Young children are often seen by health professionals, and visits range from a check-up with the health visitor to emergency hospital admissions.
As a nanny you will need to reassure both parent and child, while giving the doctor a clear and accurate picture of the child's health. To make a difficult situation as stress-free as possible, you must be well prepared.
Before you are left alone with the children in your care it is important to make sure that you know how to get to their doctor's surgery and the nearest hospital, with clear written directions if you are new to the area.
It is easy to forget, in an emergency, the route you were shown several months ago on your first day! You will need the names and phone numbers of the doctor, health visitor, nursery or school, the parents at their work, and a friend who could look after a child in an emergency. It is also a good idea to have a written record of each child's full name, date of birth, blood group, allergies or medical conditions and the name and dosage of any medications they take. Write all this information down in a diary or personal organiser, so that while you are out of the house you will have everything you need.
EMOTIONAL CARE
On any emergency trip to the doctor, the child is likely to be confused and frightened, so it helps if they are already comfortable with the idea of visiting the surgery. When well they can read books about people who are ill and play with toy doctor's sets, toy ambulances and small-world hospital sets.
If you dislike visiting the doctor yourself, take care not to say so in front of the child, since they too might pick up on that attitude and view the surgery as a place to avoid. Instead, try to make routine trips as fun as possible. Perhaps a new story or colouring book would make the wait more enjoyable, or a trip to the cafe on the way home as a special treat. Tell the child's parents how patiently they waited or how brave they were, to help foster a sense of pride in behaving well - and making things a little easier next time!
However, if the child is due to have any kind of painful treatment, such as an injection, it is very important not to promise that 'it won't hurt'. It will hurt, and the child will discover that you lied to them, destroying their trust in both you and the doctor or nurse. Instead, agree with the child that it will hurt, but only for a moment, and focus on a planned treat afterwards.
If a child becomes ill while in your care, you will need to make a written record of all symptoms and any treatment given, including times and any relevant circumstances, such as how the child had eaten that day. This will be necessary if the parents take the child to a doctor when you are off duty, as they will be asked for details. Information given to you by the doctor should also be written down, with the full name and dose of any medications. This will not only ensure that all the relevant information is passed on to the parents or other carers, but it will also reassure parents that they are being kept fully informed and that you are giving their child the best possible care.
Back at home, unless you have been given specific instructions by a doctor, be guided by the child when deciding what type of care to give them. Some children will want to curl up in bed, in which case it is generally a good idea to make up a bed on the sofa in the room the family normally uses.
This way the child will be near to you and feel less isolated. The distinction created by going back to the bedroom in the evening will also make it much easier for the child to settle at night.
PLAY IS OKAY
If the child would rather get up and play, however, there is no reason why they shouldn't. Keep the room free from drafts and dress the child in comfortable clothes, perhaps just a jumper worn over pajamas and a pair of thick socks. Soft cotton fabrics are the most comfortable, particularly if the child has a temperature. The child may like to play with toys that they would otherwise consider to be babyish, and they may have a shorter attention span than usual. Keep a good supply of quick games and activities to distract them and see if you can bring some old favourite toys out of storage. If the child wishes to play outside for a short time, it should be all right, provided they are dressed appropriately - they are unlikely to be very ill if they want to go outside, anyway.
Children often can seem quite ill but make dramatic recoveries. You can reassure the parents that this is normal, particularly when a child stops eating. Although one who refuses to eat may cause adults a lot of worry, an older child can go for several days without eating and will probably make up for it as soon as they are feeling better.
Do make sure that they always have plenty to drink, if necessary by relaxing the rules on fizzy drinks or by mixing fruit juice with sparkling mineral water. Ice lollies made from fruit juice are another way to take in fluids, and they do help to soothe a sore throat or mouth. To tempt a reluctant eater you could try arranging very small portions of food attractively on a pretty plate - a potato hedgehog with sausage spines on a tray with one or two flowers might do the trick. A doll's or teddy's tea party with tiny sandwiches, a handful of grapes and a small jug of juice, all set out on a rug on the floor, could prove irresistible! Just don't make a meal into a battleground - if the child really doesn't want anything to eat, let them go and play until their appetite returns.
If children feel well enough to enjoy having friends over to play, and their illness is not contagious, there is no reason to keep them shut away, but do keep the visit short, as they will probably tire more quickly.
One nanny found an unusual way to cheer up her charges and their friends when they all had chickenpox. She organised a 'chickenpox party' where the children ate 'spotty cakes' and round 'itchy-bread' sandwiches. They watched an episode of the 'Tweenies' featuring Dot Man, and played various games. The children, and nannies, had a great afternoon and it made a difficult time much easier.
Some parents are keen for children to catch the usual childhood illnesses early, before starting school. You may be asked to take children to play with friends who have chickenpox in the hope that your charges will catch it too. Opinion is divided about the wisdom of this: some people argue that it is wrong to deliberately make a child ill and risk possible complications; others feel that it is better for a child to become immune before starting school and be prevented from catching the illness as an adult, when the symptoms are often worse. Whatever your opinion, you will have to consult with the children's parents before taking any action. If their views are different from your own, explain your reasoning to them but be prepared to carry out their wishes. In any case, it is always best to avoid exposing children under a year old to any illness.
RISKS TO NANNIES
There may be occasions when a child is ill and you are afraid of catching it from them yourself. If you have been caring for the child in the weeks before their illness shows, it is highly likely that you have been exposed to the infection. A child can be contagious for days or weeks before they show any symptoms, and by the time they are actually ill there may be no risk to the nanny. Ask a doctor about the particular disease that your charge has, and be meticulous about handwashing and disinfecting equipment.
Unless a doctor advises quarantine for a serious illness, or you are pregnant or have a weak immune system, it's probably unnecessary to refuse to care for a sick child, and doing so puts a great deal of pressure on working parents. If you are very worried about becoming ill, or if you take your own child to work with you, it is important to discuss the issue with your employers before it arises, and have an agreement written into your contract to avoid problems later on.
