Advice please!!!!!!!!! Feeding tube

[mommyof2princesses]

What would you ladies do if........you had a dck who needed a feeding tube and needed feeding 3x/day, once being at your daycare during nap time while she sleeps. Feeding is done by the bag that hangs on a pole (like you see at the hospital) and goes through the pump and down the tube that goes through her nose and into her stomach. Before the feeding takes place you have to use a stethoscope and listen near her belly (for what sound I am not sure) to make sure the tube is in the right place so the formula goes to her tummy and not in her lungs or some other place it shouldn't be. I am not sure about all this and the things that could happen :( Would you accept her into care like that? Any advice is greatly appreciated! TIA

[treeholm]

Nope... I think my insurance company would not allow it. You need to check with them to make sure they will cover increased risk.

[daycarewhisperer]

I would but I would have to charge for the procedure. I'm a RN though.

[sunnydays]

No...not a chance! I am not trained in the medical field. Way too much risk and responsibility and it would be very difficut to give that kind of specialized care while caring for 4 other kids. I would think that they would be better off with a nanny with some training in these things.

[bright sparks]

I am pretty confident that no insurance company would cover you to carry out this kind of thing regardless of whether you were an RN past or present, or not. It's not being carried out in the healthcare field, and the liabilities are HUGE!!! I have experience with feeding tubes having originally come from working in healthcare, but even I know better than to take on a child with these needs in a home daycare setting.

[Spixie33]

I wouldn't and not because of insurance since the insurance coverage for daycare is such a waste anyways (They will only cover a fall on sidewalk basically and not anything that they will deem preventable or you being neglectful). They left themselves a huge loophole. I doubt they will pay for much of anything that your regular home insurance doesn't cover based on conversations with insurance companies earlier this year.

But back on topic - the reason I wouldn't do it is based on the sheer responsibility of it. If something goes wrong, you would feel horrible and you could potentially lose your daycare.

Also, you are caring for multiple children and it seems this child may need more 1 on 1 attention and should really have a nanny or someone specifically catering to her needs. It is a lot to take on feeding tubes with other kids around and when you never know what the other kids might need from you on any given day.

Best of luck

[momofnerds]

no I wouldn't. I was a nurse and i wouldn't even do it.

[Momof4]

I would not take on that responsibility. What if one of the other children pulled on the tube by accident? I think that is covered under our sick policies. If a child is too ill to participate in our daily programs then they must be kept at home.

I think you are a wonderful person to consider this mommyof2princesses, but please, please do not take that responsibility on yourself. This child NEEDS her parents!

[playfelt]

The potential for problems developing of a serious medical nature outweigh the income you would get. I realize this means losing two children but don't let your concern for loss of income cloud how restrictive and time consuming the feeding will be.

Even many schools now won't even let the parents come to the school at noon to do the feeds and require a nurse to be present while they are done. It is possible the family would qualify to have a nurse come for the feeds. Given all of the issues this child has they should probably look into either a nanny or a daycare centre that can accommodate medical needs. The advantage of the daycare centre with specialized help is that they will also have access to other professionals to help monitor the child's other issues.

If this was your only family and you wanted to be trained in the procedure that would be fine but consider the liabilities of you being in the middle of inserting the tube and another child screams for help or time goes by and bag is empty and too much air is getting into system because you were busy changing a bum and lost track of time.

Is there a chance the family would leave the brother with you so his life can stay normal but move the sister to a centre where she will also receive the medical care she needs.

[Mama W2]

This would be scary enough to do to my own children. There is no way I would do it for a dck. The chances of something going wrong and the child becoming sick or worse (dying if tube in wrong place) are too great and I don't think it is a smart move. On top of that, you are going to be taking so much time to be with this little one, your other kids are going to suffer. I would just explain to the parents that it is not something you can be responsible for. If they are half decent parents, they will understand. I know you may lose money if she is out for a long period of time, but I would prefer to lose some cash, than to lose a child or my career. Good luck to you. I can't believe they even asked you to do such a thing!

[Spixie33]

This would be scary enough to do to my own children. There is no way I would do it for a dck. The chances of something going wrong and the child becoming sick or worse (dying if tube in wrong place) are too great and I don't think it is a smart move. On top of that, you are going to be taking so much time to be with this little one, your other kids are going to suffer. I would just explain to the parents that it is not something you can be responsible for. If they are half decent parents, they will understand. I know you may lose money if she is out for a long period of time, but I would prefer to lose some cash, than to lose a child or my career. Good luck to you. I can't believe they even asked you to do such a thing!


