Any ideas on what to do?

[mommyof2princesses]

Update....So, after an email and a text (to ask how things are going, etc...) from me on Friday I still have not heard back at all from this family (the dcg who has a feeding tube). I am on holidays this week but they know I am not going away and they have a payment owing by this Friday. What would you do? TIA

[playfelt]

Considering the situation I would just wait. I thought Monday was also the decision day for the doctors in terms of what they were going to do regarding the feeding tube, transferring the child to the other hospital out of town, etc. At this point the family likely doesn't know how to respond.

[mommyof2princesses]

playfelt - DCG was discharged this past Friday and parents are doing tube feedings 3x/day for at least the next 3 months or more. They were expecting me to do the afternoon feed here and I told them no because 1) I don't feel comfortable and its a big risk for something to go wrong and 2) My insurance says I can't do it because if something goes wrong they will not cover me.

[mommyof2princesses]

Just got a text from mom saying she will still be working a 3/4 day (like before dcg went in hospital) and doing her afternoon feed at home. She says the nurse won't come to my house to do feeds. This will mean that dcg will not have anything to eat/drink from 7am until 3pm every day once again (that's how it was before she went in hospital and all this happened) UGH!

[momofnerds]

I'm wondering if there this is a CAS case now. Someone needs to check in on this child and to not have anything for 8 hours a day is neglect. You can always call and ask them too what to do.

[playfelt]

When a child is tube fed this is not uncommon. It sounds really bad I know but even as infants kids were fed every 4-6 hours not every 2 like we seem to think they need now either a snack or a meal. With permission she can be offered sips of liquid in between feedings but many kids are on a tube feed because every time they take something by mouth they don't swallow it and it ends up in their lungs causing infection so many have nothing by mouth when tube fed.

I doubt the doctor discharged the child without plans for weekly weigh ins etc.

[mommyof2princesses]

I doubt the doctor discharged the child without plans for weekly weigh ins etc.

She has daily morning weigh ins that they have to call in I believe.

[sunnydays]

Personally, to cover myself, I would request a doctor's note saying that it is okay for her to be in your care and to not be fed for those 8 hours. I would still be concerned about the tube though...what if the other kids pull it out?

[apples and bananas]

Personally, I'd get out while I can. It just seems too complicated, too much risk. However, If I were to continue with them I would ask for a dr. note as well to cover your behind.

But honestly, this is way more then I signed up for and way more then I think I would be able to safely handle with 4 other ones running around.

[playfelt]

This child is a good example of why we used to have separate fees by age grouping. Parents of infants paid a higher rate than those of toddlers/preschoolers. While some used ages, I used skills as my rationale for moving to the lower fee because I do take some special needs kids into my daycare. In this case the child is not walking/feeding self finger foods/using a cup so would still be on the infant rate regardless of how old she was. The extra fee for extra work balances out. I stopped the fee categories when we went to the one year mat leave as it seemed weird to have a child in care for 3 months at one rate and then change rates - just raised my rates to the infant rate and all paid that when they started on and it just never goes down now.

Not so much worried about covering myself on this one as much as I would want a copy of the treatment plan from the doctor for the child's file detailing when and what she is to eat and what is ok, not ok, care of the tube, what to do if it is dislodged etc. All of that should be on file. Parents will have been sent home with info in writing so you should ask for a copy too.

[Momof4]

I'm concerned for the child, she should be with a qualified medical professional or her parents and nobody else until she is well and thriving. Are you seriously still considering doing this?

[bright sparks]

For me this is not about the actual feed as with proper instruction it's not difficult, even remotely. Let me give you a couple of scenarios of when this child's "special need" will take you away from the other kids. When the tube gets pulled out and she is extremely upset because it hurt and/or uncomfortable.... Whether she pulls it a little, a lot, or all the way out you will have to console this child, clean up the mess and have to call the parents. How are you going to deal with this potentially common occurrence and still provide adequate care and attention to the others?

I also wonder if in a few weeks or a couple of months time there will be resentment based on how much extra time you have to give the child and the reoccurring times you are calling the parents to come and collect because another child has pulled the tube, or it has become caught? If it becomes regular, there's every chance the parents are going to become frustrated with you for not "paying enough attention" to their child in preventing the tube from being pulled or caught.

It's very different if the ratio is smaller but you have four other children who demand a lot of your attention which means the extra attention this child needs, is at the expense of the other children or even the special needs child's best interests and regardless of how nice this family is, if anything should happen big or small, the fingers will all be pointed at you. Walk away for goodness sakes. This isn't a reflection of your ability to safely and adequately feed the child, but the reality of the logistics of providing adequate care for all the children in your care. Just my two cents...

[momofnerds]

if this was my child I would take a loa from work or work part time or cut my hours.. I just couldn't imagine leaving my sick child with someone all day.

also, I don't think a child would pull the tube out because its attached to the belly and usually a shirt would cover it, I would be worried that I would pull it out by mistake doing a diaper change or the pants would rub on it and pull it out.

[bright sparks]

mom of nerds.... they will grab at it where it goes in the nose. I have lots of experience with this from working in acute care, and the sanest of adults find the dam things irritating. From the posts I have read, this feeding tube will go in via the nose and down into the stomach, not actually through the belly, hence why it is at risk for being pulled out. Also lets not forget we are talking about a 17 mth old. With lots of 1 on 1 this child will surely adapt and learn to cope well, but initially it will be a huge adjustment requiring one on one to constantly remind her not to touch and to make sure it stays clean. I shirt will likely cover part of the tube where the end will no doubt be taped underneath and out of the way in between feeding, but it will still be on the face and neck.

[abster]

There is no doubt that the child will pull out the tube and maybe on a daily basis (my son had ng for long time) it doesn't normally hurt them they are usually pleased with themselves lol... and going all day with not being tube fed is very common to get the oral aversion to be better. Continuous night feeds are very common so the child gets all their recommended intake for the 24hr period. So its not neglect for the child to not get tube fed for during the day :-)