0121 350 8020

3.8   Children with Medical Conditions & Communicable Diseases.

 

The following guidelines and policy set out for dealing with and administering medication to children should be followed before a child starts at the nursery, or if the child is already in the nursery, as soon as medical condition is diagnosed.

 

Medical conditions and medication

 

The definition of the term ‘medication’ in this context is taken to mean any medicinal preparations specifically prescribed for the treatment of a non-contagious condition and non-prescribed medication for temperature and pain control.

 

Treatment plan/Medicine Form

 

A treatment plan must be completed for any child who has a known medical condition. This form can only be completed by a General Practitioner. This form details all information relating to a child’s treatment in the event of the condition arising.

All details of treatment plans and medical conditions are recorded in the child’s key person pack, which is completed prior to the children starting the nursery. If a child becomes ill once they have already registered at the nursery, parents and carers will be expected to put all information regarding their child’s illness in writing along with any medical treatment plan we need to be aware of when the child is in the setting.

 

Medication

 

The management team (Room Leader and above) will administer medication.

 

Children will not be permitted to attend the nursery for the first 48 hours after commencing a new medication which they have not had previously, or changing a course of medication. This is to ensure that any adverse reaction is monitored by the parent and it is also likely that the child will not be well enough to cope with a nursery day at this early stage of their illness. It also reduces the risk of cross infection to other children and the staff team. This decision is entirely at the discretion of the management team. Dependent on the nature of the illness and the type of medication.

 

Children should not attend nursery if suffering from a communicable disease or one that requires special treatment during the day, e.g. injections, change of dressings etc. My First Friends’ procedure for the Control of Communicable Diseases is available in the Managers office.

 

Medication will be stored in a locked cupboard in the office area with the exception of inhalers and epi-pens, which will be in the same location as the child for whom they have been prescribed. Any medication requiring refrigeration will be kept in a closed container in the Milk Kitchen refrigerator under the supervision of the Room Leader.

 

Medication must be in original containers, clearly labelled to indicate the following:

 

  • Child’s name
  • Date of prescription
  • Expiry date
  • Dosage
  • Any other relevant information

 

Failure to provide medication that is not in the original container and label must result in a refusal by the management to administer.

 

The parent / guardian must complete the Medicine Authorisation Form (MAF1) including the following details:

 

  • Date of instruction
  • Name of child
  • Condition to be treated
  • Name of medication
  • Date course of medication commenced
  • Prescribed dosage and frequency
  • Time of dose and duration of treatment
  • Method of administering dose
  • Storage instructions
  • Expiry date of medication
  • Any other valid details

 

These instructions should be signed by the parent and counter-signed by the management to acknowledge their understanding of the instruction before the parents and carers leave the child at the setting.

 

This form must be completed in full. Failure to do so must result in a refusal by the management team to administer the medicine.

 

Any variations must be recorded on a new form

 

Parents should complete the previous dose details on the form (MAF1) when they bring their child into the nursery, if they have administered a dose of medication within the past 12 hours. This is to ensure that a recent history of the child’s intake is kept to inform decision making regarding future doses. In this instance it is unlikely that a witness name and signature will be relevant.

 

Administering medicines

 

Two members of staff must be present to administer medication – one of whom shall be a senior member of staff.

 

The medication label, the medicine authorisation form, the child’s identity, and the time of the last dose must be carefully checked (by both staff members) prior to administering the medication.

 

Staff should ensure that hygiene is maintained at all times. Hands should be thoroughly washed before administering the medicines and gloves should be worn when appropriate.

 

On the Medicine Authorisation Form (MAF1) the senior staff administering the medicine should record the following details:

 

  • Date
  • Time of last dose
  • Time dose due
  • Actual time administered
  • Explanation of any discrepancy of timing, including adjustment of timing of future doses
  • Dose given
  • Name and signature of staff member administering the medication
  • Name and signature of witness

 

N.B: If a parent administers a dose of medication to their child whilst on the nursery premises the Medication Authorisation Form (MAF1) must be completed.

 

The parent must sign the MAF1 to acknowledge correct administering of medication.

 

If for any reason the child rejects all or part of the dosage given, no ‘top up’ dose should be re-administered and this should be recorded clearly on the medication form.

 

The MAF1 may be photocopied and given to parents to ensure they have current information regarding their child’s medical requirements. A copy must be retained at nursery.

 

Temperature and pain relief medication

 

Parents will be requested to identify if they want their child to have medication for the control of temperatures and pain relief, during their initial discussions with their child’s key person. If they do request it, parents will be asked to indicate which brand they authorise. The parent will need to advise the nursery that their child has previously been given this medication and no adverse effects were noted. The nursery will not give the child’s first ever dose. This information will be recorded o the child key person interview documents and on the Parental Permission Form (MAF2).

