Annex (tbc): guidance for administering liquid paracetamol when children become unwell at the registered setting

Introduction 

The following information is supplementary to Standard 11 Medication and covers the occasional administration of Liquid Paracetamol to unwell children prior to collection by their parent/carer.

There will be occasions when children become acutely unwell during their time at your setting. The health and wellbeing of children must always be protected and is a regulatory requirement. Children who are already unwell, have a high temperature or are infectious should not be received into the setting. This is to protect the health of other children and staff (including those that are vulnerable). Children with mild respiratory symptoms such as a runny nose, sore throat, or slight cough who are otherwise well and do not have a high temperature can continue to attend their education or childcare setting. 

Public Health Wales provides a practical guide and comprehensive information for childcare providers on managing cases of infectious diseases in children and young people settings. Information for parents is available on the NHS website to determine and make an assessment if their child should attend childcare or school Is my child too ill for school? - NHS

Guidance for registered settings to obtain, store and administer Liquid Paracetamol subject to the following General conditions and Liquid Paracetamol-specific conditions being met:

General conditions

• The registered setting has a medicine policy which describes the circumstances in which Liquid Paracetamol may be administered to a child who is attending the setting. 
   
• The medicine policy has been shared with the parent/carer and sets out the arrangements and procedures in place to support the safe administration of prescribed and non-prescribed medication, including when there is an urgent need whilst a child is being cared for at the registered setting, for example, in the event of a child having a high temperature; and
   
• The child’s parents/carers have given written prior permission for the registered setting to administer Liquid Paracetamol to the relevant child in the circumstances described in the medicine policy.
   
• The child’s parents/carers will give, wherever possible, verbal consent for each subsequent occasion when Liquid Paracetamol is administered.

Conditions relating to each occasion Liquid Paracetamol is administered

In situations where a child becomes unwell whilst at the registered setting, it is most appropriate for the child to be collected by a parent or carer. 

However, in circumstances where parents have given prior written consent and they are not able to collect their child immediately the following options would be appropriate:

Option 1: the child’s parent or carer has been contacted but there is going to be a delay in collection:

• the child’s parent or carer gives verbal consent for the dose of paracetamol to be given.
• a period of at least 4 hours has passed since the last dose of paracetamol was given to the child; and
• the parent or carer has undertaken to collect the child from the registered setting as soon as is practicable.

Or 

Option 2: the registered setting has attempted to contact the child’s parent or carer, but they cannot be contacted:

• the registered setting must contact NHS 111 and a healthcare professional (at NHS 111) has advised that it would be appropriate for a dose of Liquid Paracetamol to be given.
• the registered setting should subsequently contact the child’s parent or carer to arrange for the child to be collected from the registered setting at the earliest opportunity/as soon as is practicable. 

In addition to the above, registered settings must continue to adhere to Standard 10.2 which states:

“No child is received if he/she appears to be ill. If children become unwell during their time in the childcare or play setting, care is taken to prevent possible infection of other children and parents are notified as soon as possible.”

The standard above relates to occasions when children become acutely unwell, especially if they are at risk of seizures, have a high temperature or are infectious. This is not the same as a child who is teething or has a common cold or cough. 

It must not be assumed that a child is better after receiving Liquid Paracetamol and in all cases the child should be collected by a parent/carer as soon as is practicable after the child becomes unwell.

Storage, Administration and Record Keeping

The Welsh Government recommends that registered providers obtain, store and administer Liquid Paracetamol in the limited circumstances described in this guidance. 

The Welsh Government recommends using sachets of paracetamol sugar free oral suspension each containing 120mg of paracetamol in each 5mL because they are easier to store, have labelled expiry dates, and reduce cross-contamination between children. Importantly sachets provide the correct dose by use of a single or multiple sachets, without the need for a measuring spoon or oral syringe. 

However, where sachets are unavailable, it may be appropriate for the provider to stock a bottle of liquid paracetamol containing multiple doses. In these cases, careful management of cross contamination should be planned, documented, and implemented by the manager or person responsible for administering medication. 

It is also necessary for anyone responsible for administering medication to have received information on the importance of following any directions for use such as shaking the bottle well before opening (to ensure correct dosing).

Advice about purchasing Liquid Paracetamol can be obtained from any pharmacy.

The registered setting must ensure arrangements are in place for the safe storage, administration and record keeping of doses of Liquid Paracetamol used in accordance with the medicine policy. 

The expiry dates of all stocked medicines must be checked regularly (at least every three months), and before each administration.

All doses of Liquid Paracetamol administered to a child at a registered setting, following this guidance, should be recorded at the time of administration. The childcare provider is required to maintain a written record and notify the parent upon collection of the child.

The administration of Liquid Paracetamol is reserved for urgent situations in which it is impracticable for a child’s parents/carers to collect the child promptly.