WWYD: CMs - a child of mine is allergic, and has breathing problems but mum does not give me inhaler unless i ask for it. (bit long)

[Numberfour]

I have a very good relationship with the mother of the 3 year old I childmind. He adores me and I adore him and all is good!

However: two weeks ago I took the children to the park and when I put the child in the car,I noticed that he was really struggling to breathe. It was bad enough for me to race him to the GPs straightaway - which was quicker imo than getting an ambulance. By the time I got to the GP's, child's breathing had eased. He was checked over by the practice nurse and I was told that he was not having an asthma attack and was fine to go but that the doc would look him over first.

The nurse checked his records and told me that he had been prescribed an inhaler and that as a CM I should have one in my possession - I replied that I had not been informed that he had one and that mum had not mentioned it to me.

Mum then arrived at GP (I had called her to say we where there etc) and I talked to her about the inhaler. She said that she did not like to use it often, and had not thought about letting me have it. She said she would order one for me to keep at my house.

Then during half term I wanted to take the children to a different park, and because mum had still not let me have the inhaler each day, I specifically asked her to let me have it seeing that we were going to a park again and that the same problem may arise.

And it did: within about 40 minutes of getting to the park, the child was struggling to breathe and even asked me to take him to the doc. I was FURIOUS with myself that I had left the inhaler at home (yes yes yes - bloody stupid thing to do!) so raced (carefully) home.

By the time we got home, his breathing had eased quite a lot, but he was still not 100% so I administered the inhaler as per instructions.

Later I told mum about it and she said in a very decent, non confrontational and everything 100% fine way that his breathing eases up noticeably, that she would prefer the child not to have the inhaler. Also, that if the breathing becomes laboured, she takes the child out of that environment and if the breathing eases then she again would not use the pump.

I said very very carefull so as not to offend her, that when DS was prescribed an inhaler, I was advised to use it as prevention as well as to ease breathing and I suggested to her that she talks to the doc about how best to use the inhaler for her child. She said to me that she is certain the doctor would give her the same advice as I had but that she prefers not to give her child the inhaler if at all possible.

My concerns are as follows:

1. She does not let me have the inhaler despite knowing that the child has had two asthma / breathing difficulties in as many weeks while in my care.

1. She does not want him to have the inhaler if his breathing eases.

1. She suggests that a wait and see approach should be adopted when child's breathing becomes laboured.

1. She chooses to go against the doctor's advice as to how to administer her child's medication.

I am very worried that a similar situation will arise again - not being in possession of the inhaler while her son is with me puts her son at risk and I am not sure if it is a risk that I am able or prepared to take. IYKWIM.

Any suggestions or advice please? Apologies for it being so long..........

Can the child talk to you when they start having an attack? if they can, then you are doing the correct things by removing the child from whatever has triggered the attack and calming the child down.
Have any triggers for the attack been noticed, is it exercise or an allergy.
I'm no expert but I thought that inhalers were either used for prevention or cure and they were a different colour, i'm sure someone with more experience will be able to comment.
Have you asked to be trained to use the inhaler.
I would ask mum to put in writing exactly what she wants you to do when her child is having an attack.

thanks for the reply, Danthe4th.

Yes, the child can talk and I suspect it is an allergic reaction that is causing the problem because his nose runs a lot then, too. Mum told me that they noticed this happening before at the park I had first taken him to.

Yes, as far as I remember some inhaler is for prevention and other cure - he has the blue "cure" one.

I used the inhaler with the spacer with my son for a couple of years so I don't think I would need specific training ?

Good idea about having the mother put the info in writing.

Tell her that unless she allows you to follow the prescribed advice for her child's medication, you don't feel able to offer a place as you feel he is at risk.

colditz, that is my feeling, too. I am not sure if I want to take that risk of having her child fall seriously ill or worse because she does not want me, or so it seems, to have or to use the inhaler.

I have concerns about my 20 month old possibly having asthma. I would definitely want my cm to administer an inhaler in these situations.

I am an asthmatic myself and there are different types of inhalers for prevention and for during an attack.

On another thread, I had asked the question about whether or not it was bad for a child to have the medication in the inhalers at a young age and it was explained to me that it only goes into the lungs temporarily and then is out and doesn't goes into their system. (I may be totally butchering this response). Maybe the mother is worried about him having it too much for that same reason that I was worried? Maybe if that is explained to her she won't be so hesitant to give it when needed?

Another thing I still wonder, and need to ask, is - with young children, will giving the inhaler more often make them more dependent on it in the future? Maybe this is her thought process and why she doesn't want to give it to him if at all possible not to?

Just trying to see her POV. But tbh, if I were you, I'd be very, very uncomfortable not having an inhaler in my possession for the child. And as a mother of a child at a cm, I'd want her to be actively dealing with the situation as you have been (and would want you to have an inhaler with you all the time).

Star, can you link me to your other thread so that I can read the responses, please?

" She said to me that she is certain the doctor would give her the same advice as I had but that she prefers not to give her child the inhaler if at all possible"

Makes me think she has never experienced an athsma attack. If she had she'd understand that the child would want anything, anything to make it better. It's frightening and horrible.

I would write it up much the same as you have here and also as Danthe4th suggests get the parent to write up what they want you to do - exactly.

I would discuss and write up when the inhaler is supposed to be used (in the parents opinion and that its against doctors advice) and in what circumstances you are supposed to seek further help.
Get it all very clearly in writing and explain to her what you are and are not prepared to do.

