Bathroom Accidents/Change of Clothes

[NanaPoo]

Happy Monday! Are you counting days til Summer? 3.5 days for me!

So, I have a question for those of you in elementary schools and how you handle potty accidents.

I am the lone nurse at our school and when our littles have pee and poop accidents the responsibility falls to me to handle the clean-up and change of these kids. I make a point, whenever humanly possible, to hand these kids a change of clothes & either send them to the restroom or give them privacy in my clinic closet to change. Then I always notify their parent of the situation via email and give details of how they were able to change/clean on their own.

BUT, often at the beginning of the school year, my K5 kids need significant help with changing and clean-up. Or there's a kid in the bathroom that needs me to come wipe their bottom. And there's this one kid in 1st grade that has ZERO modesty and before I can leave the closet he's porky pigging it right there. He's been doing that for 2 years now. I love him but I'm ALWAYS telling him, "wait til I get out, buddy!"

So, how do you guys handle these situations? Do you pull another staff or faculty in to witness? Do you insist a kid do this on their own without your help? How do you protect yourself?

[NanaPoo]

I agree that one allegation would ruin my career and potentially my life. This is why I'm here asking about this.

But I absolutely do not have the heart to have a 5 year old sit in urine until it dries. Some of these kids are soaked all the way down to their socks!

I had a mom jump all over me via email for helping her kid change out of urine-soaked undies, pants, and socks last year. She said next time to let her know and she would come take care of him herself. I replied to clarify that next time I should let him sit for 20 minutes in his own urine and have him wait for her. I really did honestly want to be sure that was her desire. She personally came to the school and apologized to me and thanked me for cleaning him up the very next day & said, no, of course, she wanted him cleaned up and back to class ASAP.

[NanaPoo]

Even when I was a SAHM 6 miles away I wouldn't want my daughter to sit humiliated, soaked in urine while she waited on mama to arrive when there was a perfectly nice nurse to care for her.

But I do absolutely get where you guys are coming from as well.

Ugh.

[mom to many]

So...my question. What do you guys do if you have a student who has an accident, no change of clothes, no extra clothes in backpack, and no phone numbers work??? Do you send them back to class?

If the child doesn't have extra clothes, and I can't reach a parent, I do keep a few extra changes of clothes. I give the clothes and wipes to the student for them to change and clean themselves.

[kbrn2002, ADN, RN]

It's sad that you need to be so concerned about your reputation, your career, your entire life really if one errant accusation from a kid can ruin you. It's also true that it can happen so I wouldn't suggest that anyone other than a parent be anywhere near a child's genitals. If the little one truly can't clean up himself or herself then the parent needs to be contacted, at that point if the parent give's you the OK to help if it is inconvenient for them to come in and take care of it then make sure and document that very thoroughly. I would further suggest that you don't do a thing without a second trusted adult there as a witness, preferably the teacher or somebody from administration.

[mc3, ASN, RN]

There is one child in our school who has spina bifida. She is too little to adequately clean and change herself, and can't tell if she's gone (except for the odor..). The classroom has an aide, and she will clean and change her if she's there. If not, they send her to me and I have to. I always, always get another adult to witness me changing the child. I've even borrowed teachers who happen to be free on break and walking by my office to be my witness. And I write "changed student, witnessed by: whoever" when charting my clinic visits.

[lifelearningrn, BSN, RN]

Calling a parent and asking them to come clean their student up is not feasible, in my opinion. We live in the suburbs of a very large city. Commutes to and from work can be an hour or more due to traffic. Having a parent drive back to school to wipe a bottom or change underwear is a ridiculous request.

With all due respect, children are supposed to be toilet trained prior to starting school. While I agree it's sometimes impossible for parents to come in a timely manner... and I'm certainly willing to offer clothing (if I have them), wipes and privacy.. but I will not make it my duty to wipe bums all day...

[Farawyn]

With all due respect, children are supposed to be toilet trained prior to starting school. While I agree it's sometimes impossible for parents to come in a timely manner... and I'm certainly willing to offer clothing (if I have them), wipes and privacy.. but I will not make it my duty to wipe bums all day...

What about viruses? Kids who just can't hold it? Special Ed kids?

I don't know. I don't have to run in to this problem in HS. :)

Yet.

[DEgalRN]

What about viruses? Kids who just can't hold it? Special Ed kids?

I don't know. I don't have to run in to this problem in HS. :)

Yet.

