Are day care centers/providers bound by law to contact 911 if child's temperature = 105?

Question

My best friend's 16 month old ended up with a temperature of 105 in the afternoon while at day care.They contacted her and her husband. Both work pretty far from the house and from his day care, which is by the house. She rushed as much as she could - in DC during rush hour there is no such thing as rushing given the amount of traffic. She made it there, but by that time, he ended up having a seizure :-( They had not administered tylenol or motrin and they had not clld 911. He was there with a 105 degree temperature for an hour. My gut feeling is that his temp spiked even higher within that hour. To me, it would seem that a temperature of 105 in a 16 month old would warrant a call to 911 for him to be taken to the nearest hospital.

Clarity : 1) I did not indicate that my friend dropped her child off to day care while he was ill. He was not ill in the morning. 2) As for the protocol, we checked the parent handbook and it mentioned that in severe cases of illnesses or injuries, the procedure is to notify the parent and then call the authorities as 1 responder commenter. So I guess, I want to poll whether you all would consider a 105 temperature a serious illness. I would, but maybe I am overly cautious.

3) It is amazing how many people assume that the parent is bad and that she is looking to sue. If she was looking to sue, we'd be talking with a lawyer in an office. Anyway, It is very possible that a temperature can spike high quickly. It has happened to my son when he was an infant. Just b/c you have never experienced it, it does not mean it can't happen. The hospital has determined he has a severe sinus infection and a severe ear infection which will lead to him having surgery to place tubes in his ears.
Any maybe I have found a heaven sent day care, but my day care would fax over a consent form for me to sign so they can administer meds before I arrive.

Answer 1

As a former day care worker, we could not administer ANY medication that was not dropped off by the parent (and it usually had to be accompanied with a doctors note.) This included Orajel and medicated diaper rash cream as well as Tylenol and Motrin. As an organization, that was the policy, like it or not. We are not allowed to give the child any medication without prior written approval. (That is what the legal department said.)
Now, about the 911 issue: That is a touchy issue. I had parents who wondered why we didn't call for a scrape on the knee and others who were much less.....well anal. Perhaps they should have called 911, but it really was not an emergency until he was having a febrile seizure, and then they only need to be transported (via ambulance) if the seizure lasts more than 5 to 10 minutes and if accompanied by excessive vomiting, stiff neck, or extreme lethargy (This is the wife of a paramedic and a nursing student talking now). Otherwise a parent or caregivers would need to accompany him via PA (personal auto).
There are many other techniques that could have been implemented to help decrease the child's fever besides the medication (cool sponge baths, cool compresses, cold drinks, etc.). The sudden onset of such a high fever is probably what lead to the seizure, not the fever itself. It is also common to see kids have a febrile seizure when a fever suddenly disappears as well.
So, by law, the daycare did what they thought was best by not calling 911. The parents could have requested that 911 be called for their child. The daycare is not legally bound to call in this instance and any aid they did (or didn't) provide would be protected under the Good Samaritan Law, as long as they were acting "in good faith". Even if the caregivers are trained in American Red Cross First Aid and CPR, it is not enough training to know what to do or what to anticipate when babies/kids get sick like that. Most parents don't know what to do. Maybe the parents should give more specific instructions so that in the future the care protocol is on paper and there is no guessing on anyones part.
Also, contrary to other answers, if 911 is called, the EMTs are REQUIRED to transport and provide treatment, even if the parents are not there to give consent (unless there is a DNR order on record). It is called implied consent.

Answer 2

Saying that the paramedics can't touch or take the child without direct consent is silly. Would they stand around waiting for parents if a child had been hit by a car walking to school or in a bus accident. No. They take all the procedures deemed necessary at the time and work on making contact with the parent as soon as possible. The baby would have been much safer in the care of the hospital. Most fevers cause no harm even when seizures are involved but they still cause major problems on occassion. On the very small chance that it could have turned dangerous or possibly deadly he should have been with people who could care for him and take action to lower the fever. Not with caretakers who can't afford to lose their jobs or be sued for something as simple as giving Tylenol in an emergancy. In the future whether she changes daycares or not she should make it very clear that they should err on the side of caution and she would much rather they call.

Answer 3

My son has gotten a fever many times DURING daycare hours. I have never dropped my son off at daycare with a fever. With being around other little kids all day they are bound to get each other sick. Daycare does not have to call 911 if the child gets a fever above 105. If the instructor were to call 911 the paramedic would not be able to do anything anyway because they need the parents permission face to face to touch the child. The daycare call also write up a agreement basically saying if anything bad happened to the child while in daycare the ambulance should be contacted to help the child. Then the owner of the daycare and the parent sign. Allot of day cares do not do that. Also daycare is not allowed to used any type of medication on the child including Tylenol, Motrin, rash cream. They are only allowed to do that id again there is a written agreement between the state, daycare owner and parent. With the fever thing the only thing they could possibly do is call the parents.

