underweight kid

Specialties School

Published

dear school nurses,

im new to school nursing and have a question and hope i can get some answers please. a teacher brought down a kid to me who is 37lbs and has a BMI of 14.6. now this is in the 5th percentile which means the kid is underweight. now will u handle this situation. call the parents, send a letter home? what? any info is very much appreciated

Maybe just ask the parents. They may have a reasonable explanation. My oldest child had an appendectomy when he was 8 he weighed about 55 lbs before and when he finally could go back to school he weighed only 35lbs. He was very under weight for over a year spanning two different grades. Both of my boys are under weight and it is because of the medications they take. I agree with the others, as long as the child doesn't seem to be neglected or abused then the parents probably have an explanation for the weight.

Specializes in Maternal - Child Health.

Flare's response is accurate for my state as well. Public health regulations require school screenings of height, weight, BMI, vision, hearing, dental and scoliosis at prescribed intervals with "norms" written into law, and specifying deviations that must be reported to the parents.

With approximately 2000 students in 4 buildings, I was fortunate to encounter only 1 irate parent, who became much more reasonable after a discussion.

Weight is understandably a sensitive issue and must be approached as such. Parents don't get ***** over a note home about a failed vision screening because they don't feel personal blame if their child has a vision problem. Obviously the same is not true for weight, hence the heated reactions.

We send a notice home prior to all screenings, including the parent's right to opt their child out. At the middle school and high school levels, we will allow a child to opt him/herself out, but will notify the parent. Screenings are done in private and all data is held in the nurse's office. In the event that a parent is notified of results out of range, we explain that the information is for their purposes only, to be shared with their health care provider if they so choose. We reassure them that we do not share the information with anyone, not even the student, unless the parent requests it.

And even though our state law sets limits at which notices are to be sent to parents, we still use discretion in doing so. If a child is well known to the nurse and known to be under the regular care of a health care provider, we may opt not to send a notice, if doing so would just be "piling on." For example, a newly-diagnosed diabetic student for whom we are in regular contact with the parent and doctor. Or a student with celiac disease for whom we have just participated in a care planning session with the parents, student and teaching staff. In these cases, a brief note in the students' records will explain that notification was not deemed necessary at that time due to recent/regular contact with the parents and health care provider.

I'm curious with the parents here who have indicated that they would be irate if they received a note from the nurse about their child's weight...would they be indignant over a note detailing a possible vision problem? What about a note from the teacher about poor classroom performance in math? Why would they view objective information about their child's weight or BMI any differently?

Specializes in ccu.

I'm the parent to a peanut-kiddo. At 8 years old, and in 3rd grade, she is smaller then her 1st grader brother, and a decent number of the kids in his class. She has been in the 5th percentile for height and weight since she was 4mos old.

I don't understand why anything needs to be done? Does he look malnourished?

I don't know that I would be mad, per-sey, if the school called me about her size, but I would probably be irritated....I don't know, the whole thing sounds odd to me, but maybe that's because I'm not a school nurse?

Specializes in kids.

Our job is to observe assess and formulate a plan....would you prefer the nurse NOT notice and advise? If you know your child is underweight for whatever reason, it is ok to advise the school what is up....then you as a parent have addressed it and no one will bother you. I have found out very interesting things in my conversations with parents, sometimes really important health information that they just assumed I knew, that they assumed the doc had sent etc.

Sometimes the school nurse will be the first to notice something that needs to be addressed, a lump a rash and pustule that turns out to be MRSA.

Feel free to call me any time, I, as a nurse appreciate a heads up. I don't appreciate being disdained for sharing a observation in a profession and nonjudgmental manner.

Speaking of sticking my nose where it doesn't belong, I'm not a school nurse but did want to add this: I was raised in a single parent home, and some things got missed. The school nurse at my elementary school was the person who noticed my symptoms of a common autoimmune disease, and brought it to the attention of my parent who immediately got me into the pediatrician. Thanks to that school nurse noticing my weight disparity (among other sx), I was able to get early treatment. Weight problems in kids are not always "you're not feeding them enough," sometimes it's a real health issue nobody's picked up on yet.

