Procedure REGULATED ACETAMINOPHEN ACETAMINOPHEN is the generic name of the medication that is commercially available under the following brand names: Atasol, Tempra, Tylenol and other house brand names.
Under the Regulation respecting childcare centres and the Regulation respecting day care centres, acetaminophen may be administered without medical authorization to a child received in a childcare centre, a home childcare setting or a day care centre, provided it is administered in accordance with this Protocol and that a parent has given written consent.
Parents are not required to consent to the application of this Protocol. However, if a parent does not sign theauthorization form, the medication may not be administered to the child unless the parent and a member of theCollège des médecins du Québec give written authorization. BASIC RULES
Under no circumstances must the dosage exceed thedosage guidelines below or the dosage prescribed on
Within the framework of this Protocol, acetaminophen
may be administered solely to reduce fever.
A tablet for adults must never be cut up and
It may not be administered
administered to a child as it could alter the dosage: an
• to children under two months of age;
inadequate dose would not provide the expected result,
• to relieve pain;
while an overdose could pose serious risks to the child. • during more than 48 consecutive hours (two
It is important to always check the concentration of
days); or
acetaminophen and to follow the dosage instructions
• to children who have received medication
on the container since new products of greater or lesser
containing acetaminophen in the preceding four
strength may appear on the market. It is also
recommended to use only one concentration if the
In those four cases, the Protocol does not apply and
brand name selected is available in more than one
written authorizations from a physician and the parent
are required to administer the medication.
Any administration of acetaminophen must be recorded
Centres, persons recognized as home childcare
in the register of medications prescribed by the
providers and day care centres may have their own
Regulation and the parent must be informed.
acetaminophen container, in which case the brand
(See over)
name, the dosage form (drops, tablets, syrup) and theconcentration must be indicated on the authorizationform.
To avoid confusion, centres, persons recognized as
This Protocol was prepared by the Ministère de
home childcare providers and day care centres should
l’Emploi, de la Solidarité sociale et de la Famille
keep acetaminophen in only one of its 2 liquid forms:
and approved by a working group composed of
drops or syrup. If they receive children under 24 months
representatives from the health and social
of age, it is recommended that drops be used instead of
services network and childcare services. The
syrup. If they elect to use syrup for the other children, it
information it contains reflects the state of
is recommended to use only one concentration. AUTHORIZATION FORM FOR THE ADMINISTRATION OF ACETAMINOPHEN
Parents are not required to consent to the application of this
to administer to my child, in accordance with this Procedure,
Protocol. However, if a parent does not sign the authorization
acetaminophen sold under the following brand name:
form, acetaminophen may not be administered to the childunless the parent and a member of the Collège des médecinsdu Québec give written authorization. A parent may limit theperiod of validity of the authorization by indicating the
Brand name, form (drops, syrup or tablets)
duration of the authorization in the space provided.
(name of the childcare centre, the person recognized as thehome childcare provider, the person who assists the provider
or the person designated under the second paragraph ofsection 67 of the Regulation respecting childcare centres, ifany, or name of the day care centre)
WHAT YOU SHOULD KNOW
The only sure way to measure fever is to take thechild’s temperature. A child’s temperature must be
What is a normal temperature?
checked whenever the child’s general condition
The normal temperature range will vary depending
(persistent crying, loss of energy, change in general
on the measurement method used, as illustrated in
condition, loss of appetite, etc.) or physical
symptoms (flushed cheeks, excessively warm skin,sweating) could be sign of fever.
Measurement Normal Variation Method in Temperature
The following measures are recommended:•
take the rectal temperature of children under
temperature of children between two and five
take the oral temperature of children over five
always use disposable plastic tips as they are
What is fever ?
more hygienic; otherwise, disinfect thethermometer properly between each use;
Fever is defined as a body temperature that ishigher than normal. Normal temperature may vary
if the child has just been physically active, wait
somewhat depending on the child, the time of day,
approximately 15 minutes as the child’s body
the outdoor temperature and the level of activity.
