Today I had to go against my better judgement and follow a daycare parent's orders in providing care for her son, even though I KNOW it was the wrong thing to do. .
This little boy had a bad diaper rash on Friday, starting to turn into a yeast rash. I let Mom know, advised on treatment methods, and he was with them up until today.
This morning, Mom informs me that his rash got worse to the point of bleeding and they took him to the doctor on Monday, who proscribed the same course of action I suggested on Friday.
Mom also hands me a lunchbox (first time they've brought his food) and asked me to feed him from that today, as the doctor also recommend they feed him pasta, rice, yogurt, etc. until he heals more. I look and it's a container of pasta with marinara sauce, a container of strawberries, watermelon, and cantalope, and a container of strawberry fruit-on-the-bottom yogurt.
When I suggest that the fruit and tomato sauce might be very acidic and do more damage to his bottom, she informs me she has two Master's degrees in pediatrics (she's a surgical P.A.) and she knows what she's doing.
So, I fed him the food she provided, even though I know it's going to make his already super acidic poops even worse, making his rash even worse, causing him more discomfort. I feel like dirt because I didn't do my best to care for him by feeding him that stuff for lunch.
What would you have done? Have you ever had to go against your better judgement because someone in a "superior" position trumped your imput?
Sorry for leaving everyone hanging!
He pooped at nap, as is his usual. It was a huge, loose poop, so acidic it burned our nose just smelling it. His poor butt was bright red all over and started bleeding again. When I laid him down for nap, it was closed, not bleeding, and was only red/pink where the bumps that had opened over the weekend were. I happened to be changing his diaper again when Dad picked up around 5, so I showed him how it looked now as opposed to the morning and told him about the super acidic poop at nap and his response was "That's better than it looked this weekend."
In response to a few other questions:
I am a home daycare owner, not an employee in a center. I cannot and will not risk my reputation as a professional or put my integrity or honesty into doubt by ignoring the requests of my clients unless they are against regulations, state law, or will directly cause harm to the child, in which case I would also have to report them to CPS. While I strongly disagreed with the provided food and knew it would make the situation worse, I couldn't refuse it as it's not the same as say a parent requesting food withheld or asking me to improperly mix formula to save money. While I felt what I fed him was the wrong choice, it was still the parents' choice and would never be considered neglect in the eyes of the state. Neither, as one person suggested, would me complying with their request.
While I have a cooperative relationship with all of my clients (even this one until yesterday), unless I've been given free reign to make substitutions to the items they've provided, like diaper creams, I cannot and would not do that. Under NO circumstances would I EVER administer an adult, over-the-counter medication like Maalox, even externally. THAT is unethical, illegal, and would be considered child endangerment in State's eyes. The child came in with a prescription cream and an over-the-counter antifungal per the doctor's orders, so that is what I used.
On Friday I had recommended the over-the-counter antifungal mixed with A&D ointment as that is what I've always used in the past for yeast rashes with my children (daycare and biological) at the recomendation of several pediatricians, including my own, but suggested they run it by their doctor first. They chose to do neither, because of Mom's extensive medical knowledge, AND feed him acidic food on top if it, which is why it got so bad over the weekend on their watch.
And, yes, parents are allowed to provide food for their children in my daycare, even though I provide food for most of the children. They do so in the case of food allergies that are severe or extensive or special dietary needs (vegetarian, organic, etc.).
I doubt the one meal you fed him did much to make his poop worse. I wouldn't worry about it. I work w/ kids - pedi ICU - and see *terrible* diaper rashes. Dietary modifications have always failed to impress in their ability to either improve or worsen a diaper rash.
I feel for you. I don't know what else you could have done. The only thing I could think of is if you had food to give him in it's place, rinse the sauce off the pasta, and toss the rest.
As the parent of a child on the autism spectrum, I see a lot of stories of "professionals" that don't have a clue. It's frustrating. Sigh.
Hugs for trying to get her to listen.
Well, for starters, I had a kid whose skin got really bad and I felt terrible, but the nurse assured me it happens sometimes, here's the treatment. I would feed the kid what they offered him, change him often, use water and paper towels instead of wipes, etc. If you think it made it worse, you can say, "Just so you know, I fed him the lunch you provided, but it didn't seem to sit well with him." Or say, "He has had diarrhea today. Can you send in more yogurt or a banana? He really liked the yogurt." Or rinse the sauce off before you feed him. Maybe she was thinking that the fruit yogurt would be more likely to be eaten. You might also ask for pain medication for him if you think they would provide it and it would help.
They took him to the doctor. They are trying to resolve it. I had to get into it with my daycare provider when she thought I wasn't giving DD enough milk because she was used to formula fed babies. I think if you respect the parents' opinion, they may be more willing to work with you on the details. What bugged me most was the implication that I wasn't caring about my child, so think about if you possibly came off that way, especially to a parent who may be stressed already. I know my kid's bleeding butt drove me to tears before it got resolved.
You tried, but she's the mom.
If a mom was on this board and posted "I sent in this specific food to feed to my child, and my childcare provider purposely ignored me and fed him something else", people would be posting - you are the mom, what you say goes, and find a new childcare provider!
So yes, you did the right thing, even though you know it was the wrong thing.