Answer 4

Having previously worked at a KinderCare in Maryland and knowing that most of the parents worked in the DC area I understand the difficulties getting back to the daycare center. I also know that KinderCare was able to keep fever reducing meds on hand with a permission slip, but that policy was changed several years ago. I will try to answer several of the questions. At my center we would have called 911 if a 16 month old in our care had a fever that high. A fever does not have to be over 106 to cause a seizure, it just has to go up quickly. Even a temp of 102 can cause a seizure if it goes up very quickly. Yes if they had called 911 there are things the hospital could have done without the parents being there. First they could have contacted the parents for treatment. They could have placed cold packs on the child to bring the fever down. They could have given IV fluids (saline) to bring the fever down. I think they could have given Tylenol or Advil with consent over the phone. So yes there are several things that could have been done differently. I will also say that if this had been my child I would have probably called 911 myself knowing I coudln't get there in a reasonable amount of time and I would have been very mad at the center for not doing so themselves. Other than that there isn't much the center couldn't have done. Most centers don't have the staff on hand to tend to a very ill child.

Answer 5

I agree with Emily on this one. Saying the paramedics can not touch a child with out the parents present is NOT true. They can. They make judgment calls every day. Their job is to decied what needs to be done and do it. If they thought a child was in a life threatening situation. They would have done whatever they needed to do to help the child. Even if it meant doing so with out parents premession. (at least that is how it is around here) I know many paramedics who have all told me the same thing.


I have been in a similar situation. (except I was working at a daycare and had 1 year old temp spike up. The kid was fine all morning. Played ate snack. At lunch time the child didn't eat very well. I kept an eye on her. Put her down for a nap. After nap I tried to give her a snack. She wanted nothing to do with it. I took her temp it was 104.7. The protocol at the daycare was to call the parents. and put a cool cloth on her head. (This parent kept Tylenol in the diaper bag.) I got verbal permission from the parent to give her Tylenol. Then when her mom got there I had her sign saying she gave me verbal permission. I was NOT supposed to give her Tylenol but I made a judgment call. Had her temp got any higher I personally would have called 911. I was not however legally obligated to do so. I did however get yelled at for administering Tylenol with out written permission. Needless to say I DID NOT stay there much longer.

Different states have different daycare rules. Here in NY we can use the medicated diaper rash creme. and we can use orajel. Even with no Dr's note. A note from the parents is all we need. At the daycare I worked at the owner (what ever you want to call her (person in charge) was hardly ever there anyways. She ended up getting in trouble because she was under staffed and she was out shopping.

Answer 6

They may not be bound by law to call 911, but the idiots working there should have. That's why, at least at my work, the illness reports hav a place for calling 911 or doctors. I've heard of 104 as an emergency, and anyone past 2nd grade knows 105>104

About the medicine, there is either a law or DHS guidelines that say that the parent must be the one to administer medicine, or they must give the caregiver written consent to do so. Also, the parent must be the one to bring in the medicine.

Either way, they should have called 911, or at least discussed it with the parent. Idiots. Maybe DHS can look into it...

Answer 7

Tough call. I would wonder how the baby's fever got to 105 b/f they bothered to call (unless he was napping & no one had physical contact w/ him.) Daycares aren't allowed to administer medication without prior written consent from the parent & many won't even give over the counter medication without a Dr's note. At any rate - I would think they should have called 911 when the seizure started, unless they have certified medical personnel on staff.

Answer 8

My son had just been to the Dr. and while we were waiting for his prescription to get done he spiked a fever and had a seizure. So your friend probably had no clue , no one ever does until it's too late. Likewise the daycare had no way of knowing he would have a seizure. I don't know about D.C. but in Michigan you sign a consent to treat form when you enroll your kid in daycare or school just in case something like this happens. As far as I know they can't give him meds without her consent.

Answer 9

I am a mother of a 2 year old bot and I would be very upset if this had happened to me, I know that my daycare provider would have called 911. If they aren't bound by law, then someone should change that!
My daycare called me one day when my son was having trouble breathing, she said if I had not gotten there by the time I did she would have called 911

Answer 10

Did the parents ask the daycare to call 911? If the parents knew that the thermometer was 105 they could have asked the daycare provider to do a number of things. I doubt that there's any law that would require the type of action you're describing.