Nursery refusing to give saline drops?

[mirah2]

FTP so unsure whether to post here or under AIBU...

We are first time parents so trying to work out if our nursery is being unreasonable or not. Our son is 8 months old.

DS has had an ongoing cough/snuffly breathing for nearly two months now, which was tentatively diagnosed by his GP as bronchiolitis around mid-Nov (he was also put onto a week's course of antibiotics as a precaution, and we were prescribed an inhaler which we have been using at home at the start and end of the day). The GP said at the time that any virus DS had picked up would be past the contagious stage by then so there was no problem in continuing to send to nursery.

Last week DS had a bad 'crash' where he coughed violently, went purple, and had the paramedics called in while I was running back from work (having been called by then). We then took him to hospital where he stayed overnight to stabilise his breathing and oxygen. We were told it was still bronchiolitis, that it was probably he'd picked up a new virus on top of the tail-end of a previous one (hence the crash), and that unfortunately this is fairly normal for this time of year. (we're also not entirely happy with the handover on the previous day's pickup, as the manager is now claiming DS was worse that day than was actually reported to me and they were surprised he was even sent in the day of the crash).

DS is now thankfully much better, has been assessed by a GP again and passed as fit to return to nursery. However, one of the 'treatments' we've been told to use to ease his congestion is saline drops/spray, particularly before feeds. We've been repeatedly told this both by the initial GP who diagnosed him back in November and by the hospital itself last week (this was even written into DS's discharge notes). I can also see this is official NHS advice online, and it does seem to have made a difference to relieving his congestion.

BUT the nursery are flat out refusing to administer DS with saline drops unless it is under prescription (which the GP, understandably, thinks is stupid and won't prescribe for). Furthermore, they are refusing to take him back until we can tell them that his breathing/condition remains stable for a full day's worth without saline drops. This means that we are having to take extra time off work to look after an essentially 'non-sick' child ourselves despite continuing to pay the nursery for this.

When asked for an explanation about the 'no drops' policy, the manager explained that they had to have this rule because otherwise parents would be sending in all sorts of non-prescription/'quack' remedies for the carers to administer. However, given that saline drops (unlike other remedies) have been actively recommended by both individual NHS practitioners and the NHS general guidance it is hardly a 'quack' remedy. Furthermore, the same nursery is happy to administer Calpol and infant Nurofen as long as they have signed parental consent, so I cannot see why saline drops cannot be added to the same small list of 'approved' non-prescription drugs.

Is this normal and/or reasonable? We are both very frustrated but not sure how much effort to put into arguing with the nursery on this point (bearing in mind that refusing to administer drops could mean DS becoming worse under their care/us being called out/more time at home off work etc. etc.)

The nursery are within their rights to decline to administer medication, especially if it isn't prescribed, and also within their rights to say children who need OTC medication to get through the day are not well enough to attend.

I would just get the proscription and save the hassle.

Prescription *

Are you in England? In Scotland we have the minor ailment scheme from pharmacy and you visit the pharmacist who then prescribes over the counter meds. This is how most parents get a bottle of calpol with a prescription label that they can give to nursery. I think certain pharmacies do it in England.

Very common policy for nurseries to only administer prescribed meds and I absolutely agree with with it. The staff are not medically trained to know when drugs are interacting/if they shouldn't be used in certain medical conditions and so if a parent hands in any bottle they got from supermarket/chemist the nursery nurses have to administer it and would be held responsible for the consequences. For example, toddler has asthma, mum buys nurofen at supermarket, nursery administers as per mums instruction, baby has breathing difficulties.

Ok, I guess this is what we are trying to wrap our radar around as to us this just seemed like basic 'care'. It's a moot point atm whether he can get through the say without it.

Sorry, last reply was to Orlande, still getting the hang of this.

Youmador - the GP this morning refused to write a prescription as she thought the nursery was being silly. While she didn't say it, I also guess the NHS may have rules about what can and cannot be prescribed like that (bearing in mind DS gets his prescriptions free).

Jent13c - we're in England but good to know about the scheme. I would understand it better if the nursery had a strict 'prescription meds only' policy. However a) the 'medicine' here is literally salt water and b) they will administer OTC paracetamol, nurofen and teething gel without a prescription as long as the parents give signed consent, so that doesn't seem consistent with refusing to administer saline.

Have you asked them what they are anxious about? It sounds like there is more going in than just the saline drops. Did the 'crash' happen at nursery?

You need to go back to the gp and insist on a prescription explaining the nursery predicament. Don't take no for an answer.

I work in adult social care and it's increasingly common for day centres to do this even for things like over the counter hayfever medication or paracetamol. It's annoying but it's due to people putting care staff in difficult positions by insisting on allsorts being used without medical guidance.

Can you get the GP to sign a note for you to give to nursery?

They are right about the 'quack' medicines though. Many parents say random stuff has been advised by a medical professional (and that 'professional' can sometimes be someone with no qualifications).

I would give saline drops, but they are clearly outside their policy.

I was a nursery manager up till July and it’s an Ofsted requirement you can’t give anything without a prescription label on. I had many parents complaining to me but you can technically get shut down if you don’t follow the correct procedures.

The nursery can refuse to administer any medication and can refuse to care for children who they assess as being too poorly for nursery
A child who may struggle to breathe is not well enough to be at nursery

OK, thanks all. Upshot is DS is back at nursery and managing the day well without saline drops so it's now a moot point.

Thanks for your perspectives on this, we are first time parents so it is good to know how reasonable/not the nursery is being.

We had a similar situation where DS would have febrile convulsions every time he had a temperature.

Nursery would not give calpol without prescription if he became ill during the day and I was working an hour away.

I explained this to the GP and he gave me a bottle of paracetamol on prescription which nursery were happy to give at the first sign of a temperature.

Pharmacists are qualified medical practitioners too. Many of them will put their label on an over-the-counter product, showing the child's name and why they need the product, if you explain it’s required for nursery.

I can understand childcare providers erring on the side of caution. The regulations are often unclear, and are applied at the whim of individual Ofsted inspectors who have no more medical knowledge or background than you or me. Their interpretations of the rules are frequently arbitrary and sometimes entirely contradictory, yet they can downgrade or suspend a nursery at the stroke of a pen.

At one point, the regulations were so vague that Ofsted issued "clarification guidelines" that attempted to fix the problem by completely changing the dictionary definition word "prescribed".

These days they refuse to answer questions and rarely issue guidance documents: chiefly because they found that many of their "clarifications" actually caused more confusion or contradicted the original regulations.

Have you given them a copy of the discharge notes? They may accept this as medical instruction.

The nursery is not being awkward. It's Ofsted rule no medicine are to be given at nursery unless prescribed by a doctor except calpol

Err old thread but you’re wrong WellieJellie. It’s not an ofsted rule and entirely at the nursery’s discretion/ policy.

You can ask a pharmacist to apply a name label to saline drops, and this is enough normally for nursery to administer.

I am a nursery nurse and it is our policy that any medication given to a child has to be prescribed my the doctor!! It has to have the child name and date on it before we can give the medication!!