 

Wherever possible every effort will be made to reduce the temperature or control the pain without the need for medication. However, should the situation support the administration of a single dose, then the parents will be contacted? If parents cannot then one dose of medicine for the control of temperature and pain relief can be administered by a senior member of staff, if prior written authorisation has been given. The nursery will only administer one dose. Should a child’s state of health warrant further assistance then the parent would be expected to collect them from nursery.

 

If the situation arises where a child’s medical condition warrants the administration of a single dose of temperature and pain relief medication and the MAF 1 and 2 have not been completed in advance, then the room leader caring for that child must make every effort to contact the parent to gain permission over the telephone to administer the medication.

 

Any medication given for pain relief and temperature control (in accordance with prior approval by the parent / guardian) must be recorded on MAF1 and the parent / guardian notified upon collection of the child at the end of the day.

 

If there is no contact with the parents or prior written authorisation, then the medication MUST NOT be administered. The staff team should continue to offer alternative care to stabilise the child’s condition and where required request an ambulance to take the child to hospital.

 

Administering Inhalers

 

Each child that requires or may require an inhaler whilst at the setting should have an inhaler, medication form, treatment plan and appropriate face mask or spacer clearly labelled in their room. In the event of a child needing their inhaler the appropriate prescription details should be followed. Should the child not respond to the directed dosage Early Years Practitioner administering the inhaler should follow the emergency treatment as dictated below.

 

In the event of a severe asthma attack – dial 999 and ask for a paramedic ambulance.

Continue giving the child their reliever (blue) inhaler as needed until symptoms resolve.

Give up to ten puffs, one puff every minute using spacer device.

Shake inhaler device before each puff.

If the child’s condition is not improving and ambulance has not arrived this may be repeated.

Contact Parents/Carers

 

 The Emergency treatment is also outlined on the child’s Asthma alert card which can be found with the child’s inhaler in their room.

 

Procedure for the administration of oral medication

 

 In addition to the medication procedure above, guidance below sets out the specific procedure for oral medication administration:

 

·         Medicines should be given as stated on the prescription label.

·         Much skill is required in gaining a child’s co-operation to take medication, in order that they obtain the correct dose. Allow adequate time to ensure the child is settled and comfortable before adminstering.

·         Use a bib or cloth to protect the child’s clothing

·         Always use an oral syringe for babies. Administer medication gently to the side of the mouth, not directly to the back of the throat. Hold the child upright to prevent inhalation.

·         Have a drink available for the child, to wash the medicine down.

·         Have a moist cloth available for face wiping.

 

Administration of eye drops

 

  • If giving eye drops do not expect a child to keep their eye open and lay still. A reflex action will make them blink or turn their head when they see an eyedropper coming towards their eye.
  • Lay the child across your lap or sit them comfortably with head tilted back slightly. Draw up medication with eyedropper, (if separate from bottled medication) gently use a clean finger to raise upper or lower eye lid.
  • Poise with dropper about two inches above the eye, and wait until the child blinks. At this moment squeeze the dropper so that the solution falls into either upper or lower lid or corner of the eye.
  • Keep child lying still for a few seconds to allow the solution to spread over the whole eyeball. Repeat for the other eye if prescribed.
  • Eye drops and ointment may cause temporary stinging and itching. The child may also notice a bitter taste as the eye drops run down inside the tear duct, and into the nose and mouth.

 

To administer eye ointment

 

  • Follow steps as above. Squeeze ointment nozzle, allowing medication to fall from inner corner or eye along lower lid.
  • Don’t worry if the child blinks – this will help distribute the medication across the eyeball
  • Ointment may blur vision for a few minutes. Wipe away excess ointment with a clean tissue (from inner to outer edge of closed eyelid, use separate tissue for each eye).

 

Administration of ear drops

 

  • Lay child’s head across a towel, one member of staff to support child’s head and prevent sudden movements.
  • Do not touch ear with dropper or tube. If drops / ointment have been kept in fridge allow then to warm to room temperature before using.
  • Support child’s head and squeeze the requested number of drops into ear canal. Keep head tilted to one side for a minute to allow eardrops to settle.
  • If both ears are to be treated repeat progress on second ear. Please note occasionally eardrops are labelled for left or right ear only (this is to minimise cross infection).

 

Administration of nose drops

 

  • Ensure the child’s head is held gently but firmly to prevent sudden movement during this procedure.
  • Draw up medication with nasal dropper (if separate from bottled medication).
  • Use dropper to instil correct dose into nostril. (Do not insert dropper into nostril unless instructed to do so with medication).
  • Allow a few minutes for nasal drops to travel into nasal passages. The child may notice an unpleasant taste as the medication travels from nasal passages to the back of the mouth.

