The following guidelines set out the policy for managing children’s medical needs. They should be considered before a child starts at the nursery or, in the case of a child already attending the nursery as soon as a medical condition arises and/or is diagnosed.
Most children will have short term medical needs whilst attending nursery for example, temperature or pain relief or completing a course of antibiotics. However sometimes children will have continuing medical needs and may require medicine to respond to certain circumstances such as an allergic reaction or to maintain good health on a longer-term basis, for example to control diabetes.
All children are required to have a Medical Conditions and Allergies Form on their file in the nurseries, even if they do not have any such condition. The form should be completed with parents either prior to or at the child’s first settling in session.
If a child does have either a medical condition or an allergy which requires special treatment, a bespoke Health Care Plan should be on file. This must be completed in conjunction with parents and signed off by all parties. A Risk Assessment should be undertaken by a member of the Nursery Management Team and will need to be implemented from when the child commences at nursery.
In the event of any medical event or emergency, the Health Care Plan should be referred to and followed. All relevant staff including Key Workers, Room Leaders, Lead Practitioners, Nursery Management and any other relevant staff should be aware of relevant Health Care Plans which relate to children they work closely with. Failure to properly implement and follow Health Care Plans without good reason or explanation is a very serious matter and could result in disciplinary action being considered if deemed necessary.
- Parents are primarily responsible for providing information about their child’s health status and any associated medical conditions or allergies. This information should provide this on the registration form (if known), or prior to or at the child’s first settles at nursery. This information can be provided on the registration form, at the settling in sessions and also via Famly.
- Any medical conditions or allergies will require a Health Care Plan. This needs to be signed by parents or carers (see above) and co-signed by a senior member of the nursery staff.
- Only senior members of staff will administer medication except for emergency treatment that may be given by a trained member of staff as necessary i.e. Auto Injectors.
- There must always be a second member of staff to witness the administration of any medicine.
- A record must be maintained when a child requires any medication, either prescribed or non-prescribed, to be administered at the nursery (See Child’s Medicine Record).
- Before any child’s first day at the Nursery (preferably at the first settling in session), all registration documentation should be completed by the parent / guardian, which will clearly highlight if the child has any medical conditions or allergies which require special support and or management.
- All children attending any Hopscotch nursery must have a completed and up-to-date Medical Conditions and Allergies Form on their file**.**
- If the child is identified as having a medical condition or an allergy, detailed information of the condition and its management should be obtained from the child’s parents or carers. This will be input into a Health Care Plan specifically for the child (see above).
- Medical Condition and Allergy Forms should be frequently reviewed (preferably annually) and approved by parents to ensure any changes have been captured. Reviews will also take place in response to any medical incident which might occur, either at nursery or at home.
- A Health Care Plan and Risk Assessment should then be developed by the Nursery Management Team and agreed with the parents.
- If the medical condition is a food allergy, the special dietary procedure should be followed at the same time as this procedure. See Hopscotch FSMS document for more information.
- Once the Health Care Plan has been approved the Risk Assessment should be reviewed.
- All relevant staff should understand and be trained in how to implement control procedures and the requirements of the Health Care Plan.
- The master copy of the Health Care Plan and Risk Assessment should be stored in in the child’s file in the nursery and photocopies accessible in other appropriate places.
- Parents are required to review, approve and sign all Health Care Plans.
- The Hopscotch Head of Operations should always be notified as soon as practicably possible in the case of any allergy breach at all.
Senior staff may administer prescribed medication in accordance with the prescriber’s instructions provided that the parent has requested it, authorised it in writing and signed all relevant paperwork.
However, children should be encouraged not to attend nursery within the first twenty-four hours of starting or changing a prescribed course of antibiotics. This is to ensure that:
- Any adverse reaction can be monitored by the parent.
- To ensure that the child begins to feel well enough to attend nursery and participate in the day’s activities.
- Reduce the risk of cross infection to other children / staff.
However, where children are not clearly unwell or might frequently be prescribed antibiotics for ongoing health issues, the Nursery Manager may use their own judgement to allow children to attend in such circumstances. The Nursery Manager’s decision on this is final.
All prescribed medicine must be provided in their original container with the pharmacist’s label visible and be clearly labelled with:
- Childs Name
- Type of medicine / name
- Date of prescription
- Expiry date
- Dosage
- Any other relevant information e.g. storage conditions, method of administration, side effects.
