) ?

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I;d wondered about a diabetic nurse, so it's interesting you should mention it - would I be ok to write to her GP practice and ask that they arrange a visit from one. In my mind, if Mum is fabricating in a Munchausen Syndrome by Proxy - kind of way, that would flag it with her GP, or would that be ill-advised. It's a very fine line with 'team around the child' isn't it!

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Think you need parental consent to write to gp about anything. think it is time for a chat with mum and try to get to the bottom of it all... ask about the medical side and if you could get advice from them as you need to have something in place for Ofsted.. I blamed them for lots of things to get parents to comply or give more info!

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I dont see why you couldnt write and request a visit by the nurse. You could word it that you're wondering when it will take place because it was a while ago that you were told about the hypoglycaemic and you'd like everyone to be aware of symptoms ect.

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I;d wondered about a diabetic nurse, so it's interesting you should mention it - would I be ok to write to her GP practice and ask that they arrange a visit from one. In my mind, if Mum is fabricating in a Munchausen Syndrome by Proxy - kind of way, that would flag it with her GP, or would that be ill-advised. It's a very fine line with 'team around the child' isn't it!

 

 

I would agree with Inge, you need to speak to Mum to get her permission to approach either the health visitor or doctor - I've done this before when I had concerns about a child ie would it be ok if I ask the health visitor for advice as to how to manage this condition. I then had an informal chat with the health visitor.

 

I think you need to have a formal chat with the parent - and have your questions ready so that you won't be sidetracked if somebody were determined to fob you off. Either you will be able to support a potentially busy parent by formalizing the child's care, in our profession we naturally follow guidelines/procedures but we understand that some parents are more casual in their approach, or you might have more evidence to back up your concerns.

 

You say the child started with you in September, is this the child's first experience of early years or did the child move from another setting? If so, would the parent give you permission to obtain the child's developmental records from that setting to support the child's learning journey?

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Having just read through this whole thread I wonder if asking for a meeting with the Health Visitor would be a good way forward.

 

You can approach the parent saying that as her child clearly has complex health needs you feel it is important that you ant the rest of the staff fully understand how best to manage them. Ask her to contact the health visitor or to give you permission to do so and arrange for you to all sit down together to put together a plan for managing her daughter's needs.

 

You could have a letter ready for her to sign giving you permission to contact the health visitor so you're not relying in her getting round to it herself.

 

Her response to this request would be quite telling and, hopefully, it will help to answer all your questions and show the parent that children's health needs must be managed responsibly.

 

If she resists the idea of making things more formal you will then have to think about whether to take the matter further yourself.

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Having just read through this whole thread I wonder if asking for a meeting with the Health Visitor would be a good way forward.

 

You can approach the parent saying that as her child clearly has complex health needs you feel it is important that you ant the rest of the staff fully understand how best to manage them. Ask her to contact the health visitor or to give you permission to do so and arrange for you to all sit down together to put together a plan for managing her daughter's needs.

 

You could have a letter ready for her to sign giving you permission to contact the health visitor so you're not relying in her getting round to it herself.

 

Her response to this request would be quite telling and, hopefully, it will help to answer all your questions and show the parent that children's health needs must be managed responsibly.

 

If she resists the idea of making things more formal you will then have to think about whether to take the matter further yourself.

Hi Cait - sorry missed this yesterday - have to say that I totally agree with Upsy........and yes, I would be very concerned if this was a child in my care.

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The other thing would be insurance? It is my understanding that if you have a child with a life threatening illness or condition you must inform your insurance company. So diabetes would qualify or any one with an epi pen- interestingly enough asthma no longer does, I guess as so many now have asthma.

 

I would be inclined to ask for all the relevant information and state quite clearly that if it isn't forth coming I would not be able to care for the child. I have only had to excluded a child once for this but it was a for a child with an epi pen, that Mum took away for the weekend and despite being told that her child would not be able to stay if she didn't have it forgot to bring it back. So sent the child away with her, she bought back the epi pen and child stayed!! must admit Mum not very happy as sh ewas on her way to work but that;s the way it is

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I had a quick word with Mum this morning as she was dashing off to work. I simply said that I'd be grateful if she could come in sometime and we could sit down properly and discuss her child's medical needs. I threw in that I would probably need to get in touch with her GP to ask for a District Nurse or someone to come out and talk to staff about the child's care.

 

She blustered and backed down a bit. 'Actually I must go in to the doctors to find out what they think now. It might just have been a one off episode and I need to find out'

 

(Hmm, yeah). So I said, 'oh, when you're there you can perhaps have a word about someone coming out too'

 

'Well, it could have been a one-off, I'll have to find out.....'

 

So, should I be more concerned or less? It's really quite bizarre!!

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Hi i think i would be more concerned if on your questioning she then implied that it may have only been a one off.

We do obtain signed permission from parents when they start to talk,and liase with other professionals with regard to any child in our setting.

Although we would also tell them verbally before we did so. Maybe this is something worth considering in the future.

Have you ever seen the child go floppy?.

Also many cough medicines are not suitable for a child with asthma so would certainly be concerned about that.

Defintely feel a proper discussion with the parent as a matter of urgency is the way forward.

Do let us know how you get on. :o

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No, I've never seen the child go floppy.

 

My intention today was to alert her that I'm going to need a proper chat with her, which will be either next week or first week back after the break. I told her it needs to be a proper 'sit down conversation'.

 

We haven't seen the child ill at all, and neither has the childminder, who is also quite concerned about the random information we're getting from Mum.

 

I had no intention of giving the ASDA medicine for just that reason, Bridger. Had the child coughed sufficiently to warrant it, I was going to telephone Mum to come and get the child.

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I used to work as a pharmacy dispenser .... often been useful at work now, and in life generally.

I feel you need to have a firm chat with mum, and the idea of a pre-written letter for her to sign for a health visitor visit is perfect.

It sounds like mum needs a bit of help.... or at the very least, an understanding that her behaviour regarding illness and medication is not usual and has to be followed up.

 

I also think you need to document what has occurred so far...and ask mum to recognise and sign what you have.

If mum is reluctant... then my next step would be to ask for advice from the safeguarding duty officer.

 

 

Good luck... I feel you have a confrontation ahead.

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