How to handle a 3rd grade hypochondriac?

  1. I would appreciate any advice on how to best handle this student.

    Student quite dramatically holds his chest and starts breathing heavily claiming he has chest pains. Comes to me clutching his chest and when I assess him, his pulse ox is good, breath sounds are clear, vital signs are within normal limits. Once I explain this and get him breathing slower, he is quickly back to normal and heads off to class. This has happened multiple times a week in the last three weeks. Student has been doing this in classroom more frequently than I realized as the teachers have somewhat figured him out and only send him to me when the symptoms persist. In addition to chest pain, sometimes it's his nose tickles or he's "allergic to the classroom."

    Mom is aware and tells me it has started happening at home and she is the one that told me "he is becoming a hypochondriac and something is ALWAYS wrong." PCP ruled out any medical issues and getting into some sort of counseling is in progress.

    In the meantime, any ideas? He is missing quite a bit of instructional time and being disruptive to the classroom with his frequent "episodes." The teachers are at their wits end, I was thinking maybe have him come see me daily on the way to recess which is before lunch for a quick check out and talk to try to prevent disruption to the classroom but don't know if that will help feed the issue?

    I honestly don't know if these are true panic attacks or a bit of acting on his part as yesterday he was fine and everything had subsided and when the assistant principal popped her head in to ask me a question about something else he immediately clutched his chest again.

    Appreciate any help from the nurse's station
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  2. 24 Comments

  3. by   JenTheSchoolRN
    Oh, River Song, you and and I must have the same student. Mine took me he couldn't feel his arms, yet could perform any task I asked him to perfectly with his arms and hands. This student also has diagnosed anxiety (specifically around attending classes) and is seeing a counselor.

    I've brought out the tough love. I also allow this student one check-in per day, limited to 10 minutes or less. After that, I will only see student if it is true emergency. I've also had teachers call me to check-in, which means they are acknowledging him, but then report back to student that I say they can remain in class at this time and use their scheduled check-in at lunch if needed.
  4. by   OldDude
    Let him know the only thing you can do is nothing or call an ambulance. Teach him how to assess himself, when he comes in, have him do a self assessment, and ask him if he wants you to call an ambulance or if he wants to go back to class. Make him take ownership of the episodes. Based on what you've seen so far, you'll be able to recognize if he is really in distress and intervene if necessary.
  5. by   River Song, RN
    Quote from OldDude
    Let him know the only thing you can do is nothing or call an ambulance. Teach him how to assess himself, when he comes in, have him do a self assessment, and ask him if he wants you to call an ambulance or if he wants to go back to class. Make him take ownership of the episodes. Based on what you've seen so far, you'll be able to recognize if he is really in distress and intervene if necessary.
    I do like this idea. I feel like pulling out my pulse ox and stethoscope every time is only fueling the problem but as a first year school nurse I'm always worried about my liability. Given that his mom is aware and understands that his medical problems aren't *really* problems, I think I can take a different approach.

    I have started beginning our interventions with asking him how many times has he seen me and has there been a *real* problem and he acknowledges zero. Then he will tell me he is "uncalm" and doesn't know why. We have then talked about how his "uncalm" comes from his brain and he needs to tell his brain he is ok.

    I will be honest that I'm just winging it as this is all new territory I really appreciate the advice!!!
  6. by   BeckyESRN
    Can you use something to help calm him before he gets to this point of increased drama? Like a glitter bottle, some "brain" putty, a stress ball- Some of kiddos have had a bit of success with these to help chill them out before it gets so amped up that they can't function. Obviously, there is some bit of dramatic flair going on here, but anxiety is scary and he is ill equipped to deal with it right now. Teach him some deep breathing, maybe the 4,3,2,1 technique to ground himself when he feels it getting bad? (4 things you can see, 3 things you can hear, 2 things you can smell, 1 thing you can touch)