Thanks for all your responses especially to you Flare. I appreciate it. Im surprised at all the people who are just about ready to cut my head off. Maybe u need to read my post again. i was just asking if there is anything to be done. geez people seriously.... in case u were wondering this is the last thing i wanna be dealing with. my day is full enough and im new to this so i still have alot of learning and organising to do. if i dont have to do anything, i wont. do u think i care. just trying to stick to the job description thats all. i did speak to my manager who asked me to just get some info from the parent and see whats going on with lil man(sthing i dont even wanna do) but i guess i didnt get hired to what i feel like. still waiting for mom to call me back. in the meantime, take it easy people. its not even that serious. no where in my post did i say i thought the kid was abused. y,all hav a blessed day

Age is important here. I remember when I was younger, I was the epitome of scrawny...and I'm STILL much skinnier than I'd like to be (current BMI as underweight...I hate my metabolism). Really does depend on the child, but talking to the parents might be all it takes. If there's any indication of abuse, you'd see it when meeting with the parents (i.e. noticeable fear of parents, changed character when around them, etc). :)

Specializes in ER volunteer.

interesting how everyone immediately either gets ***** off or wants to know if there's other signs of abuse... but you're forgetting about another big weight factor - eating disorders. that's something that the kid could be very good at hiding from his/her parents, so they might not know about, and a notification home could allow them to get their child help while it's still early enough to make a difference. Eating disorders are a lot easier treated when they've only been going on for a few months then when they've been part of your life for years...

And what if the child was being neglected?

I don't understand why a parent would be mad?!?!

I suppose it would depend on the tone of the phone call/letter - as in an "FYI" or an "accusatory" sort of way...I can relate - my girl twin is also just over 10th percentile - up until she was 5 she wasn't ON the chart - her pedi never worried, she followed her own growth curve and never dropped/fell off it...

All just opinions here...I think we are on the same page, OP. If you perform a nursing assessment, the rest of the nursing process needs to follow. To screen and not intervene if there are abnormal results would be pointless and not in the kid's best interest. From my perspective, referral to a healthcare provider for further evaluation is an appropriate next step if the weight is out of normal range. I wonder why your employer doesn't have guidelines for referral & follow-up spelled out somewhere???

It seems like a lot of responses are from a parent's perspective, rather than a nurse's. Those perspectives may help the OP to be more sensitive when approaching the parent & remind her that there are a variety of factors to consider, but it doesn't really give her nursing guidance.

One last thought: "Underweight" means

Specializes in Med/Surg, Neuro, ICU, travel RN, Psych.

I agree that I think the tone and how it is approached is what is most important. I have a tiny peanut for a daughter who has not even been on the growth chart. Having personally dealt with both aspects, Dr's who say it's not a problem, to others who made it a big deal, I can understand why some would be upset. I actually switched pediatricians because I got tired of the back and forth. One doctor said it's not a worry, the next appointment we'd see someone else, and I'm told we need to address this issue and it's a big deal. Being told your child is underweight can feel like a personal attack, or that someone is telling you that you are doing something wrong. Maybe because even being told your child is fine, it can still be in the back of your mind that you are not feeding them enough or something.

A phone call over a letter would probably appease me more. It's easier to handle it with less miscommunication. Starting with this is just a protocol, part of our assessment and we are trying to gather all the facts type statement can make a big difference.

About 8 month ago, my daughter was in the hospital overnight with an injury. There was a student nutritionist (didn't know that at the time, as she didn't identify herself) just comes in the room and starts talking. Asking me all these questions because there was "something wrong". She had no clue what she was talking about. Being a nurse, I didn't freak. I actually spoke with the teacher, and they used it as a learning experience. But had I been anyone else, it could have been a bad situation. I could have gotten even more upset, believing there was something wrong with her.

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