Positive Relationships: Let's talk about ... Administering medicine

Q. What is your policy and procedure on administering medicine to children?

'We take this issue very seriously, so trained staff only, plus it is always witnessed by another team member. A form is completed by the parent to give authorisation and dates and dosage are checked and double checked. We also never give medication for the first time.'

'Only medications that have been prescribed by a doctor for a particular reason may be administered, normally by the child's key person and witnessed by another member of staff. Parents have to complete a permission and instruction form for each medicine and sign afterwards too, so they know we have given medication. We use the PLA booklet for recording all this. In the case of emergency medication, such as EpiPens, we keep a completed form filled in ready for use when needed. Antibiotics should be taken at home for at least 48 hours if they have not had them before, in case of allergic reactions. Medicines are handed over at the end of each day by the key person.'

'We seek signed permission at registration to administer Calpol, Nurofen and Piriton. We also get verbal approval on every occasion from the parent before administering. No approval, no medicine. Perhaps we don't need to do this, but I would not want anyone to give my child medicine without asking me first, no matter what I had signed.

'We do not administer cold and cough medicines, since the government policy that these are inappropriate for children under five. Anyway, if they need it, they shouldn't be in nursery.'

'While it is not our policy to care for sick children, who should be at home until they are well enough to return to the setting, we will agree to administer medication as part of maintaining their health and wellbeing or when they are recovering from an illness.

'In many cases, it is possible for children's GPs to prescribe medicine that can be taken at home in the morning and evening. As far as possible, administering medicines will only be done where it would be detrimental to the child's health if not given in the setting.'

Q. How would you ensure you are an inclusive setting if you had a child with long-term medical needs?

'When we have children on our register with long-term medical needs we ask the parents to organise specific needs-related training and to gain written needs assessment from the child's specialist consultant. The parent must provide us with written agreement for us to administer any required medication. Our staff have the choice of whether they wish to take responsibility for the medicine administration, although we have never had anyone refuse to administer.'

'We get the training we need to offer barrier-free childcare - we have never yet turned a child away because of complex medication requirements.'

'For children with long-term illnesses requiring medication, such as inhalers, we follow the prescription medicine route. That is no problem. Where it gets a bit fuzzy is administering an injection. I would have to understand the risks and the need in the child to ascertain what we would do in such a circumstance.'

'Long-term medical needs should not exclude any child from the setting. Training in the administration of more invasive or extensive medication is sought, usually through parents and their contact with appropriate professionals, although more recent paediatric first aid courses have included the use of EpiPens and inhalers.'

Q. Do you think parents may sometimes give their child medicine, such as ibuprofen and paracetamol, to pacify them so the parent can go to work, due to the pressures from their employers?

'Parents occasionally tell us that their child wasn't so good first thing so have been given some pain relief and now seem OK! In fairness, this doesn't seem to be our working parents - they seem to have contingency plans ready to avoid being called during the day.'

'We do sometimes experience this, which is why our medicine administration form records the time of the last dose of medication. Our health and illness policy makes it clear to parents that if, in the opinion of the staff, the child is too poorly to be in the nursery environment, they will be requested to collect their child.'

'I do not allow our team to be "opinionated" about issues like this. However, it is clear in our policy that if we feel medicine is being administered inappropriately in a way that puts the child at risk, we would address it. To me this is not being opinionated, this is doing a serious job seriously.'

'Do parents administer Calpol too freely? Yes, without doubt. What is their motivation? It could be that they just want the child to be comfortable and happy and any tool at their disposal will suffice. If a child comes to us and the parent says give them Calpol at 10am, we ask why. Then we say, please take them to a doctor or take them home as they are clearly not fit to be in nursery - using words that are more co-operative, of course!'

Q. Are parents and staff aware of the dangers in giving children medication?

'I feel parents and staff do not know the dangers of giving children medication. When thinking about this, I asked five parents who are teachers and all but one told me their schools also administered Calpol on the parents' consent.'

'We are aware of the research that has linked infant medications to an increase in asthma, eczema and hayfever. If the guidance changed, then we would change our approach.'

'Any possible side effects from a medicine need to be considered and listed when presented to us, so I think staff are perhaps more aware about the dangers, especially when following the necessary form-filling, policy and procedures, whereas parents can just give medicines without much thought at all.'

'Because there are so many brands of medication available over the counter, the possible dangers of over-medication and wrong medication appear to have increased recently. This is one of the reason we have introduced the policy of only administering such medication for three days before insisting that the child is seen by a medical practitioner.'

'The nurseries do not keep a stock of "over the counter medicines" and if a child should become unwell while in our care their parent will be contacted immediately with a view to collecting their child and gaining professional advice from a medical practitioner.'

Q. Should more guidance be issued for parents and practitioners on giving children medicine?

'I do feel there is a need to give more information regarding temperatures and administering medication. I did not know that a temperature was a good thing to show they are fighting an infection off, until I looked into the issue for this feature. I also learned that a child could not have a convulsion with a temperature under 101.'

'More advice for parents would be good, especially in light of the new research suggesting not to medicate for fevers.

But we can only administer on specific medical advice, so should be receiving the appropriate guidance already.'

'I don't think so. Packets are crystal clear. Parents make choices based on what they think is best at the time. The answer for us lies in a clear policy, clearly communicated and consistently followed by all.'

AN EXPERT'S VIEW

By Laura Henry, managing director, Childcare Consultancy and UK representative for the World Forum in Early Care and Education

Recently I read a report from the American Academy of Paediatrics which stated that if a child has a temperature of less  than 41 degs, they should not be given ibuprofen or paracetamol, as this is the body's signal of fighting an infection. It is at this point that if the body's temperature reaches more than 41 degs, a child is more likely to have febrile convulsions. The report says parents are creating a 'fever phobia' and reach for the medicine bottle even if their child's temperature is less than 38 degs and in some cases waking them from a sleep to give it.

The British National Formulary states that children should have no more than the right amount of ibuprofen and paracetamol in a 24-hour period.

I was interested in this on many different levels, as a parent and as a professional supporting settings nationally. I have inspected a range of medicines policies and procedures and witnessed a variety of approaches. Current guidance in the EYFS does not specify any training for practitioners in the administration of medicines. Ofsted states the requirement to have a current paediatric first aid certificate and provides some loose information about food hygiene legislation. I would say that there should not be an assumption that administering medicine to a child is 'common sense'.

If a child requires fever-reducing medicine should they be in a setting? On a wider safeguarding agenda, are we unintentionally colluding with parents (who may not be fully aware themselves) when we give their child medicine? However, we should always be inclusive to children who have a specific medical or health need that requires daily medication, but remain mindful of the BNF guidance.

I would say that we need more guidance for providers and parents on this, and be aware that even if the medicine is prescribed, there may be some circumstances when it still may not be suitable or right for the child.

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