    I like how you're letting him lead the assessment and having him say that nothing has been truly wrong! Do you have a guidance office, maybe direct him there when it starts because it's not a medical issue and a whole team approach may be more successful. Or you could always tell him to knock it off!
  7. by   Flare
    Quote from OldDude
    Let him know the only thing you can do is nothing or call an ambulance. Teach him how to assess himself, when he comes in, have him do a self assessment, and ask him if he wants you to call an ambulance or if he wants to go back to class. Make him take ownership of the episodes. Based on what you've seen so far, you'll be able to recognize if he is really in distress and intervene if necessary.
    The problem with offering them the ambulance is that these dramatics want that level of show over nothing. They truly think that an afternoon spent in an ER and pulling parents away from their jobs is a worthwhile venture for their hypocondriasis. The trouble is though that their symptoms are real to them. So while on one hand I want to shuffle my little malingerers out the door with a pat on the shoulder and wish them a good day, i know that sometimes I just have to suck it up and let them stew for a few minutes or they will be right back, doubled over, tears streaming down the face.
    Things that have helped calm them:
    setting a timer - x minutes of rest. a concrete number that lets them know that they ARE going back but that they are getting a break
    breathing exercises - google has a thing that will come right up if you type it in the search bar. works well too with the littles if you use a pinwheel.
    peppermints
    saltines - naturally
    I may call a parent for to give a pep talk - but i use this as an absolute last resort - as all too often the student ends up crying their way into getting picked up and it perpetuates into a cycle that the parent doesn't know how to break / say no to. I hate seeing the student dig themselves into that hole.

    I like the idea of the glitter bottle - i'm going to have to look into that - sounds like a winner!
  8. by   MrNurse(x2)
    My FF that was missing LOTS of class time had the provision that he could only come during recess. This was mom's idea, she is a teacher. Nipped it in the bud, he sees me maybe once a week.
  9. by   Farawyn
    Quote from Flare
    The problem with offering them the ambulance is that these dramatics want that level of show over nothing. They truly think that an afternoon spent in an ER and pulling parents away from their jobs is a worthwhile venture for their hypocondriasis. The trouble is though that their symptoms are real to them. So while on one hand I want to shuffle my little malingerers out the door with a pat on the shoulder and wish them a good day, i know that sometimes I just have to suck it up and let them stew for a few minutes or they will be right back, doubled over, tears streaming down the face.
    Things that have helped calm them:
    setting a timer - x minutes of rest. a concrete number that lets them know that they ARE going back but that they are getting a break
    breathing exercises - google has a thing that will come right up if you type it in the search bar. works well too with the littles if you use a pinwheel.
    peppermints
    saltines - naturally
    I may call a parent for to give a pep talk - but i use this as an absolute last resort - as all too often the student ends up crying their way into getting picked up and it perpetuates into a cycle that the parent doesn't know how to break / say no to. I hate seeing the student dig themselves into that hole.

    I like the idea of the glitter bottle - i'm going to have to look into that - sounds like a winner!
    Best answer.
  10. by   JenTheSchoolRN
    Quote from Flare
    The problem with offering them the ambulance is that these dramatics want that level of show over nothing. They truly think that an afternoon spent in an ER and pulling parents away from their jobs is a worthwhile venture for their hypocondriasis. The trouble is though that their symptoms are real to them. So while on one hand I want to shuffle my little malingerers out the door with a pat on the shoulder and wish them a good day, i know that sometimes I just have to suck it up and let them stew for a few minutes or they will be right back, doubled over, tears streaming down the face.
    Things that have helped calm them:
    setting a timer - x minutes of rest. a concrete number that lets them know that they ARE going back but that they are getting a break
    breathing exercises - google has a thing that will come right up if you type it in the search bar. works well too with the littles if you use a pinwheel.
    peppermints
    saltines - naturally
    I may call a parent for to give a pep talk - but i use this as an absolute last resort - as all too often the student ends up crying their way into getting picked up and it perpetuates into a cycle that the parent doesn't know how to break / say no to. I hate seeing the student dig themselves into that hole.

    I like the idea of the glitter bottle - i'm going to have to look into that - sounds like a winner!
    YES and YES and YES.

    You say "I can call an ambulance" and their face will light UP! I am serious. They think the attention of an ambulance is great. I learned that quickly and changed my ways. Now I limit options and set time limits and do not budge. It acknowledges I am listening and know they need a break, but that break will not last forever.

    I have also checked a temp, for example, showed student it was normal and said firmly "I know you are safe to return to class." I like the word safe as it seems to also acknowledge that I know student needs comfort but that comfort can be achieved quickly. I do allow a parent check-in if absolutely needed, but I will tell student that I will be telling parent that they are healthy enough to remain in school and that the agreed plan is for student to have a 3 minute or less check in before I let them return to class.