Staff should not accept and never administer medicine if it is clearly not labelled or provided in its original container or recently prescribed. Medicines that are out of date will not be accepted and never administered. Failure to abide by this is a breach of company policy.
Staff should always carefully read the label ahead of administering medicine. Sometimes wording on medicine labels might be unclear or awkwardly phrased. Staff should take time to acquaint themselves with the proper dosage as set out on the label for administering any medicine.
When medicines are administered the ‘Parental agreement to administer prescribed medicines’ form should be completed by that member of staff.
If a child refuses to take the medicine, staff will not force them to do so, but will note this in the records and follow procedures agreed with the parent or set out in an individual child’s health care plan. Parents will be informed immediately of any such refusal and should advise how the nursery should proceed.
All medicines should be provided on a daily basis by the parents and stored as recommended. If under refrigeration it should be stored in an airtight container that is clearly labelled and placed in a designated area of the child’s room fridge. The Room Leader or Lead Practitioner will be responsible for ensuring access to this fridge is restricted. All other medicines should be stored in a secure container or cupboard as detailed above.
It is advised that medicines are stored in Ziploc Bags or similar with white labels attached clearly showing the child’s name and the expiry date of the medicine and a photo of the child should also be attached if possible. Ideally this should also be stored with the child’s Health Care Plan which will outline any treatment plans required for the child’s medical conditions or allergy. A new label should be attached each time the bag or container is reused to ensure the previous information cannot be seen and does not create confusion.
The only exception to this is the storage of emergency medication for example, asthma inhalers or Auto Injectors which might be required to be kept in rooms where children are present. These may be stored in a labelled and lidded container or Ziploc Bag within a designated safe location in the child’s room.
Children who require emergency or on-going medication will also require an individual Health Care Plan and Risk Assessment, as previously set out in this policy.
Medicine expiry dates must be checked as part of the Nursery Management Team’s monthly checks. For further clarity, medication expiry dates should also be clearly listed on the nursery’s Medical Conditions & Allergy Boards in each room.
Any medication that is out of date must be returned to the child’s parent for disposal and a replacement immediately sought. If a child still requires medicine for a long-term health condition or allergy but a replacement is not provided immediately by the parent then the child must not attend nursery until this has happened. Failure to implement this means the child could be at increased risk of suffering a medical emergency without having the proper medicine available to assist them whilst in the care of Hopscotch. If the parents inform the nursery that the child no longer requires this medicine then an updated Health Conditions & Allergy Management Form should be completed immediately.
Unused medication should be returned to parents when a child leaves nursery or when parents have confirmed with an updated Health Conditions & Allergy Management Form is no longer required.
If a child is suffering from a recognised communicable disease, then the appropriate exclusion periods should be applied. They may also need to be excluded if the child requires special treatment that has not been identified as part of the on-going care plan for example, injections, change of dressings etc.
Only medication for temperature control or for allergic reactions will be administered to children at nursery in response to an urgent medical situation. For temperature control this will be a Calpol only. For allergic reactions this will be Piriton only.
Consent for the emergency administration of non-prescribed medicine i.e. Calpol and Piriton is sought in the Hopscotch Medical Conditions & Allergy Form, which should be completed on initial nursery settles.
If a child unexpectedly requires emergency temperature or allergy medicine the nursery should contact the parents to seek further verbal consent for a single dose of medicine to be administered provided, even if previous written authorisation has been provided. A record should always be kept of when and how much medicine has been administered. This should be shared with the child’s parents or carers and kept on the child’s file.
Children will normally feel warm or hot to the touch before a thermometer registers a high temperature. In such circumstances, children should be closely monitored and temperatures taken on a regular basis. Temperatures should be recorded.
Depending on the child’s temperature and their general wellness, the Nursery Manager should use their own judgement and knowledge of the child to make an informed decision about whether the child should be sent home or whether some OTC medicine i.e. Calpol could be given.
Any temperature of 39C or over should prompt the Nursery Manager to contact the child’s parents to collect the child at the earliest possible opportunity.
If it hasn’t already been given, the Nursery Manager should consider administering OTC medicine i.e. Calpol to reduce the child’s temperature. In circumstances where the parents or other suitable carers are not able to come and collect the child promptly, then the Nursery Manager or a designated member of the staff team should continue to monitor the child closely.
