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'intimate' Care And Procedures


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We have a child starting next year who is undergoing tests and may require suppository treatment while at our setting. I have just spoken to our administrator who is unsure what may be wrong but thinks it may be to do with having fits...

She asked if mum would prefer to be contacted but she said it may be a case of emergency and waiting for her would be too long.

 

Anyway, my question really is does anybody know if there is any training (like Epipen training) for the procedure?

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We had a child who was having fits and was given these, we felt that we couldnt give them to chid becaue we didnt feel like we had the training or felt that we were covered to do these things.

 

The child only had fits very occasionly when had temperture so we had time to call parents etc. Its hard to see what crossed the line as for as care goes and what we should be expected to do on a day to day basis, even if there was some kind of training available would you feel 100% happy doing this?

 

Im not sure what setting you work in but I know that most schools woulnt be happy to do this at all, I mean most make a fuss about changing a wet child! Hope you manage to find a solution

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Yes I am sure there is training - I think you need a lot more information from the parents and from others but I am sure there is training available. The new DFES booklet on adminstering medicines does cover this and tells you what help you need or who you can contact - I think you need to draw up a health plan with the parents so that everyone knows what can or cannot be done. It's obviously a difficult situation and I think you need more facts. Sorry I cannot be of any more help but really you need to get a lot more information on this.

Nikki

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A couple of years ago when I worked with MLD children I hade a child with epilepsy who had suppository treatment- diazapan.

 

As a school and as her teacher we recieved training from the school nurse and had to sign a form to say that we had been trained and were happy to administer the medication if needed.

 

Its the storing of the drugs that is more complicated if you have a child who needs them as they have to be locked away.

 

I would get in contact with the school nurse service and see if they can arrange trainiong for your setting.

 

L

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Many thanks for the replies. At the moment it isn't definite as the child is still having tests.

Personally, if I had been shown the procedure and was ok with it I would be happy to administer them but can't say the other staff would...

Our school nurse is fab and I know her really well (my daughter is an 11 year old bedwetter bless her!) so I will contact her if we need to consider it.

We can't refuse to take the child on these grounds and as mum is happy to let us do it I don't see a problem as long as, as you've said, everyone is briefed, papers are signed etc etc.

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When I went on my First Aid training recently the trainer told us a cautionary tale about such treatment.

 

There was a boy at a local(ish) school who needed life saving suppositories and three members of staff duly agreed to administer in the case of an emergency. They signed and received the necessary training. One day the boy started fitting and one of them actually needed to do it. Remember - this child was having a fit and thrashing about and the teacher in question had never actually had to perform it before. She managed to do it but in the process damaged his rectum slightly. The parents tried to sue her for negligence. Of course, they didn't have a leg to stand on and it was thrown out of court but she suffered terribly in the interim. After that all the teachers withdrew their agreement and the boy had to be taken out of the school.

 

Make sure you're absolutely 100% sure about what you are taking on and the responsibility you will have should something go wrong. :)

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In my first year of teaching, in a Reeption Class, many years ago!, I was asked to administer suppositories too, apparantly the Nursery staff had agreed. I discussed this with Nursery Nurse and we both felt really uncomfortable about this especially wondering what other chn. in the class might think about what was happening (presumably it has to be done on the spot). We refused and the child was simply given different medication. I think I would still feel the same way now after 18 years experience.

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Do you realise now that even if you have been trained in the past to use things like epipens, if you have a new child start with you you have to be re trained to use them by the chiulds surgery so that you are covered legally..... :D

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As a parent of a teenager with epilepsy, I would suggest that should you be in a position to need to administer this medication, if indeed that is the problem, then you should also have called 999 for an ambulance. We only once felt that the seizure was severe enough for us to need to use this and we did not receive any training when it was prescribed and it was quite difficult. Fortunately the seizures that we experienced while frightening were not as commonly portrayed with excessive shaking etc and often resulted in a loss of consciousness. I think you would need to remove all other children from the immediate vicinity.

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This thread worried me a bit. What is the concern?

 

Speaking as a "phamacist" (still technically a phamacist, but now totally EY), 'per rectum' (pr) administration (i.e. giving suppositories) of some drugs is by far and away the best method. The absorption of some drugs via the rectal mucosa is excellent (diazepam and paracetamol are examples - during an epileptic fit, diazepam cannot always be adminstered orally; paracetamol can be tolerated by rectum , e.g. when a child has migraine, and is vomiting). With parental advice (in writing), I would never refuse to give a medicine pr to a child in my care. Damage is extremely unlikely: suppositories are soft - they are designed to "melt" at body temperature, and tearing of the rectal mucosum is a very remote possibililty. Obviously there are hygiene precautions (akin to nappy changing, e.g. wearing of gloves/appropriate disposal) - common sense!