I would INSIST that the parent leaves a spare inhaler with you - if not you will have no alternative but to seek further medical help each and every time.

Write up each time you have requested the parent to leave an inhaler with you - each time the child has an attack and what you done etc. just to cover yourself.

TBH, the parent is not responding adequately to the childs needs and welfare and as lovely as she is you may have no alternative but to take this further.
I personally would not be happy or comfortable caring for a child who has a diagnosed condition and the parents were going against medical advice and not providing the recommended course of action.

It sounds like the mum doesn't understand about the inhalers - many people hear the word 'steriod' and freak. Does this mum realise how quickly a mild asthma attack can become serious or even fatal?

Can you get some information of Asthma websites to discuss with her.
Would she be agreeable to you seeing the practice nurse perhaps - with or without her.

Just found something in a st johns first aid book that states'in a childcare setting you will only need to use the blue reliever inhaler. The preventers are prescribed twice daily and should be used at home. All ashmatics, if they are under the care of a respiritory paediatric specialist should have a management plan either from the gp or asthma nurse.
It also says the blue releiver inhaler is the first step for a child under age 5 as asthma is difficult to diagnose.
The second step is a steroid inhaler which is brown, burgandy or orange.
It is also recommended that all children under 3 should be using a space inhaler for their inhalers.
Not sure if this helps, but have a look in the paperwork from your last first aid course you may find some details.

here
But it's a bit of a desperate first time mother plea for help about my pfb's cough. I'm about to post on that thread, the second question that I had asked in the post on this thread.

I asked the question toward the bottom of the thread about if it was ok for young children to have this medication.

Read the one from Pixieonaleaf at 17.29.
That's one of the posts that explains it well

Yes danthe - the brown steriodal one is for regular use. The blue one is for emergencies to stop or ease attacks. I never go anywhere without my blue inhaler - even though I don't often need it.

Star - I have not looked at the thread yet, but please don't be about your child's cough. DS had it for AGES and became really ill sometimes. We (DH and I) had the same air of desparation about us regarding his coughing. It is so difficult to see and hear your child struggling like that.

Thanks for the other posts. Will read and digest and reply.

good idea - call an ambulance every time the wheezy episode happens. explain to the ambulance staff that the mother will not leave the inhaler with you.

Yes, it seems like a waste of resources but better that than a toddler dying because his idiot mother is more scared of an inhaler than she is of an asthma attack.

TBH it sounds like tree pollen allergy anyway.

Sorry pixie's post on Thursday 03, June at 17.29.
DS has a blue one with a chamber for emergencies. Oddly, my blue one in America was my preventative one and my yellow one was for emergencies. Strange this isn't internationally consistent. Or maybe colours change with decades...

colditz, again i agree - i think it is tree pollen allergy.

BTW: I am childminding now but both little ones are asleep - just in case....

Starexpat - my mother's reliever has been blue all my life, I'm 30!

I think you need to speak to the mum again about the allergy side of it as controlling the allergy side of it - perhaps giving anti histamine shortly before going to a park that causes the problem would prevent the breathing issues.

If my child had mild asthma the approach of using the inhaler as little as possible would be the one that I would take however you are absolutely right to insist that you have his inhaler because asthma is a killer.

I have been told by mums of dc with mild (and I stress mild) that there consultants told them to use the inhaler as little as possible and get the child to exercise plenty etc because that would increase the probability of the dc growing out of asthma.

colditz are you in US or UK? In UK my son's reliver is blue. In US my reliever is yellow. How odd. And confusing if people travel...

Cargirl - this is exactly what I have been thinking... and why I thought this mother might not be so crazy after all... that the less you use it, the less likely they will grow to need it/become dependent on it and maybe could outgrow it. Is there truth in this do you know? Or was it just what you thought?

oh goodness, maybe I'm confused on my inhaler colours, then . Thankfully haven't had to use mine in a long time!

"Ventolin should always be administered in an attack" Chuck, is that even if the symptoms subside as they have done with me?

This whole situation is looking worse than I thought it was.

I need to find out much more, before I approach her, I think. Yes? No?

I think that both you and the mum arent used to the whole asthma thing tbh, perhaps call some kind of 'review' meeting to get the record set straight.

I think that you need to be left with an inhaler, every day not just when going to the park. (But do take it to the park, dont leave it at home again!)

You can have written instructions form parent about how to administer medication and follow them

If you feel that the child is in distress/danger administer the inhaler too

Some drs do seem to overprescribe inhalers (though this does seem to be changing) so i can see the mums concerns and she does know the child best but the incidents you describe makes it sound like child does need an inhaler

Has the child got an official diagnosis? Our drs wont diagnosis asthma that young

It is what friends have been told be there consultants but I would look up latest research on mild asthma treatment and see what it says?

Clearly if anyone has asthma brought on by allergic reactions then controlling the allergic reaction is key - surely better to take antihistamine than having to take steroids etc?

I've only ever had a couple of brething problems brought on by my allergies (I don't have asthma) and yes my moving away from the source of the allergen I was quickly fine (from feeling like I was suffocating, coughing, not being able to breath) - perhaps this child doesn't have true asthma just this type of allergic reaction.

However back to the op - I don't know where you go for here with the parent, I think you need to insist that you will follow her guidelines but you absolutely need to insist that you have that inhaler in case removing him from the area doesn't improve his breathing or you are confined somewhere and can't leave immediately etc