In such circumstances, the Nursery Manager should continually assess the situation and make a judgement based on their own assessment and knowledge of the child in question. If they have any concerns then they should immediately consult with the Hopscotch Head of Operations.
OTC Medicine (Calpol only) might sometimes be considered for pain relief for child in an exceptional circumstance, but this needs to be considered on a case-by-case basis and be comprehensively risk assessed by the Nursery Management Team. This does not include relief for pain associated with teething. If the Nursery Management Team has any concerns, they should discuss the matter with the Hopscotch Head of Operations. It is advised that a child under 16 is not given aspirin or medicines containing ibuprofen unless prescribed by a doctor.
Medication for pain relief will only be considered and permitted if there is a clear health reason for doing so and only if the child’s parents have requested it, consented in writing and have confirmed in writing the medicine has been previously used at home without any adverse effect.
The Nursery must never administer a child’s first dose of a new medicine**.**
Only senior members of the nursery staff team (i.e. Room Leader, Lead Practitioner, Nursery Management Team) should ever administer medicine to a child.
Doses must always be in line with those recommended by the manufacturer.
Supplies of Calpol and Piriton will be kept at the nurseries for these purposes only.
If emergency medicines have been administered then children who have received such medicines will be closely monitored.
If a child suffers from persistent, frequent or acute pain or recurring symptoms then staff should advise the parents to seek further medical advice through their GP, Health Visitor or other suitable healthcare professional.
Non-prescribed lotions and creams for the control of dry skin conditions are acceptable to be used on request and should be applied in accordance with the manufacturer’s instructions, provided that they are branded and of reputable make. Parental consent should be sought and recorded in a Medication – Parental Consent Form but a Health Care Plan is not required.
Non-prescribed lotions and creams (i.e. Over-the-Counter) for the control of dry skin conditions which may be applied following manufacturer’s recommendations are as follows (not an exhaustive list):
- Aqueous Cream
- E45
- Oilatum
- Diprobase
- Drapolene
- Aveeno
Hopscotch uses Vaseline, Sudocrem and Metanium in our routine treatment of nappy rash and common skin ailments.
The above applies to suncreams parents have requested to be applied to children which are not normally applied.
Teething granules may be administered to children whilst at nursery. Parental consent must be recorded in a Medication – Parental Consent Form but a Health Care Plan is not required.
Pain relief medicine (i.e. Calpol) cannot be administered at nursery to alleviate teething pain.
Non-prescribed remedies to aid digestion to babies are not administered at Hopscotch. If children suffer persistently from digestion or wind-related issues parents should seek medical advice from a healthcare professional.
It is not the usual policy of Hopscotch to decline to admit or to exclude a child already on our register – only in the most exceptional circumstances or in cases where a child has a communicable disease. As a general principle, the Hopscotch will make every effort to accommodate the requirements of children with special or medical needs. The contract with parents provides that the Nursery may require a parent to decline a registration or withdraw a child when:
- The child requires special medical care and attention (including 1:1 staffing) to be provided by the nursery which is not available, or which is refused by the parent.
- The Nursery has reasonable cause to believe that the child is or maybe suffering from a contagious disease, and there remains a danger that other children at the Nursery may contract such a disease.
- The Manager reasonably considers the child to be overly disruptive as a result of their medical needs or requirements and therefore as having a significant impact on the well-being of other children and staff.
- Actions of the parents which might require the booking/registration to be terminated.
It may be necessary to exclude a child for a short period of time in order to ensure that there is no unnecessary risk to that child.
Exclusion might also be considered as a precautionary measure in any case where a parent is not able to be completely open about a child’s condition, withholds or is subsequently found to have withheld important information, whether about a child’s health or any other matter which will impact on our ability to fully and safely look after the child and support and maintain their health, safety and wellbeing whilst attending any Hopscotch nursery.
Hopscotch will be responsible for establishing and maintaining the appropriate UKHSA contacts for information and notification with regard to the control of communicable diseases. Nursery Management Teams should keep the Head of Operations updated with any cases of any suspected notifiable diseases. If they are unsure they should seek advice from the Head of Operations. The Head of Operations will review the situation and liaise with the Company Director and if deemed necessary will notify UKHSA of any suspected outbreak of communicable disease in any Hopscotch setting if needed.
