Any ideas for this student?

[jnurse74]

I have a 3rd grader who is 9 and not even on the growth charts he is so tiny. He is on three psychiatric meds, 2 of which cause loss of appetite, for ADD, Anxiety & Depression. He gets a tray for breakfast and lunch, but rarely touches the food or even opens the milk, despite lots of encouragement. If he brings a lunch it is a baggie of dry ramen noodles or a few crackers and nibbles on them, but doesn't bring a drink or anything else. Since he is free lunch, our principal has him get a tray anyway, not that it helps any. He just looks so completely emaciated and malnourished and he has sores on his face and head that he constantly picks at; I have found that if I put neosporin on them he won't pick so I have been doing that daily and also talking to him about eating. I told him today, after he spent breakfast staring at his completely untouched food while picking his sores, that I know he isn't feeling hungry, but that he may have to force himself to eat something to stay healthy. Family services is already involved with this family, they have other kids, and it is a mess of a situation. I just don't know what, if anything else, can be done on our end. Any ideas? He is such a sweet kid and I just hate this, it makes me so sad.

[Jolie, BSN]

My long term goal would be to have him re-evaluated medically. I have had a number of students taken off ADD/ADHD drugs because their growth was negatively impacted. This poor kid only has so many years to grow and develop, including brain growth and development. I don't know his psych situation, but would question if it is so serious as to justify the negative side effects of these meds.

In the short term, is it possible to bring in home-made food, or purchase special take-out items for him? I know that's unusual, but let's face it, school lunch typically is less than yummy, and perhaps he would show more interest in meals that are really good, especially if he gets to share them with a friend or staff member as a special treat.

I once cared for a pregnant mom on long-term hospital bedrest who had zero appetite due to her lack of activity and side effects of her medications. The only way we were able to get any food into her at all was to bring home-made meals and milkshakes.

[raidermom]

You might try Pediasure milkshakes. I have used this with my own underweight child and it helped.

[Cherry Ames Peds RN]

Could you do his morning medications at school after he has had breakfast? Maybe then he'd have an appetite to eat at least that meal.

Also, can you get a release to talk to his PCP? Maybe you could work with him or her to come up with a school plan to boost this kid's calories.

Good Luck!

[rdsxfnrn]

I agree, think outside the (school lunch) box here...... milkshakes, homemade meals, special lunch plans, etc. This is a chance to make a difference in the life of a child! He will probably never forget your kindness. :)