temperature may be higher than normal if it is
The cause of the fever is more important than the
always comply with the time requirements for
the thermometer being used since the time
It is generally considered that there is fever if
required may vary with the thermometer. A
the rectal, oral or tympanic temperature is
digital thermometer, which requires less time
above 38.0°C or if the axillary temperature is above
to take the temperature, is recommended. WHAT YOU SHOULD DO
inform the parent of the child’s condition;
If you notice the start of an increase in body
administer acetaminophen according to the
temperature (a rectal, oral or tympanic
temperature between 37.5°C and 38.0°C or an
instructions on the medication container, in
axillary temperature between 37°C and 37.5°C),
accordance with the rules in this Procedure;
and if the child’s general condition is good and
one hour after administering acetaminophen,
there are no specific medical precautions that need
take the child’s temperature again; if the
temperature is still high, ask the parent to
come and pick up the child. If the parentcannot be reached, call the persons designated
have the child drink (water, fruit juice or milk)
by the parent as emergency contacts and if
they cannot be reached, take the child to a
keep an eye on the child and take the his/her
medical service, to the local community service
temperature again after 60 minutes, or sooner
centre or to a hospital emergency department.
if his/her condition seems to be worsening;
inform the parent of the child’s condition. When you administer acetaminophen, If a child under two months of age has a fever (a
always use simple words, appropriate to the
rectal temperature above 38.0°C or an axillary
child’s age, to explain to the child the
relationship between his/her condition, themedication being taken and the expected
apply the measures listed above for an increase
in body temperature (dress comfortably, havethe child drink and keep an eye on him/her);
notify the parent immediately; ask the parent
to come and pick up the child and, in the
check the concentration, dosage instructions
meantime, apply the measures listed above;
and expiry date on the medication container;
if the parent cannot come to pick up the child,
pour the medication (drops or syrup) into a
call the persons designated by the parent as
administer it to the child; never put a medicine
reached, take the child to a medical service, to
dropper directly into a child’s mouth, unless it
the local community service centre (CLSC) or to
is a disposable dropper. The spoon must be
administer acetaminophen without a written
medical authorization for the child.
if administering a tablet, put it in a medicine
cup then have the child take it. If the child
If a child two months of age or older has a fever
wants to, he/she may drink a little water after
(a rectal, oral or tympanic temperature above
38.0°C or an axillary temperature above 37.5°C),
apply the measures listed above for an increase
in body temperature (dress comfortably, havethe child drink and keep an eye on the
(See over) ACÉTAMINOPHEN : DOSAGE CONCENTRATION 80 mg/5ml 160 mg/5ml 80 mg/tablet 160 mg/tablet The dosage unit may be repeated every four hours. Do not exceed six doses in a 24-hour period. The dosages shown in the chart above are based on a maximum dose of 10 to 15 mg/kg/.
This Protocol may be applied as indicated even
if a child has been given ibuprofen at home
before arriving at the childcare establishment,
regardless of the time elapsed. There is nocontra-indication to or danger in givingacetaminophen to a child who received
IBUPROPHEN:
ibuprofen earlier since the two medications donot work in the same way.
A warning is needed since a clear distinction
OTHER MEDICATIONS:
The availability of an increasing number of
Although both medications have antipyretic
combination medications containing acetami-
(fever-reducing) properties, they must not be
nophen and another pharmaceutical product on
confused because they belong to different
the market calls for greater care in applying this
classes of medications and work differently.
Ibuprofen must not, under any circumstances,
be substituted for acetaminophen for thefollowing reasons:
Good communication between parents and the
person authorized to administer the medication
ibuprofen is a non-steroidal anti inflam-
medication the child received in the four hours
before arriving at the childcare establishment so
the dosage and frequency of administration
that the Protocol may be applied safely, for the
it has been established that all NSAIDs may
If an educator or a person recognized as a home
affect respiratory functions; that is why
childcare provider notices fever in a child within
four hours of the child’s arrival and has been
other medication earlier, she may contact a
between salicylates and ibuprofen (allergic
pharmacist to obtain the necessary information
concerning the medication and apply theProcedure accordingly.
When applying this Protocol, care must be taken
to never confuse ibuprofen and acetaminophenor substitute one for the other.
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Table of Contents Letter of Introduction ………………………………………………Page 2 Daily Schedules ……………………………………………………Page 3 Infants, Creepers, Toddlers Clothing and Personal Belongings .……………………………….Page 5 Arrival and Departure Procedures Transportation Procedures Emergencies and Hazardous Weather Health and M