Taking Back an Asthmatic Child?

Has anyone had experience with dckids and asthma??

I have a dcg who originally started with her younger brother (now about 18 months). He was here for 2 days, then ended up in the hospital with an asthma attack that weekend, had to stay overnight and have oxygen masks and breathing treatments.

At the time, I felt the parents had downplayed the asthma ("oh, he used to have breathing issues, but he's fine now") and I was pretty panicked about him having an attack while in my care. I wrote them a letter saying that I didn't feel I could provide proper care for him and all the others with his current medical state. They had no problem with this, and I still have dcg. Dad works from home and mom only worked part-time, so I don't think it was too big of a problem for them, and he was pretty sick.

Fast-forward to now, the little boy has gone without incident for a few months, is on puffers, and mom just got a full-time job. She wants me to take little brother back, since Dad is probably realizing he can't get work done when she's not there to take care of little brother.

I am on the fence with the idea.
Pros - I have had one spot open for months, and would REALLY like to fill it. I haven't gotten any other nibbles from my ads. They have their quirks, but they pay on time and have great hours, and have always been very flexible with the few times I have had to close (for a funeral and my son being in the hospital). They have family that can help out if needed with the kids.

Cons - They downplayed the asthma the first time, so I don't really know if I can trust them now. Obviously they wouldn't want to send him if he was having asthma attacks all over the place, but now that they actually NEED care, as opposed to just wanting a break and some socialization for their kids, I'm worried that their idea of "ok for daycare" and mine will not be the same.

I already have a child with a peanut/tree nut allergy, and will be starting a child with MILD, controlled asthma in the fall. Her mom has been extremely forthcoming about it, and the little girl has never had an attack when on her preventative puffer. I have had both sets of parents (the allergy and the mild asthma) sign off saying that I will do everything in my power to ensure the safety of all children, but am not responsible should anything happen and cannot be held liable in the case of an allergic reaction or medical emergency.

IF I agree to take him, what other things should I have in place?? Liability insurance, parents signing consent, puffer here just in case...what else?

Would you take him on? I feel like they're dangling a carrot in front of me. The last thing I want is for anything to happen to him, but if he's on meds now, and it is controlled, is that enough of a safety net?

Thanks guys.

I have what is called severe chronic asthma. It stinks- its hard on everyone.

As a child I was not in daycare as I required lots of meds everyday. Now asthma management has gotten a lot better, and it tends to get easier to control as kids grow- small air passages grow which means it takes more swelling and mucous to close off.

That said- attacks do happen. Do his parents know his triggers? Can they provide them in list format?

Will you have access to his pulmonologist if the need arises?
Will you have a rescue inhaler?
Will you have a copy of his treatment plan?

What are his current meds?
His current peak flow (and what are his zones?)

I would ask for a letter from his doctor saying that he is in stable condition and his asthma is controlled as well as answers to the previous.

If he hasn't had an attack in awhile it means the hospitalization scared the parents and made the parents and the doctors take his condition seriously. If he now uses his meds regularly you should be fine. Keep puffers at your house and do not be afraid to use the rescue inhaler and call parents. If he develops a cold or other respiratory condition then he should be kept home till you know for sure how he is going to adjust to it. Watch for triggers such as sudden temperature changes ex coming inside/going outside in winter, strenuous exercise, pets.

Their signature to say you will call 911 at their expense in any medical emergency and no one can rule that out with these two children, that way you are covered and you would have done the right thing anyway, prevention is always better than cure and him having his puffers to hand is definitely the right thing, but the ambulance and emergency for sure as back up.

After hospital the doctors would have ensured his correct meds (puffers) are in place and work well for him, got to feel sorry for any child with a breathing problem such as asthma though. Most of these things happen in mid to older age with smokers not a young innocent child.

Ensure the puffers are always well supplied and not empty of course.

If you aren't comfortable though remember you don't have to do it at all and can refuse care of the child.

Thanks everyone for their responses. I sent a list of questions taken from your suggestions to mom, including a list of all of his meds, a note from his doctor saying he is stable/healthy enough for daycare, an extended list of emergency contacts I can call if mom or dad can't get there fast enough, etc. I asked them to sign a consent form of what procedure I will follow should he have an attack or if he isn't breathing well, and a release of all liability. They said none of it will be a problem. IF I get everything I've asked for, I'll probably take him on starting at 3 days/week. We'll see how it goes. Thanks again!

Well done crazyeight, sounds perfect :)