 

In my experience, a child who routinely recieves medication via this route accepts it as normal. I think you just need to take advice from parents and health professionals (e.g. health visitors, epilepsy nurses etc.) Indeed, how could practical training be given? It's not like Epipen where you get to practice with a "blank". A suppository slips very easily into a child's anus; it's easier than you might think. The suppository can only go the right way; the "administrator" keeps the child still for a few moments (so the suppository doesn't slip out before it melts), and that is it. In fact, it is much more reliable than administration by mouth and is infinitely safer than adminstration by injection. I'm very surprised that someone managed to damage a child when adminstering a suppository. This is such a rare occurence that it has never been documented on the professional (pharmacist) resouces that I access!

 

Actually, I believe that none of you will have a problem with giving a suppository - it is so much easier than getting a child to swallow a spoonful of something that doesn't always taste so great!

 

Diane

 

PS One of my own children has required regular treatment with suppositories since she was about three. She suffers from frequent migraine and takes paracetamol by suppository and her anti-emetic by mouth. Even if she does throw-up she still has pain relief. She has self-administered her own suppositories since she was under five years old. At the age of 14, she still finds this the best solution (as pain relief never gets vomited up).

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We have a child starting next year who is undergoing tests and may require suppository treatment while at our setting. I have just spoken to our administrator who is unsure what may be wrong but thinks it may be to do with having fits...

She asked if mum would prefer to be contacted but she said it may be a case of emergency and waiting for her would be too long.

 

Anyway, my question really is does anybody know if there is any training (like Epipen training) for the procedure?

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We have a junior child who has mild epilepsy and may need to have a suppository administered, although at this time she has not needed one before. Her parents came to a staff meeting with a nurse who went through the proceedure with us. After which, members of staff who felt that they could administer the suppository if required, signed up so as to be 'on call' if needed. I hope this helps. EmmaB

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Hi Diane,

 

I agree that in a case of a child with epilepsy you cannot take the chance of not giving the medication. My husband has epilepsy (light form) and I 'suffer' when I cannot do anything for him, only make him feel secure.

 

About the suppository... well... when I was a child I remember my mum trying this with me and I do recall that it wasn't that easy all the time. I don't know if it was that I 'pushed' it out or what, but my mum had to hold tight so it would not slip out. This was the case with me... being completely conscious and able to control my body.

 

But... a child who is having an epilepsy fit does not control his/her body in that moment so it can become difficult to adminster the medication. One of the things that is said to not to do during an epileptical seizure is to hold the person. So it is not so easy as it seems.

 

I think that, in this case, everyone involved should be present in an inset training: parents, child's doctor, school nurse, administration and all the staff since a seizure can happen anytime anywhere.

 

I think we need to overcome our fears for the sake of the child. Life and health are precious gifts :o .

Edited by SmileyPR
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Thank you Diane, I agree with you and am curious about the migraine mention as I suffer terribly (I now have Maxalt melt which are fantastic but having looked online are mega expensive so I wonder how long the surgery will let me have them for!)

Anyway, I wonder if the damage mentioned was by the person inserting theri finger as well (as you would a tampon...) and that caused the damage?

 

As a parent I find it appalling that someone would sue over this. Personally I would probably rather stay home and be called in if I was worried about others doing it. In our case (should it happen) the mother has already said she is happy for us to administer and I think if the child is in need it should be done and fears of repercussions dismissed.

 

In fact we have staff who don't want to change nappies for various reasons and rightly or wrongly I don't insist they do it if I'm there.

 

By the looks of it from the posts here it is fairly unlikely we would need to ever do it but as long as we have a staff member on each session who is prepared (in training and willingness) to do it I won't be refusing.

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When I used to Nanny in Switzerland giving suppositories was the norm. And I never once had a problem with it administering it, that was many years ago when I was 16/17. I think the thought of it for many people is much worse than actually having to do it. Provided you have the relevant papers signed etc I don't see a problem with it.

Jo

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Funny you should say that Jo.. a nanny I knew had worked in France and was told the child had to take their medicine before lunch. She called the child, got the pill and was thinking how on earth is the child going to swallow it it's HUGE! She turned to see the child laying down pants off... even with teh language barrier she got the gist!

 

This may be why I'm not having a problem with it... I know that teenage girls are left to do it abroad with no worries!

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in schools, most teachers unions (I know mine - NUT and HAHT- were) are very clear that teachers should not administer medication. It always came down to a few (usually support staff) who agreed, but the problems always arose if they were off sick or otherwise occupied when required - this happened a few times with the ritalin dosages for a couple of children when the medicators were both absent and noone else realised.

