Advice need on how to approach hygiene issues

[mc3, ASN, RN]

Hi everyone - I have a second grade student whose is terribly obese and has major hygiene issues. She lives with her Dad and brothers, and there is no female influence at all in the family. BMI letters went out recently, but few came back, and certainly not hers. In addition, she came to clinic today reporting her toes were hurting. Her sneakers were too small. While she was showing me her feet, I saw that she did not have panties on under her shorts. If I could see it, I'm sure others could, too. Overall hygiene is very poor, and she's so obese that her breathing is labored with even minimal effort. Nobody - even some of the teachers - seem to like this kid. I spoke to the guidance counselor, and they have had many conversations with Dad to no avail. I swear, I don't think the poor thing knows that she's a girl - she's the only one in the family. I think she needs to see a dr to get her breathing checked out. I offered, and guidance thought it would be very helpful, to have a private "talk" with this little girl on "girl stuff". Problem is, I have no idea where to even start or what to say so she won't be offended or upset. I will get permission from Dad if I can, but he does not answer his phone, and will not return messages. The address we have on our records is wrong, and they keep moving and won't give the new one. Sorry if this is too long! I've only been a school nurse for a few months, and I find this very sad. How should I best approach it?

Thanks!

mc3:nurse:

[Flare, ASN, BSN]

such a sad situation. I think you are on the right path. It is a delicate subjec and you need to approach with caution - perhaps by seeing what her perceptions of acceptable hygiene are. Ask her is she bathes daily, ask her if her clothing gets washed between wearings or how often she brushes her teeth. Once you get a dialogue going about hygiene, you will be able to gauge how you can steer the conversation. I personally am not one for coddling. I tend to think that you get better results from being repectful yet matter of fact. This is not appropriate for all situations or students, so i do keep a pair of "kid gloves"" tucked away for the times that you need them.

Try to keep a line of communication open with dad. If he continues to dodge your calls or does not do something to help remedy the situation - especially the breathing and medical issues - you may need to make a call to CPS to put some pressure on him. Also, if you have a social worker, get him or her involved with the situation - especially since this requires a doctor visit for breathing issues.

Good for you for wanting to advocate for a child that probably feels like an afterthought in this world. Good luck and keep us posted.

[Purple_Scrubs, BSN, RN]

Could not have said it better myself :)

I would definitely consider a CPS call for medical neglect. That kiddo needs to be checked out.

[Rosie67]

Ohhh, This happens so often! Sometimes the odor is so pungent that I know there isn't any hugging and kissing going on in that family let alone washing. The way some of these youngsters are raised is disgusting. Several times, when it comes to girls especially, I will acquire a piece of clothing, socks or new underpants. I can get them from our Social Worker or Goodwill. I call the student down and tell them I was thinking of them when I saw .... and thought "I know who would like these..." Then I talk to them about caring for the new item and switch to how to keep our bodies clean. When the child is young it's easier to gain some trust and get a conversation going. I call them down after wards for a few days in row. See if anything changes. Get the Social Worker involved. There are success stories and those make everything worth it. Some of those girls will just beam a smile when they start to feel better about themselves. Don't forget about CPS to get those medical concerns taken care of. Hygiene may not be her only issue. Good Luck!

[missfixit]

I agree with everyone and think you have gotten good advice. I also want to add that there are times when sexually abused children have poor hygiene on purpose to make themselves less "desirable". Not saying it is the case- just a thought.

[bunsterj]

What I found on a few occasions is that the family does not have access to a washing machine or laundromat funds, and hand washes the laundry in the tub...I don't know that it gets done often, and I don't think it gets really clean. On one occasion I had a parent come in for a different reason, and had planned to discuss her child's odor and overall hygiene issues with her...well I was just flabbergasted, because the mom was just as bad, if not worse. I'm not talking simple BO, but a very bad odor that lasted in the office well after she left.

One family was referred to CPS for some very serious issues, and they worked together and made some progress. I know the mom had a contract with CPS that the children would bathe on two specific days of the week. It was a rather sad situation, as she was a single mom with two kids and she was cognitively impaired. She loved her kids, but just didn't know how to deal with everything.

I always dreaded when teachers asked me to talk to so-and-so about their hygiene. These were never simple situations of talking about bathing and such and making sure they had supplies, they always seemed to come from complex home situations with parents that were not always appropriately responsive to any discussions/suggestions.