    Of course, parents need to be on board, but usually I have found they are and appreciate my cooperation. I have also called a parent to check-in after I have gotten student to return to class to update them on their day and help prep them when student arrives home. Sometimes the parent will also be very grateful for the fact that I acknowledge it is hard on their end as well. It really can take a village .
  11. by   Farawyn
    Quote from JenTheSchoolRN
    YES and YES and YES.

    You say "I can call an ambulance" and their face will light UP! I am serious. They think the attention of an ambulance is great. I learned that quickly and changed my ways. Now I limit options and set time limits and do not budge. It acknowledges I am listening and know they need a break, but that break will not last forever.

    I have also checked a temp, for example, showed student it was normal and said firmly "I know you are safe to return to class." I like the word safe as it seems to also acknowledge that I know student needs comfort but that comfort can be achieved quickly. I do allow a parent check-in if absolutely needed, but I will tell student that I will be telling parent that they are healthy enough to remain in school and that the agreed plan is for student to have a 3 minute or less check in before I let them return to class.

    Of course, parents need to be on board, but usually I have found they are and appreciate my cooperation. I have also called a parent to check-in after I have gotten student to return to class to update them on their day and help prep them when student arrives home. Sometimes the parent will also be very grateful for the fact that I acknowledge it is hard on their end as well. It really can take a village .
    Okay. A tie.
  12. by   River Song, RN
    I feel bad for the teachers as his behavior is so disruptive to the class as he is doing it multiple times a day ... classroom, art, PE, cafeteria. Miraculously it never happens at recess.

    This afternoon when he came in he was holding one armpit then the other saying "oww!" and doubling over randomly. I've tried having him deep breath and he will be totally calm but then when I tell him it's time to go back to class he starts doing the "oww!" clutching himself action again.

    The counselor is aware and made a referral to get an outside evaluation for counseling in the community. Basically the teachers and I are alone in figuring out how to deal with this in the classroom. Mom knows it's a problem but doesn't have any suggestions. I'm not sure if calling her when he is in my office would be helpful or not ... I do know that she WON'T leave work to come pick him up and create that cycle.

    It is pretty obvious that he is trying to get out of class as it seems to happen most often during things that he does not want to participate in. I don't mind him coming in but the whole process gets old of him seemingly fine then getting pains as soon as going back to class is mentioned. The fact that is happened today right as I was going to eat lunch didn't help
  13. by   Mango Juice
    Please let me know when you find the answer so I can apply it to my student population 😐
  14. by   JenTheSchoolRN
    Quote from River Song, RN
    I feel bad for the teachers as his behavior is so disruptive to the class as he is doing it multiple times a day ... classroom, art, PE, cafeteria. Miraculously it never happens at recess.

    This afternoon when he came in he was holding one armpit then the other saying "oww!" and doubling over randomly. I've tried having him deep breath and he will be totally calm but then when I tell him it's time to go back to class he starts doing the "oww!" clutching himself action again.

    The counselor is aware and made a referral to get an outside evaluation for counseling in the community. Basically the teachers and I are alone in figuring out how to deal with this in the classroom. Mom knows it's a problem but doesn't have any suggestions. I'm not sure if calling her when he is in my office would be helpful or not ... I do know that she WON'T leave work to come pick him up and create that cycle.

    It is pretty obvious that he is trying to get out of class as it seems to happen most often during things that he does not want to participate in. I don't mind him coming in but the whole process gets old of him seemingly fine then getting pains as soon as going back to class is mentioned. The fact that is happened today right as I was going to eat lunch didn't help
    River Song, again I have a couple of students in the same boat and I feel your pain!

    Yesterday, I just looked at the student and said "You have been resting in my office for xx time during which I have seen nothing that tells me you cannot be in school at the this time. Therefore, I am signing your pass and you will return to class." I have taken other options out of the equation.
    Student and I had a brief staring match, student sighed and took pass.

    I have found frequent communication with principal and teachers helps A LOT. I will send an FYI email about frequent visits and that student is okay to stay in class. We have a space student can take a brief "rest" in that we make as boring as possible.

    Same student sat with me for observation once after telling me they had "sharp stabbing pains in every part of my body" (Vitals normal, skin color normal, etc). I did not engage them and after 10 minutes student said they were bored and I smiled, signed their pass. Student started to protest but I told student that it appears they are healthy enough to be bored in my office, so they are healthy enough to be bored in math class.

    Hang in there - these are the students that came just plain exhaust me!

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