 

It is also true that schools can have problems with changing soiled children, but sometimes this is simply down to the adult child ratios that do not allow a teacher to drop everything and the other 29 children to find the clothes, wash/clean up and change a child. And frequently they don't have a suitable area for this procedure to hand. I know we didn't in a building from 1886. Sometimes just finding someone to take over was pretty difficult !! It may not be that they don't want to, it may be that they just don't have the capacity. We also didnt have the clothes to fit often or even have spares as parents never felt they needed to send the clean clothes back!! So calling a parent for clothes was often the best course of action - better than having a child in soiled clothing.

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I see what you are saying but we are in a purpose built building with extra staff to account for the age of hte children so we have no excuses that way!

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It's interesting to read that the use of suppositories for administering medication is widely used in other European countries.

Catma, do you know how the unions give advice to teachers/schools on meeting the Disability Rights Act when a child attends who requires medication or who has a bowel disability and needs nappy changing facilities?

We should all be asking ourselves How can we adapt our provision ( school or Nursery) to meet the needs of all children.? If we can build ramps for wheelchair access then surely we can provide a screen, soft flooring, wet wipes and change of clothes, even in the smallest of classroom spaces.

Let's not also forget that the child should be included in discussions, plans, ideas on how their needs can be best met, they are the ones that have to live with their needs 24/7, the least we can do as adults is to 'care' for them with regard to their dignity, their own independent self care skill and their courage on a daily basis of having to deal with their needs.

 

Peggy

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Updated guidance on medicines in schools and early years settings 2005 here

 

Teachers pay and conditions do not require them to administer medicines. Also GMB gives guidance for support staff that they shouldn't unless trained and all Dfes guidance in place.

 

Document v clear and will be of use I think.

 

Cx

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It may be my own paranoia as I started this thread but Catma, I feel like you're telling me off for even considering taking this poor child!

From what you are saying you are in a school setting, which is a different kettle of fish.

As supervisor of a preschool, I have read the guidance and we already ensure that we are not alone when we are doing any 'intimate care' procedure. Usually this is by being by the door of the toilets so the child feels they have privacy but we can be seen by staff in the main room.

In terms of administering rectal medicine to a fitting child, I would probably ensure we had a portable screen ready to shield the child so they wouldn't have to be moved but would be out of sight from the other children.

 

I appreciate what you say about teachers 'pay and conditions' but have to say tehre is an awful lot that us lowly nursery nurses don't have in our contracts that we do :o

 

I whole heartedly agree with you Peggy by the way. Whatever the outcome for the child in question, I will be totally prepared to accept him/her needs and all into our setting.

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oh no!! don't get me wrong - I was just pointing out that one sector of Early years provision don't have a requirement in their conditions of service to administer medicines and that unions will support this. Which adds a whole other dimension to the discussion. I just know how I have had to struggle to meet specific demands in the past with young children with no spare adult help (eg child having fit in reception class, just me and the children, LSA was on her lunch break having done dinner duty) and how hard it can be if the systems and facilities are not in place for children to get medication/intimate care sensitively and safely for both child and giver. So it was just to widen the discussion!! Not aimed at anyone. Sorry if you though that!

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Phew! Thanks for that Catma. I was worrying that now I might offend you... :o

 

I can imagine how hard it would be in a class. Do schools not have anyone like a welfare officer (was that what they were called) any more? Or maybe they were replaced by LSAs...

 

What would happen then? I mean if you had a totally educationally fine epileptic child?

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well, in that case it was the first time, and as my mum and sister are epileptic both I wasn't fazed by the fit but just had to send a reliable 5 yr old to get what help they could with the aid of the "help" card we all had for emergencies. Child was OK and it wasn't diagnosed as epileptic (actually it's so long ago now I can't remember what the outcome of the doctors was - just that he never fitted again in school) But yes, it can be tricky. Various solutions can happen though but it comes down to someone agreeing to administer medicines. We had one child who had to have a catheter changed - noone was willing to do it so the school employed her sister for the lunchtime everyday to do the changing and check her which worked OK in that situation but had sister been working I don't know what the other options were.

 

 

(And don't worry i'm not offended - I know sometimes text doesn't read to others how you say it in your head :):) )

 

Cx

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Thanks for the reassurance C! You're right about text not always conveying feeling! I had to edit my post after I read it first time!! Anyway, glad you're not offended - I tend to jump in with both feet!

 

 

So back to the subject.... What if a school/setting couldn't afford extra staff for these jobs?

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