I agree ! To me it seems that they are looking for the cheapest and easiest solution to meet their needs so that neither of the parents would have to lose their job or that they wouldn't have to pay a nurse or nanny more.
What better way to save money than asking your existing daycare to take on that responsibility.
I am sure they are stressed and were not expecting to deal with this issue but I really get the feeling that they are putting too much trust in a daycare provider and thinking about what is cheapest and easiest for them rather than what is in the best interest of their child

[mommyof2princesses]

Thanks for the advice everyone...I told dad this morning that I don't feel comfortable doing it and won't do it, but will also tell him about the insurance part of it ( I never thought of that). All in all I think I just may have to let them go as much as I don't want to its just too much of a risk and liability with having her here and all the other children too.

I love this forum and all of you for helping me out and giving me such good advice :wub::flower:

[apples and bananas]

Good call! I wouldn't have taken on the responsibility either. I would be too stressed about doing it right or wrong. And if something went wrong in my care it could ruin my business.

I would, however, let the parent come in and do the procedure as long as there was no issue after the procedure was done or risks coming from it. But even this would be a long shot. I would really have to be hard up for clients to take even this much on.

[mommyof2princesses]

So I called my insurance and they didn't give an outright "no" but are "strongly" suggesting I don't take her back until the feeding tube is out!

[daycarewhisperer]

I am a present licensed RN in the State of Iowa. I wouldn't charge an insurance company. I would charge the parents. If I were being paid the going rate for the service I would take additional training and do the procedure. I would not do it for free. Anywhere else this child acceses health care charges for this. Child care shouldn't be any different.

[playfelt]

The fact the child reached 15 months without mom seeking medical advice tells me that she is still in denial - like ok we take the tube, we go home, and life goes back to normal. This is a really big deal and only the start of a very long process that little girl is going to face. There may already be some brain damage from lack of nutrition meaning the brain never catches up to what it's potential could have been or they discover down the road there is a genetic condition responsible for the issues. By encouraging mom to go to a daycare centre where there is help may be the best thing you can do for this child.

[abster]

I don't think the parents were/are trying to take the cheap route as some are mentioning, this child and brother are already in her care and maybe wanted to keep as much routine and normality for the kids during this stressful time. The trust is already established so why wouldn't the parents want to try and keep that in their lives? Just my thoughts :)

[momofnerds]

why does she have a tube to begin with.

[mommyof2princesses]

The fact the child reached 15 months without mom seeking medical advice tells me that she is still in denial - like ok we take the tube, we go home, and life goes back to normal.

This is exactly how they seem to think playfelt...it frustrates me as what she has is called oral sensory processing disorder and it requires extensive therapy. She still isn't eating, just being tube fed 3x/day formula.

[mommyof2princesses]

why does she have a tube to begin with.

momofnerds...this 15 month old dcg has a feeding tube in her nose and is fed formula 3x/day because since the time the parents started trying to feed her baby cereal, etc she has refused to eat/drink anything but breastfeeding, not even in a bottle or water, etc. Therefore this caused her to lose a ton of weight, not be able to walk, crawl, sit up from a laying on back position, etc. All the things a toddler should be able to do. She has basically been starving for the past several months and the parents let it go too long. Its not just that she is stubborn like everyone thought, she has an actual oral sensory processing disorder and it takes a long time to "fix" everything.

[bright sparks]

You also have to understand that this child will almost definitely try to pull this tube out. She is so young, and then a community nurse will either have to come out to replace it or she will have to go back into hospital and this may happen frequently because she is so little. I am sure she will adapt, but she will require much more one on one attention which you just won't be able to give her.

DCW- I agree that she deserves childcare as much as the next person, but I have read many posts from you and others who give notice to families for far less. I see so many people who won't even tolerate bad behaviour and work with a child in terms of behaviour modification, which is also in most cases a normal part of child psycho-social development. This is a medical issue, one that requires a much smaller ratio than 1:5 or 6 in some cases to make sure that the tube doesn't get pulled out, get caught on anything, get grabbed, get dirty etc etc. It increases the workload AND responsibility on the daycare provider. The liabilities of childcare are high enough already, do we really think that overall it's necessary to increase that at the expense of the child and other children regardless of prior experience in healthcare??? I think not. It doesn't even get beyond this to talk about charging extra money for the extra service.

I think a Nanny would be best. Someone qualified, licensed and insured to carry this out, or a Nanny in addition to a Community Care Nurse making daily visits to administer and train the parents. This seems much more realistic. Also if there is a sibling, it will quite possibly be cheaper to have a Nanny for two children than two daycare spots.