And yes, anyone who reports to a boss at work has probably had that happen at some point.
Following the parent's instructions was the right thing to do. If you had a problem with it, your ethical option was to tell the director of the daycare that you could not follow these instructions and understand that you could (rightly) lose your job. I cannot believe that there are people on here suggesting a provider purposely disregard a parent's instructions and apply medication to a child not their own. If I ever found out that happened, I would pursue this until that person lost their job.
If my day care had ignored my instructions regarding my child, I would have been livid.
But then again, I would have also been willing to listen to ideas about how to treat a rash without discarding them out of hand.
I've been in that type of situation. It's hard to go against what you feel is best and do what you are told to do instead. I just did as they said, but in my weekly records, I did submit a notation regarding the situation and with the personal newsletter each parent got at the end of the week, I also noted what the child(ren) ate and what if anything the parents instructed. This way, you please them and protect yourself.
Just take a deep breath and do as they (within reason, of course)
I don't know that this one lunch would matter too much. The yogurt is the most important part. Watermelon and cantaloupe are very mild, and I'd be surprised if a little tomato sauce made much of a difference.
I understand your concern, but I really think it's going to be ok.
Do what the Mom orders but then use liquid Mylanta on his behind before applying any diaper rash cream.
The antacid takes care of the acid.
I'm sorry. I don't know all the protocols for this stuff (day care.. mine were never in one)... but can you or can you suggest that she apply liquid maalox to his bottom and let it air dry after diaper changes? Coating his bottom with antacid will help neutralize the acids he passes from those foods (and others) before they have time to further irritate his bottom.
Good luck.
I'm so sorry for that little guy! :(
M.-
Do you work in the daycare? What does the director have to say about this? What are your guidelnes? Ours couldn't apply any medicine, cream or balms apart from those that we provided (so the mylanta would not have been an option). Kids have so many sensitivities nowadays, and people are so litigious, that it is probably best to not get creative, or underhanded about the care you provide.
Best,
F. B.
You have to follow the mother's wishes. You did the right thing by advising her to the best of your ability/knowledge, but ultimately, she is paying you and you have to treat her baby the way she wants. Please don't beat yourself up about it. Sometimes, we have to do things that we don't agree with. Just know that you've made your recommendations and are doing your best to help educate the mother.
Please don't put A&D ointment on a child with a yeast infection as Dana T. suggested. A&D ointment will most definitely make the infection worse.
You left us hanging! What was the result of his acidic lunch???
I am glad in Oklahoma we aren't allowed to have parents bring outside food into our facilities. I'd have had no problem pulling out the regulations book and showing mom we loved her little one but we couldn't comply with her wishes. That he'd need to go home to eat what she wants until he was well or he could stay here and eat what we were serving for lunch.
I think you don't have much choice as long as mom is this way. If she does have the degrees she says she has she is probably more knowledgeable than all of us about medical issues.
IF it was just an acid butt, from a stomach issue and NOT a yeast infection, then I'd have put liquid antacid on his butt last week and got it cleared up. That's what one of my parents had me do. We dabbed it onto the rash with a cotton ball dipped into some we poured into a disposable bowl.
This worked like I'd never seen anything work before. Rashes from stomach issues would be gone with just one or two applications. It kills the acid that is coming out.
Part of the beauty of taking care of diaper babies is they can't tell on you. You could have fed him today but nothing needed to come from his lunch box. Often the daycare provider would just feed my kids what she was feeding her own it was fine with me and worked out well.
This is a case of you knowing better than the "super smart" mom. While the child is in your care provide the best care you can. Sometimes that means go with your gut. By the way here in NJ the authorities could be called for neglect in a case like this which is why you should be doing what you know is best for that baby.
tough call. but NONE of us like it when our parenting decisions are second-guessed, do we? had she asked for your opinion it would be one thing, but since she has chosen a different course of action and does not want your input, you handled it correctly.
some situations just don't have perfect solutions.
khairete
S.
It is possible that she actually is right and you are wrong. If she does have these degrees then she may have info we don't.
Just sayin.
I would have fed him then changed his diaper/pull-up and slathered his poor tuckus with A&D ointment every hour.
Ultimately, whether you agree or not, it's mom's choice on the medical care for her child. Working with children you will always see things you disagree with. You will overhear things that make you cringe. You'll worry when certain kids leave. You simply do what you can for each child. If you dropped your kiddo off with someone who thought strawberries and marinara were fine, you'd be furious that your instructions weren't followed.
Let's say you didn't do as mother instructed and his diaper rash got worse. And she discovered that you started your own coarse of action....who do you think she will blame for the turn of events?
And who knows, maybe she KNOWS you were right when you mentioned the issues with acidity and didn't like being questioned. Maybe she was saving face for now and tomorrow it will be a different, more appropriate lunch.
Sometimes parenting involves learning things the hard way....we have all done it on some level. This may be a case where she has to see for herself. Something I learned after years in the classroom, you do the best for each kid that comes through your door with the tools you have. And then you hope for the best when they leave. Mother's instructions were your tools on hand. If you followed them, you have done nothing "to feel like dirt". It's awesome that you care about your job and kids so much, we should all be so lucky to find such dedicated day care providers.