I had a 10th grader who, how do I put this delicately, had some flatulence that wasn't just gas. Apparently there was a small stain in his underwear and he was freaking out. I mean legitimately loud voice, very upset, being overly dramatic. I had him call mom because I don't carry extra underwear. He had to leave a message, and left this very vague, cryptic message that ended with, "I need you to pick me up right now!" Then he proceeded to jump, physically jump, around my office. He had the option to wash his underwear in the sink or take them off completely, but he declined both offers. Because he was making a ruckus, there was no odor, nor any on his pants, and it was obviously not a medical issue that caused the problem, I did send him back to class.

Mom called back a little while later, I told her what happened, and she brought in some new underwear, and we were all happy.

[MrNurse(x2), ADN]

I have to say that in 1.5 years here, I haven't dealt with this situation. I have dealt with menarchal girls, but no incontinence. We have the blanket extra clothes request, but few do it and most kids have no room in their book bags, anyway. I concur with OldDude, any part covered by a bathing suit stays covered.

[OldDude]

There is one child in our school who has spina bifida. She is too little to adequately clean and change herself, and can't tell if she's gone (except for the odor..). The classroom has an aide, and she will clean and change her if she's there. If not, they send her to me and I have to. I always, always get another adult to witness me changing the child. I've even borrowed teachers who happen to be free on break and walking by my office to be my witness. And I write "changed student, witnessed by: whoever" when charting my clinic visits.

For kids with chronic medical conditions, some special ed, life skills, etc.,...toileting is included in the IEP and approved by the parent. These circumstances are in a different category. Otherwise poop accidents at school are just that...poop accidents... whether caused by illness or accident. It's inconvenient for the kid and inconvenient for the parent. It stinks, literally and figuratively, but it's not an emergency and it's not even an urgency. So, unless it's an emergency, I'm not exposing or contacting a kid's genitalia at school.

TRUE STORY - happened last year at the local pediatric urgent care I work at.

MD writes an order for Tylenol suppository for an infant. Female Nurse, RN, goes into the room, parents present, explains the order and administers the medicine. A short time later two police officers arrive at the clinic and ask to speak with Female Nurse, RN. The parent of the infant Female Nurse gave the suppository to called 911 and alleged Female Nurse inappropriately inserted her finger into the infant's rectum AND did not wear gloves while administering the medicine.

So, insert your name instead of Female Nurse and imagine how that would make you feel. You are now guilty until you prove yourself innocent and, even then, the "stains" won't come out. It's mommy and daddy's word against your word. Throw in race differences and it adds another level of dynamics. What would you do? But by the Grace of God, Female Nurse, RN, picked up the paper towel, which she had laid out for the suppository and the foil lubricant packet, when she was done and threw it all away, inside her gloves as she removed them. She went into the trash can in the room, retrieved the gloves, which contained the Tylenol and lubricant wrappers inside, and showed the police officers. Fortunately that discredited the allegations of "sexual assault of a minor"" to the degree the police left it up to the parents to pursue on their own. Which they never did but I can imagine the sleepless nights Female Nurse, RN, went through.

At urgent care I always bring another nurse with me when I administer Tylenol suppositories. I always bring another nurse when I give gluteal injections. Or if I'm administering an enema, cath UAs, etc...sad but true.

[AdobeRN]

What about viruses? Kids who just can't hold it? Special Ed kids?

Viruses and Special Ed kids are a special circumstances that as a nurse I feel it is ok to assist.

But when you have these kids that just can't hold it or are to busy to take the time and go when the teacher tells them to, those that mommy still wipes at 5-6 years old and when they get to school they are yelling in the bathroom for someone to come wipe them, the kid (not a special ed & no medical issues) that the parent has not toilet trained and sends to school in pullups and expects him to sit in a wet, smelly pull up all day, the kids that do not have a medical diagnosis of a problem - these kids need to have change of clothing, need to be able to take care of themselves or parent needs to come up and do it.

[Farawyn]

I had a 10th grader who, how do I put this delicately, had some flatulence that wasn't just gas. Apparently there was a small stain in his underwear and he was freaking out. I mean legitimately loud voice, very upset, being overly dramatic. I had him call mom because I don't carry extra underwear. He had to leave a message, and left this very vague, cryptic message that ended with, "I need you to pick me up right now!" Then he proceeded to jump, physically jump, around my office. He had the option to wash his underwear in the sink or take them off completely, but he declined both offers. Because he was making a ruckus, there was no odor, nor any on his pants, and it was obviously not a medical issue that caused the problem, I did send him back to class.

Mom called back a little while later, I told her what happened, and she brought in some new underwear, and we were all happy.

This is... interesting. Sounds like a Hothouse Flower aka High Maintenance Snowflake.

I have to say that most of the teenage boys in my school would love to have permission from the nurse to "go commando".

Or, they would just strut the halls in damp farty pants.

Teenage boys. *facepalm*