Risk assessment

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sunnyday

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Hi, just wondered if anyone had experience of a nursery doing a risk assessment on an asymptomatic preschool child and could given me pointers for what to add onto it please
 
Welcome @sunnyday 🙂 Who diagnosed the child as at risk of developing Type 1 (if that’s what you mean)? Are they under the care of a consultant? If so, presumably they’re receiving regular checks?

Why are you having to do a risk assessment?
 
Have you had any training/input from a specialist nurse or the parents in order to understand the child's risks and needs?
Using the term "asymptomatic" is a little confusing for us with regard to Type 1 diabetes. It just doesn't seem applicable, probably because the most serious symptoms are those of an overdose of medication rather than the diabetes itself. ie a hypo.... dangerously low Blood Glucose. Hypers (high Blood Glucose) are generally less serious or obvious and are less of a short term concern, whereas hypos need immediate treatment and are potentially life threatening.
 
sunnyday said:
the child already has type one. Our area advisor told us we needed to do one
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Then they’re not asymptomatic. I thought you meant they’d been identified in a study as being at risk of Type 1.

If the child is pre-school age, then they would need watching around some foods, eg if you were, say, making something very sweet. They’d also need watching around all foods as they’d need their carbs counted and appropriate insulin administered. Obviously hypos are a big risk, so you’d need a plan to identify and deal with those and training for staff.

If you haven’t yet had input from medical people and the child’s parent(s), then it would be best to wait and follow their advice as to the risk assessment.
 
Here’s some basic information from Diabetes U.K.:

Caring for children with Type 1 diabetes in nurseries (our position)

There are approximately 1,700 children under the age of 5 living with Type 1 diabetes in England and Wales, and 110 in Scotland. As the steepest rise in diagnoses of Type 1 diabetes is in this age group, the number of children who have Type 1 diabetes in nurseries is set to increase. Children...
www.diabetes.org.uk www.diabetes.org.uk

.
 
Inka said:
Then they’re not asymptomatic. I thought you meant they’d been identified in a study as being at risk of Type 1.

If the child is pre-school age, then they would need watching around some foods, eg if you were, say, making something very sweet. They’d also need watching around all foods as they’d need their carbs counted and appropriate insulin administered. Obviously hypos are a big risk, so you’d need a plan to identify and deal with those and training for staff.

If you haven’t yet had input from medical people and the child’s parent(s), then it would be best to wait and follow their advice as to the risk assessment.
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They are diagnosed and asymptomatic. We have had training from the parents but I just wanted to guidance as to the main areas to cover on a risk assessment.
 
rebrascora said:
Have you had any training/input from a specialist nurse or the parents in order to understand the child's risks and needs?
Using the term "asymptomatic" is a little confusing for us with regard to Type 1 diabetes. It just doesn't seem applicable, probably because the most serious symptoms are those of an overdose of medication rather than the diabetes itself. ie a hypo.... dangerously low Blood Glucose. Hypers (high Blood Glucose) are generally less serious or obvious and are less of a short term concern, whereas hypos need immediate treatment and are potentially life threatening.
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training has been from the parents
 
sunnyday said:
They are diagnosed and asymptomatic. We have had training from the parents but I just wanted to guidance as to the main areas to cover on a risk assessment.
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What do you mean by “asymptomatic”? That they’re on insulin? It’s not a term used with Type 1. If their blood sugar becomes high after diagnosis, they’ll still get some of the symptoms they had prior to diagnosis - ie thirst, urinary frequency and tiredness. Type 1 is always there, with the accompanying risks of hypoglycaemia, hyperglycaemia and DKA, and longer term potential issues.

Now they’re on insulin, they are also at risk of hypos. Hypos can be potentially serious, leading to seizures and unconsciousness.That would be one of the main things to put on any risk assessment, along with more obvious ones such as sharps and the storage of medication.

Are they on injections, or a pump?
 
I find it really odd that anyone would use the term asymptomatic in respect of Type 1 diabetes. A hypo can happen at a moment's notice and whilst a hypo is not a "symptom" of diabetes as such, it is probably the main manifestation that you would need to deal with and the condition is in a constant state of flux. BG levels rise and fall all the time throughout the day and night and can drop dangerously low or go dangerously high surprisingly quickly and easily and with very little warning.
 
I think suggesting a child with Type 1 is "asymptomatic" could perhaps lull you into a dangerous false sense of security.
 
Perhaps they mean no obvious hypo symptoms?
 
silentsquirrel said:
Perhaps they mean no obvious hypo symptoms?
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Which is of course a very dangerous situation!
Using the word "asymptomatic" just seems to suggest it is benign and nothing to be too concerned about, which could really catch someone out if they weren't clued up.

@sunnyday How long has the child been diagnosed? Do you know if they are on injections or an insulin pump? Have you been trained to calculate and give injections and how to treat a hypo and what to look out for?
Do you have any realistic expectation of how frequently the child might hypo? When I was first diagnosed and started on insulin I naively thought that a hypo might happen once or twice a year if I was unlucky. In reality I average almost one a day. Some people's diabetes is more erratic than others and children due to their small but growing bodies and that they run around expending energy and then just crash and sometimes/often don't eat all the food they are given, so they can be more prone to hypos because balancing their insulin doses can be a very fine line to get right.
 
Which would be of more concern, potentally, than having symptoms.
Questions i would want to ask are...

Do they have a insulin pump?
Do they wear a continous glucose monitor (cgm eg libre, dexcom) and would your staff have ecess to see this ( i would say this would be crucial to keep them safe)
Do they have hypo symptoms/ how do they show others they are going low?
 
Does duk have some document/ guidelines on this? It must come up often for schools, preschool/afterschool clubs.
I take it when you say preschool you are talking children under 5, is that right?
 
The child would have a medical care plan @Tdm I took this to mean an additional risk assessment based on the environmental/situational risks.
 
Tdm said:
Does duk have some document/ guidelines on this? It must come up often for schools, preschool/afterschool clubs.
I take it when you say preschool you are talking children under 5, is that right?
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I linked to nursery info above but there is school info too.
 
If somebody at the organisation the nursery belongs to, states that you need to do a risk assessment then the person doing the assessment must surely to hell have been trained how to do them? (for a child with any medical condition whether that be Type 1 diabetes; ADHD; autism, anything for any child not in tip top health) So - who is going to do it?

Again I'm making assumptions here but surely they'll be asking you eg What do you ask whoever is dropping the child off to you - every morning? (eg if they ate all their breakfast this morning and have had the appropriate amount of insulin for that) Who asks them? Is that recorded, if so where? Is this always the parent(s)? If not, who?
 
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