Advice needed for Anxious Kindergartener making himself barf

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Specializes in Pediatrics, Community Health, School Health.

Help a colleague out :arghh: please! I am starting my second school year at a small, inner-city charter school with only K and 1st grades. We have a new K student who just joined our school last Monday 9/19. He had started the school year 2 weeks before at the local public school he was zoned for, but then was admitted to our charter school after being wait-listed, so mom enrolled him.

He started last week in one classroom but by Wednesday, it was clear he needed to be in a different classroom where both teachers speak Spanish as his English is limited and neither of his parents are comfortable speaking English. So last Friday (his fifth day here) he was moved to the classroom across the hall where both teachers are Native Spanish speakers (and both lovely and warm). Just after lunch he started vomiting. We though nothing of it and called mom that he was ill and needed to go home. She came and got him and that was that.

Yesterday was to be his first full day in the new classroom (since he left sick Friday). At 10 am he is brought to me vomiting. I take his temp and as I get near his mouth with the thermometer he gags violently and vomits clear sputum into the trash. So I take an axillary temp instead. He's right at 100. I call mom to tell her he is vomiting and has a very low-grade temp. She is pissed b/c she works an hour away and is scared she will be fired (a very real scenario for my population). She shows up two hours later to get him. In those two hours he was out cold asleep on the cot. Kid seemed sick enough. I arrive at work this morning surprised he is here since the rule is fever free for 24 hours (plus no vomiting for 24 hours). Just as I am getting ready to call mom, he is brought to me "vomiting clear stuff into the trash can". So I start talking to him and he keeps telling me "can you call my mom so I can go home. I am sick". So I am realizing that he clearly is not actually "sick" but making himself gag/vomit b/c he wants his mom. I just spent the last 30 minutes with him telling him he is OK and he is just inconsolably sobbing saying "call my mom I am sick and need to go home".

I am at a loss. His teachers are both awesome. I think the temp of 100 was a fluke yesterday and I know he is clearly not sick and just making himself gag so he seems sick. I told this to the teachers and they agree but are at a loss in terms of having him stay in the classroom as he is upsetting the other kids and a big distraction. But I don't want him in my office b/c he doesn't need to be here and I have other kids I need to take care of. Plus he will never get used to the new class if he never stays in there.

WWYD???

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Specializes in IMC, school nursing.

This is a parent issue. I would give him a bucket and send him back to class, call mom and make her aware of what is going on. It may be hard for the teacher, but if he is ignored he has lost the power of attention. Be sure he doesn't have a virus, because you would look like a mean nurse if he truly is sick. :nurse:

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Specializes in Nursing Professional Development.

Have you asked him why he is anxious? Is there some reason he doesn't like coming to school? I'm not suggesting a whole therapy session ... but sometimes, if you ask a kid what the problem is, they'll tell you.

He's a little kid with a real problem -- and it sounds like his Mom may be unable to recognize it or deal with it. Maybe a few minutes of talking (and listening) would help move him in the right direction. It sounds like he needs to feel cared for.

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Does your school have a guidance counselor or a psych intern? That's where I would start.

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Specializes in Pediatrics Retired.
This is a parent issue. I would give him a bucket and send him back to class, call mom and make her aware of what is going on. It may be hard for the teacher, but if he is ignored he has lost the power of attention. Be sure he doesn't have a virus, because you would look like a mean nurse if he truly is sick. :nurse:

Totally!!!!!!!!!!!!!!!!

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Specializes in Pediatrics, Community Health, School Health.

OP here. We have a guidance counselor and she has been with him the past 2 hours. He is 5 and just would rather be at home- nothing is going on, nothing has happened. We had a crier like this last year but he stayed in the classroom and just cried all day as he did his activities for the first 2 weeks of school. This kid is physically making himself vomit thinking it will get him a ticket home. For now, he is sitting at the lunch table eating with his class and seems fine, but I am betting as soon as lunch is over and he has to go back to the classroom he will start this all over again.

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Specializes in school nursing, ortho, trauma.

so I have a fifth grader who just came from Colombia who has been in every blessed day with a stomach ache saying that she is going to throw up. I feel like she is in the same boat as the OP's little guy. Stranger in a strange land, doesn't speak the language and is getting herself overwhelmed by the fact that the class is moving fast and it's hard to keep up with that. I get a stomach ache just thinking about it. And i suppose one could argue that kindergarten is a lot of playtime and naps - but not while you're doing it. Kindergarten is really stressful for a lot of these littles. I'm glad he got moved into the classroom where he can better communicate with the teachers - now he just needs to realize that puke does not necessarily = day over ride home.

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Specializes in School nursing.

OP, have you considered maybe building a "check-in" only plan with his Mom? I have some kids that I work with that can get physically sick when they get anxious. In addition to checking in with counselor, I had one student that could not focus unless she talked with her mom (and she was much older than 5). She would get physically sick and make herself miserable. At first I was resistant and realized that wasn't the way to go at all. So I talked with Mom and the counselor. We set up a "5 minute check-in" pass with Mom each day. No more than 5 minutes, could only happen during lunch or a study hall, and if Mom was unavailable, she could leave a message, but had to return to class. She was not allowed to ask Mom to pick her up.

She used it regularly for a couple of weeks, but then it tapered off. She found her grove in the school year and lost the need to have that check-in.

Now, I know negotiating with a 5 year old is very different, but maybe setting some kind of limit with him would help.

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Specializes in med-surg, IMC, school nursing, NICU.
Stranger in a strange land

... Dylan, Berlin, Bay of Pigs invasion.

Your response was very well informed and helpful but after reading it, I can't get "We Didn't Start the Fire" out of my head. I'm not upset.

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Specializes in Sub-Acute, School Nursing, Dialysis.

I had a similar kindergarten student at the beginning of September do this as well. She was also like this in preschool but it eventually stopped. It was frustrating trying to figure out what to do and to not make it a habit of sending her home all the time. Last year's teacher always wanted her sent home even though it was never actual vomit. Just a mucous type of spit up. She never had a fever and wasn't sick. Just anxiety.

I think having support from the teachers helps too. Her teacher this year is amazing and knows she is not sick and does not want her to go home unless she really needs to. The mom is understanding too. But I would always have this kiddo in my office for a good hour sometimes, calming her down and reassuring her that she was okay. Obviously not something I would want everyday to happen. But we finally found the cause of her anxiety which was eating lunch in the cafeteria. She is now doing fine and usually will eat lunch at snack time which is in her classroom which doesn't give her anxiety. It's tough. I wish you luck!

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Had a little one last year with sudden panic attacks/anxiety/fits of gagging/vomiting. Stemmed from abuse happening over the Summer that had just come to light. With the help of a counselor she improved greatly over the course of 2 months. Good luck to your student!

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Specializes in Pediatrics, Community Health, School Health.
Had a little one last year with sudden panic attacks/anxiety/fits of gagging/vomiting. Stemmed from abuse happening over the Summer that had just come to light. With the help of a counselor she improved greatly over the course of 2 months. Good luck to your student!

That is heartbreaking :(

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