 

In the event of having to administer a dose of antihistamine to treat an allergic reaction you must ensure the child is collected and taken home as they will require 1-1 observation for the rest of the day. The only exception to this is when it is stated in a treatment plan not to.

 

Administration of Epi pen

ONLY STAFF THAT HAVE HAD THE EPI PEN TRAINING ARE AUTHORISED TO ADMINSITER THIS MEDICATION. YOU MUST ENSURE THAT WHERE POSSIBLE YOU FOLLOW THE SETTINGS PROCEDURE FOR ROOM LEADERS OR MANAGERS TO ADMINISTER MEDICATION HOWEVER IN EMERGANCY SITUATIONS WHERE AN EPI PEN IS REQUIRED IF THE STAFF MEMBER IS WILLING TO, AND THEY HAVE HAD THE TRAINING THEY CAN DO SO BUT MUST SEEK OR ASK SOMEONE TO GET A MEMBER OF SENIOR MANAGEMENT AS SOON AS POSSIBLE FOLLOWING THIS TO SUPPORT THE SITUATION.

 

Inclusion and exclusion of children

 

It is our policy to decline to admit a child – or to exclude a child already on our register – only in the most exceptional circumstances or in cases where a child has a communicable disease. As a general principle, we will make every effort to accommodate the requirements of children with special or medical needs. Our contract with parents provides that we may require a parent to withdraw a child when:

 

·         The child requires special medical care and attention which is not available or which is refused by the parent.

·         We have reasonable cause to believe that the child is or may be suffering from any contagious disease, and there remains a danger that other children may contract such an illness/disease.

·         The Management reasonably considers the child’s behaviour to be disruptive and harmful to themselves or others.

 

In addition, children who are taking antibiotics will not be admitted to the nursery for the first 48 hours of the course of treatment if they have not previously had this medication. This is distinct from the 48 hour exclusion advised for streptococcal infection as indicated in the contagious diseases table.

 

Further information may be found in the Special Educational Needs Policy and Procedure for the Control of Communicable Diseases in the health and safety Manual. A copy of the exclusion table can also be located in the Health Protection Agency folder in reception.

 

It may be necessary to exclude a child for a short period of time in order to ensure that there is no unnecessary risk to that child.

 

The Management will always consult with the Managing Director if they have any doubt about the nursery environment not being suitable to effectively meet a child’s individual needs before taking any action.

 

Exclusion will be considered in any case where a parent is not able to be completely open about a child’s condition, or withholds, or is subsequently found to have withheld important information.

 

Procedure for the control of communicable diseases

 

The Management will be responsible for establishing and maintaining the appropriate Health Authority contacts for information and notification with regard to the control of communicable diseases.

 

The Management or a Room Leader must notify the Health Authority immediately of any suspected outbreak of communicable diseases in the nursery as appropriate.

 

Health Authority guidelines indicate that it is not necessary to operate a policy of exclusion for all child illnesses but it is important that staff and parents understand when exclusion is required and why.

 

Many illnesses are infectious before a full diagnosis can be made. The nursery must be aware of its responsibility to protect the sick child and to prevent the spread of illness to other children in its care.

 

Common diseases and symptoms requiring exclusion include:

 

  • Temperature of 101°F (38°C) if not reduced by medication or child has had a temperature for three days or more in a row
  • Chicken pox (Herpes / Shingles)
  • Measles
  • Rubella (German Measles)
  • Mumps
  • Gastrointestinal Infection (Diarrhoea and / or persistent vomiting)
  • Conjunctivitis
  • Streptococcal Infection (sore throat; scarlet fever etc.)
  • Contagious Skin Conditions

 

A list of communicable diseases and minimum periods of exclusion is available from the office.

 

The Management or Room Leaders must be informed immediately if a child becomes ill while at the nursery. They will ensure that the child’s parents are notified as quickly as possible.

 

If the illness appears to be communicable, the child should be cared for by a member of staff but kept away from the other children. The parents should be encouraged to collect their child as soon as possible.

 

If a doctor confirms that the child has a communicable disease, the Management will notify all other parents of their child’s exposure to infection within 24 hours. This is particularly important with regard to Rubella, given the danger it represents to unborn children in the first trimester of pregnancy.

 

The Management will be responsible for the wellbeing of the children and staff while they are in the nursery. No child or member of staff known to be suffering from a communicable disease or considered too ill to participate in normal nursery activities should be admitted to the nursery.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Updated February 2017