Nursery missed medical emergency - what would you do?

[Worriedmum97]

What would you do with the nursery in a situation described below? 2yo DS had what looked like an asthma attack (he's never had it before) and the nursery ignored it.

When I picked up my 2yo DS from his nursery at 6pm I noticed that he was breathing heavily. I asked one of the ladies if he was running around before I arrived and she said that he wasn’t and that actually he was tired all day and after the walk to the park he was very tired and sleepy and went straight to bed. I said that I’m concerned about his breathing and the high heart rate, the lady responded by saying that DS has been like this all day and she was surprised that I didn’t know, she thought that he was like that at drop off. I run with him to the pharmacy around the corner as I have never seen him being like that and wanted to check with the pharmacist. When the pharmacist saw DS he told me straight away without even asking any questions: “Call 999 NOW”. We had two teams of paramedics coming to us and they all were surprised that the nursery didn’t call them earlier. DS’s heart rate was twice the norm for his age and his oxygen levels were dangerously low. DS was given steroids on his way to A&E, it didn’t work well as he’d been suffering for quite a while by that point. The doctors at A&E had therefore to use stronger medications (second line treatment). DS spent 2 days at the hospital with a lot of medical intervention and spent his first 24 hours there on ventilation. All the doctors who saw him said that he looked very poorly and were saying that it should have been the nursery who should have called for an ambulance and leaving a child in such condition was a complete negligence. 2 days later I received a call from the nursery manager and what astonished me was the excuses that she was giving me. She said that the members of the team were concerned about DS, but they asked him (2 year old boy!!!) if he was feeling ok, which he said: “Yes”. They also asked his (6 year old!!!) brother who attended the nursery on the same day: “Do you think your brother is ok?” which his brother responded: “Yes, he is just shy”. I fail to understand how anyone could ever ask a 2 year old or 6 year old child to evaluate someone’s physical condition and moreover to rely on that. And no one ever thought of trying to call us.

Wow.

Well obviously your children can't go back to that Nursery.

I would complain to Ofsted, that’s a real problem.

Agree. Do not send your child back to the nursery. You need to lodge a formal complaint to the nursery manager and they should be doing a full review of what happened. You can report them to Ofsted too and your council.

I would pull my children out and file a complaint. Asthma can be fatal, you were "lucky", but this could easily have been a situation you read in the paper, if things had taken a turn and he hadn't got better.

I think, purely for the other children that attend, (assuming you are going to pull your kids out), you need to file a formal complaint.

That is appalling I would complain everywhere, ofsted, council etc

This is shocking, I am so sorry you had to go through this and that your DS is on the mend now. This is a safeguarding issue and I would hope there would be a system in place for it to be escalated from the hospital's end (although I'm not an expert and have no idea how these things work). But in reality I would definitely be filing my own complaint too.

I can see why they might have missed it being an asthma attack if he wasn’t diagnosed with asthma and wasn’t audibly wheezing (you didn’t know either and took him to a pharmacy rather than a dr) but they should have called you if they noticed he seemed under the weather and was having issues with breathing. Relying on a six year old to make that judgment is unacceptable.

They have to report a child who goes from nursery to hospital.

When my 18mth old had his first pneumonia, he went from having a cold and snuffles during the day to deteriorating and becoming hypoxic later that night. The deterioration can be frighteningly quick, so your DS wouldn't necessarily have been seriously ill at nursery. You say he was on ventilation; was that actual sedated ventilation or just a mask administering medication and oxygen? It can look very scary but there is a world of difference between administering medication and sedated ventilation. My DS spent nearly a week in hospital being medicated and monitored, and was such a poorly wee thing my heart felt like it would break, but it's because they are so little that things like this really knock them for six. I hope he will bounce back and you'll have no further problems 💐

If you have previously been happy with his care and DS is settled, it might be worth using this as an opener for suggesting some further first aid training for staff in how to recognise signs of various deteriorating illnesses. If you think it was due to neglect and you're not happy to send him back there, then I hope you find somewhere you are happier with.

That's terrible. I wouldn't send him back there, without sounding awful how bad would have he had to get before they intervened? Not contacting you and ignoring him could have been fatal.

I'm so glad you took him straight to the pharmacy and hope he's much better soon.