UKHSA guidelines indicate that it is not necessary to operate a policy of exclusion for all child illnesses, but it is important that staff and parents understand when exclusion is required.
Many illnesses are infectious before symptoms appear or a full diagnosis can be made. Nurseries and their staff should be aware of their responsibilities to protect sick children and to prevent the spread of illness to other children in its care.
Common diseases and symptoms requiring exclusion include:
- Temperature of 101°F (38°C)
- Chickenpox (Herpes-Shingles)
- Measles
- Rubella (German Measles)
- Pertussis (Whooping Cough)
- Mumps
- Gastrointestinal Infection (Diarrhoea and/or persistent vomiting)
- Streptococcal Infection
- Contagious Skin Conditions
These will be reviewed annually in line with the latest UK Government guidance, which provides a list of communicable diseases and minimum periods of exclusion. It is included in the index section of this manual and is also available here:
This information should also be displayed in the nursery setting so staff can easily access it.
The Nursery Management Team must be informed by staff immediately if a child becomes ill while at the Nursery. They should ensure that the child’s parents are notified as quickly as possible.
If the illness appears to be communicable, the child should be cared for by a member of staff but kept away from other children. Parents should be encouraged to collect their child as soon as possible.
The Nursery Manager is responsible for the wellbeing of the children and staff while they are at the Nursery. No child or member of staff known to be suffering from a communicable disease or considered too ill to participate in normal Nursery activities should be admitted to or remain at the Nursery.
Staff should assess and monitor any children who have been sent to nursery who clearly appear unwell or poorly and if it is deemed they are not well enough to continue attending nursery then their parents should be contacted and advised of the need to collect.
The Nursery Manager should use their own judgment when assessing whether a child should be sent home from nursery. Some children might be more prone to vomiting occasionally due to other unrelated health issues i.e. coughs or enlarged tonsils etc. In such a situation the Nursery Manager should decide whether the child is well enough to continue at nursery or whether they should go home. A single instance of vomiting might not necessarily indicate a sickness bug whilst a number of instances of vomiting in a short amount of time where other children in the group or room have already been unwell would indicate the likely presence of some kind of sickness bug.
If children are collected then the nursery should continue to correspond with the child’s parents or carers in order to monitor the child’s wellbeing and recovery.
In the event of a national outbreak of a health pandemic, we will follow all Government health advice and guidance, legal advice and advice from our insurance provider.
The setting will remain open for business as long as this is permitted by government and we have sufficient staff to care for the children safely. Depending on the nature of the pandemic we will follow all advice and implement measures to ensure that risks to vulnerable children and staff are minimised. This may include excluding infected children/staff/parents or family members from the setting for a set period of time, to prevent the spread of infection. This decision will be done in consultation with parents, staff, legal advice and our insurance provider. Each case will be reviewed on an individual basis.
If a child becomes seriously unwell and requires attention from a doctor urgently, the following steps should be taken:
- Child should be comforted and at least one staff member to remain with them at all times
- Childs’ parents should be contacted and asked to come and collect the child to take them to hospital
- If the child is extremely unwell and the parents cannot attend the nursery in good time, an ambulance should be called
- If an ambulance is not able to attend the nursery in good time, the Nursery Manager should decide as to whether to transport the child to hospital. In such a situation a taxi is the preferred choice to travel to hospital.
- Only as a final resort should the Nursery Manager decide that the child should be transported to hospital in a personal car. It might be in that circumstance that, provided staffing ratios can continue to be met without issue, that two members of staff travel together to hospital with the poorly child. One member of staff should accompany the child into the hospital and wait with them until the parents have arrived.
If a child has had any kind of hospital stay this might warrant a notification to Ofsted. The Nursery Management Team should also seek to obtain further information on the details of any hospital stay prior to reattendance at nursery, ideally through a meeting at nursery if possible. This will help the nursery staff team understand the impact on the child and help us to smoothly manage their return to nursery in the best possible way. In such a scenario a Return to Nursery Form should be completed with the parents as soon as practicable. If the child has a new health condition which requires ongoing treatment then a new Medical Conditions & Allergy Form should be completed and a Health Care Plan and Risk Assessment for the child.
If parents inform staff that a child has had a stay in hospital at the door at drop-off or collection then staff should call the Nursery Manager or Deputy Manager to inform them and they will take over the conversation and ascertain more information, as per the above.