[mommyof2princesses]

You also have to understand that this child will almost definitely try to pull this tube out. She is so young, and then a community nurse will either have to come out to replace it or she will have to go back into hospital and this may happen frequently because she is so little.

Yes mom told me that if it gets pulled out she has to go back to the hospital to get it put back in again. With all the little ones I have in care (2 others under 2 years old) I am sure that more than once someone would try to pull on it. It goes from her stomach out her nose, taped across her face and then down her back so I have a feeling its a very long tube and it has lots of extra down her back to be able to hook it up to a pump and pole while she is laying in bed napping.

[daycarewhisperer]

You also have to understand that this child will almost definitely try to pull this tube out. She is so young, and then a community nurse will either have to come out to replace it or she will have to go back into hospital and this may happen frequently because she is so little. I am sure she will adapt, but she will require much more one on one attention which you just won't be able to give her.

DCW- I agree that she deserves childcare as much as the next person, but I have read many posts from you and others who give notice to families for far less. I see so many people who won't even tolerate bad behaviour and work with a child in terms of behaviour modification, which is also in most cases a normal part of child psycho-social development. This is a medical issue, one that requires a much smaller ratio than 1:5 or 6 in some cases to make sure that the tube doesn't get pulled out, get caught on anything, get grabbed, get dirty etc etc. It increases the workload AND responsibility on the daycare provider. The liabilities of childcare are high enough already, do we really think that overall it's necessary to increase that at the expense of the child and other children regardless of prior experience in healthcare??? I think not. It doesn't even get beyond this to talk about charging extra money for the extra service.

I think a Nanny would be best. Someone qualified, licensed and insured to carry this out, or a Nanny in addition to a Community Care Nurse making daily visits to administer and train the parents. This seems much more realistic. Also if there is a sibling, it will quite possibly be cheaper to have a Nanny for two children than two daycare spots.

I guess we just look at it differently. I'm saying I would consider doing a medical treatment I am licensed to do in my State as long as I was compensated at whatever the going rate is in hospitals or clinics for the procedure. I wouldn't consider taking it on without payment. Just like any other business providing the service, I would expect to get paid. As long as I was educated and trained and felt comfortable I would consider it. I would not consider it if it was free or there was an expectation that the costs of the treatment was to be dispersed among my other clients. My client base is way way too small to put that on them.

I've never termed a kid for normal bad behavior nor have I ever advised anyone to do so.

[mommyof2princesses]

Well I told dad at pick-up that insurance says I can't do the feedings and he was shocked...I am off next week on holidays so I have no idea what will happen when I get back!

[playfelt]

There would be no cost to the caregiver in this situation and in fact less because no food would be provided - the bags would come filled from the parent. The one thing mom hasn't thought through is the lugging of the feeding pump back and forth every day. Just a lot of factors mom needs to deal with and truthfully at this point I would be considering offering family a deal of keeping the brother till either Sept or Thanksgiving while they get the girl settled in a centre or with a nanny so go ahead and fill one spot and then play the second spot by ear once plans are in place.

[daycarewhisperer]

I'm confused. How is there no cost? Where could the parents take this child and supply the equipment and liquid and have the labor free? She's already out the time to parent conference and dealing with her insurer.

I just had my first level of my house renovated and with every job I provided the materials. I had painters, flooring removers, flooring installers, drywall repairers etc. Not one single worker came in here and did the work for free because I provided the materials. The labor was expensive.

Daycare providers get stuck into the trap of that ANYTHING a kid should need while they are under our roof we should DO and not charge if it's labor intensive or requires special skills. We are expected to build the cost of special care into our fees from our really small client base.

This care SHOULD be expensive and I promise the labor fees from any other health care providers would be reflected in their fee for it.

Just because they provide the equipment it doesn't mean there is no cost.

[playfelt]

I thought you were talking about you as the caregiver providing all of the equipment etc. and having absorb those costs into your program. That is what I meant by no cost to the caregiver as in nothing to have to take money from other clients to pay for. Whether the caregiver decides to add a premium to the fees she charges is not her question - it is about whether this is something than can be accommodated in a home daycare given what information she has to work with at this point.

[momofnerds]

by the sounds of it, wouldn't this child also have therapy too. So most therapy is done during the day, so what is going to happen when she has to go to therapy.

ok, you know how we talk about bad providers and all the stuff that happens in the news, I was just wondering if this would be a neglect case because the parents did this to this child. Also, wouldn't the dr notice something amiss at the yearly check up and why wasn't anything done sooner, is he to blame too.