What was he like when you dropped him off?
The nursery by law only has to have one person on site trained in first aid so it may be that the staff didn’t know how poorly he was and thought you had dropped him off like that
If he doesn’t normally have asthma then they wouldn’t be looking out for symptoms and may not necessarily know the symptoms
Also children can deteriorate very quickly as in a matter of minutes
However the staff should have contacted you if they thought he was poorly and not ask him or his brother

If it had been a case of no-one noticing anything was wrong you could imagine it might have worsened quickly or not been obvious. The fact that they checked with your DS and his brother means a red flag went up for someone but for whatever reason they didn’t have the confidence/support from senior staff to call you and check it. That would have taken minutes. I’ve had nursery ring and give me a heads up about scuffs and scratches just so I’m not worried at pickup. The manager knows this was a serious failing and is trying to cover tracks. With this in mind I think the only way staff will get proper training and nursery have proper procedures in place is if you make formal complaints to the relevant authorities. This is not just about reacting to the situation involving your DS, it’s about safeguarding other children still in the setting.

I hope your DS is fully recovered soon

To be fair the first time my Ds had pneumonia I'd called the out of hours number. Then he perked up and was running round, so when I finally got the call back I almost said we didn't need them. They said to go in anyway. When I got there they put him on oxygen and called an ambulance to transfer us to the hospital. I think it can be hard to tell

Yes it can be hard to tell but surely the point with small children is that if you are unsure and they can not communicate very well yet (aka they’re 2!) you err on the side of caution and get them checked?!

If I had any doubt I would have contacted parents. If I was seriously worried, it would be 999 first.

insancerre - from April 17 all newly qualified Level 2 and 3 must have a paediatric emergency first aid or a full 12 hour paediatric first aid so hopefully most nurseries will have more than one soon.

An asthma attack in a young toddler is awful. There’s normally no wheezing or panicking, they just deteriorate quietly. This is no excuse of the nursery though. They need better education on child asthma and I don’t think I could trust them with my DC.

It's very worrying that you were fobbed off and excuses made. I've never worked in a nursery with only one trained first aider, usually most staff are trained and there is a named first aider who is the one to make all assessments and decisions to take things further or not. This isn't like a very rare condition no one will have seen before, most setting will have at least one child with asthma at any given time. Even back in 2000 when I qualified asthma was one of the things emphasised due to the likelihood of us seeing it in settings, along with the glass test and what to do if choking. Things happen, incidents and accidents, and a big important thing for mo is how it's dealt with after. It seems they are taking the excuses route which would put me off trusting them again.

This happened to me at school. My mum picked me up and ended up carrying me home from school and calling the doctor who confirmed I was having an asthma attack. I had struggled through the day but at the age of 4 couldn't articulate to the teacher that the was an issue.

The problem with asthma is that it often isn't the dramatic noisy wheezing but actually worse when it's the quiet, looking slightly pale and not having the energy to make a fuss.

Sorry you've been through this.

Children go down so quickly
I sent mine and she wasn't great but not sick so I thought the snuffles. Went early to pick up as I was worried but no phone call. But at pick up they said she was tired and was sleeping and she had been low for a couple of hours. I was fuming
Went home and wasn't happy so went to out of hours and she ended up hospitalised for days but hospital also took a while to get diagnosis as they also fobbed me off
So what I am saying is that it can be difficult but we also get calls quickly when there are eye conditions or any sight of dodgy poo so I would be worried about nursery
Hope your little one is better

My nursery called me when my girl had similar symptoms and I actually didn't realise what it meant. They soon put me right. They absolutely should recognise what you're describing and clearly don't have the first aid training they need. You can't trust them again.

He ended up ventilated on ICU/HDU?? It's good to know paramedic crews can now give steroids as when I had an asthma attack 3 years ago all they could do was give me a nebuliser and then they contacted the out of hours GP to come and see me to give me oral steroids.
I would be going public with this and changing nurseries.
I hope your ds is much better now.

What woukd I do? Neither child would never step foot in the nursery again. Even if there was a 'reason' will you ever trust them again? Feel comfortable and confident leaving get your dc there?

I'd take child out of nursery and complain to ofsted etc.

You must be absolutely furious!

Thinking about this further, there are a few things that my nursery noticed and looked for:

Increased rate of breathing
Rasping
Flushed
Blue lips
Catch at the neck when breathing
Tummy going in and out when breathing.
Increase in pulse
Lethargic

My little girl had a few of these symptoms (we ended up in the children's ward) and it sounds like your child did too. Knowing about these is basic first aid and you should definitely make a complaint.

I don't think I could trust them but I also had one go to doctor recently (same one who ended up in hospital) and I was concerned about her breathing. I always now take her if I have any concern. Well he saw her and said she was fine. So I said... is this breathing normal... and I lifted her top and ... she ended up on steroids and asthma thing.

So medical people do get it wrong.

But I think for me is that if there is any concern they should ring. We all moan when we get the calls and pick up and child is fine.