[mommyof2princesses]

by the sounds of it, wouldn't this child also have therapy too. So most therapy is done during the day, so what is going to happen when she has to go to therapy.

ok, you know how we talk about bad providers and all the stuff that happens in the news, I was just wondering if this would be a neglect case because the parents did this to this child. Also, wouldn't the dr notice something amiss at the yearly check up and why wasn't anything done sooner, is he to blame too.

She will be getting extensive therapy (physical, occupational, music, etc) however there is a waiting list and they can't get in until October I think they said. That would be done at a hospital an hour away from here as it si more equipped to deal with this type of case.

I was thinking the same thing momofnerds....there is no way the parents couldn't see anything wrong with her, I mean she came to me at 12 months old and couldn't sit up from a laying on back position, couldn't crawl, didn't eat/drink anything, couldn't pull up on furniture, couldn't walk, extremely weak muscle tone.........From the first week I was here I could tell there was something wrong and the mom would see the other two children in my care who are the same age as her and they were walking, eating, drinking, crawling, etc but her excuse was that she was a girl and girls are probably different...her brother was an eater, crawler, walker, etc and I couldn't figure out why she couldn't see anything wrong. She would even say that her family doctor told her the little one was just slower to do things and that with time it would come so they would just wait and wait. I tried many times to voice my concerns but they would just brush it off and say in time it will come. Finally she took my advice and got a pediatrician and a dietician referral and they saw her once and then a month later had a follow up with her and that's when she was admitted to hospital.

[sunnydays]

DCW, while it is true that the nurse or other healthcare provider is paid for their labour, here in Canada, we do not directly pay for our healthcare nor do we have to put it through insurance (except for medications, prescriptions, etc). So if the parents are having this procedure done at the hospital, they do not pay for it.
Personally, I think this child should not be in a home daycare any more. Her issues are too big for one provider to deal with unless running a specialized care facility.

[mac]

i wouldnt take on the responsibility either for many reasons. one, im not trained to do so. two, the other kids in my care would suffer as well since i would not be able to do the things that i also do with them such as swimming/skating lessons, drop in playgroups etc.

i also have always said that i wont take in a child that would change our lifestyle and family too much as in a peanut allergy since the peanut butter is a staple in my home.

i think that this family is trying to find a cheaper way to care for their child, i seems to me they may be trying to take advantage of your kindness.

[country girl]

DCW, while it is true that the nurse or other healthcare provider is paid for their labour, here in Canada, we do not directly pay for our healthcare nor do we have to put it through insurance (except for medications, prescriptions, etc). So if the parents are having this procedure done at the hospital, they do not pay for it.
Personally, I think this child should not be in a home daycare any more. Her issues are too big for one provider to deal with unless running a specialized care facility.

Sunnydays I do have to disagree somewhat with the above. Not all specialty care is coverered. My friend has a child with a feeding tube (in the stomach mind you). They have a nurse for him as there are other issues as well. OHIP covers half of the expense of the nurse while he is in school only and her benefits cover the other half. During the summer months they are out of pocket for the half that the OHIP would normally pay as he is not in school. And she is paid $30/hour! So it's not always covered and the parent may not have any benefits to cover the other half.
Obviously this is a more specialized type of care & if she was able to care for this child, I would definately charge more (maybe not nursing rates) but something.

[Cadillac]

I feel bad that the parents would have a hard time finding care but that responsibility is waaaaay to much. how would you cope if something happened? not worth it.

[eoinsmom]

When my oldest son was 2 he had an ng tube, my youngest son was about 6 months old at the time. the ng was a huge pain. I can't even count how many times eoin pulled it out when he was sleeping because i wasn't watching him like a hawk, and i caught him pulling it out often and learned how to push it back before it was too far gone and we had to go back to clinic which was also awful because i would have to entertain two kids in a clinic for hours while i waited and we were already there at least once a week anyway. and we had tube taped down in every spot that was not up his nose and it still came out. personally I would not take on a kid with a ng, it was just so much work watching to make sure it didn't come out, and as his parent I would not have wanted anyone else to watch him either. it was hard enough to leave him with Grandma because she would have freaked out if it come out! there's almost always puking involved when he pulled it out. I had my hands full with only 1 extra kid I can imagine doing it with 6 plus my son with the tube

[someone]

I'm afraid I would have to agree with the other providers. I would not take on the responsibility, I would not feel comfortable or qualified.

[LMK]

Personally, I wouldnt do it. Its a huge responsibility and yes, I agree with the insurance issue as well.

[mimi]

I am not a medical professional. I admire those who are and would leave this to them. The liability issue is a huge concern as well.