Cutting

Farawyn · Feb 11, 2016

But does that mean that we should just chalk up this behavior as "kids will be kids"? I care too much for my kids to ignore something like this. Maybe I am reading your comment wrong?

No.

I read it that way as well, hence my adamant response.

This is not normal behavior. Common does not equal normal.

PG2018 · Feb 11, 2016

With cutting and other parasuicidal behaviors, you shouldn't draw attention to it. As stupid as cutting is, most of the time it's just scratching. If they're depressed, medicate appropriately and send to therapy. RTFs and TDTs are hot boxes of misbehavior so not the best option.

Adults I have no empathy for. I have a patient who cut apart his forehead with a box cutter. My response beyond asking his motivations was "that's definitely gonna leave a scar." I have another adult who cuts and recently too deeply. Real deep. Sliced brachial artery and spurted out until her 15 year old daughter applied direct pressure and literally saved her life. She has PTSD now. I treated her and berated the mother who gets psych care from an under informed IM guy.

Kids cutting is exhausting as are the kids who come in with parents wanting them diagnosed with and treated for mental illness after texting nudie pics around the school. They're both bad and bizarre. Both are detrimental.

Farawyn · Feb 11, 2016

With cutting and other parasuicidal behaviors, you shouldn't draw attention to it. As stupid as cutting is, most of the time it's just scratching. If they're depressed, medicate appropriately and send to therapy. RTFs and TDTs are hot boxes of misbehavior so not the best option.
Adults I have no empathy for. I have a patient who cut apart his forehead with a box cutter. My response beyond asking his motivations was "that's definitely gonna leave a scar." I have another adult who cuts and recently too deeply. Real deep. Sliced brachial artery and spurted out until her 15 year old daughter applied direct pressure and literally saved her life. She has PTSD now. I treated her and berated the mother who gets psych care from an under informed IM guy.
Kids cutting is exhausting as are the kids who come in with parents wanting them diagnosed with and treated for mental illness after texting nudie pics around the school. They're both bad and bizarre. Both are detrimental.

I'm liking to call attention to your post.

Yea. It is exhausting. It is also my job, my kids and my school. We are often the only medical people in the building.

Are we to judge them? Or help them?

I treat every single kid "as if".

As I would want YOU to treat MY kid.

You trust your school nurse when you send your kid to school? You should. We know your kids bettern you do.

Tenebrae, BSN, RN · Feb 11, 2016

..... She states she did not intend to die, just needed "more" from the cutting.

Thats why I'm a big fan of early intervention for self injury.

I know from my own journey what actually seems like a long time ago now. Cutting started out as shallow scratches I could hide under my watch strap. 5 years later I was needing masses of sutures and having operations for skin grafting. I needed more and more injury to get the same level of release from self injuring

JenTheSchoolRN, BSN, RN · Feb 11, 2016

I'm liking to call attention to your post.
Yea. It is exhausting. It is also my job, my kids and my school. We are often the only medical people in the building.
Are we to judge them? Or help them?
I treat every single kid "as if".
As I would want YOU to treat MY kid.
You trust your school nurse when you send your kid to school? You should. We know your kids bettern you do.

Yes, thank you for saying this, Far.

Kids can often not see beyond the immediate consequences of an action. If they are cutting, I worry about the physical stuff first - infection control (I have seen infected wounds from cutting, covering it up may also mean not cleaning the area properly to call attention to it), accidentally cutting too deep. I talk with student about how to clean a wound properly to avoid infection vs. saying "well, just stop" because they can't. The reason they are doing it is much, much deeper.

As is the reason adults might be doing it as well. Maybe they have been doing since they were a teenager. I can't judge - that's not my job. I just help in the way I can best.

((((Poopy))))

Nothing much to say to this, except adding to Far's hug, poopy - :::::hugs:::::

NutmeggeRN, BSN · Feb 11, 2016

The behavioral health team decided that she should be seen in the ER to escalate Mental health treatment. We live in a rural area and it is sometimes is hard to get in to see a psychologist. Medically there was no need...
When the pediatrician called me to see if a CYFD report was made...I started to second guess what we had done...

If the parents did not engage and respond appropriately, then CYFD should not be a call, but it sounds like they did, unless they gave you lip service and the MD has more knowledge of the family dynamic?

kidzcare · Feb 11, 2016

This is no different than any other serious psychological issue such as induced vomiting, OCD compulsions, or various tics. It cannot be stopped by thinking to oneself "Gee, this might leave a scar"

I have a friend who's 11 year old daughter has tricholtillomania. She has been cleared to wear head coverings to school because she has pulled out all of her hair and her eyebrows and eyelashes are gone. She cannot stop simply by telling her that it will change her appearance in ways that her classmates are sure to notice

NutmeggeRN, BSN · Feb 11, 2016

I'm liking to call attention to your post.
Yea. It is exhausting. It is also my job, my kids and my school. We are often the only medical people in the building.
Are we to judge them? Or help them?
I treat every single kid "as if".
As I would want YOU to treat MY kid.
You trust your school nurse when you send your kid to school? You should. We know your kids bettern you do.

Far, once again, you nailed it!

Too often there ARE other things going on with the behavior that are not healthy for the child. One of mine HS kids was in domestic violence issue with her then boyfriend. To the point of needing a restraining order!

zombieghoast · Feb 11, 2016

I am so happy to see support in this thread. Almost 2 years ago I did a summer musical with a bunch of high school students and there was one student who faked slitting her wrists(long story but she has a past history of faking injuries and illnesses for attention) and this one adult woman(an elementary school teacher nonetheless) started going on a rant right next to my best friend that "CUTTING IS SO FAKE AND PEOPLE WHO CUT ARE DOING IT JUST DOING IT FOR ATTENTION". It is very evident that my friend used to self harm and at the time was still trying not to self harm but that statement almost caused her have a panic attack. Always be mindful of what you say in public.

ruralSchoolRN · Feb 11, 2016

It was not the MD that saw the student after the incident in the ER that called. The mother of a friend of the girl that was cutting took her child in to see her pediatrician and that pediatrician called me. Small town "politics"... The family of the student that is cutting is going through a pretty nasty divorce, but have brought in statements that the student is in therapy and have reached out to school counselor for information and support.

BeckyESRN · Feb 11, 2016

As a former cutter, I can tell you it is very complex. When I cut it was for 1 of 2 reasons: to release pain or to see if I could still feel because I felt dead inside. It's far too complex to just "stop it".

Same here. It's something I did when I could feel nothing else. Mine was exacerbated by a medication issue-no one knew then what a bad idea it was to start Prozac on a 14y/o for off-label migraine treatment-Maybe that was the cause, maybe not, but it started a cycle that was hard to break.

It took a very long time to stop idealizing what I was doing.

DEgalRN · Feb 11, 2016

It was not the MD that saw the student after the incident in the ER that called. The mother of a friend of the girl that was cutting took her child in to see her pediatrician and that pediatrician called me. Small town "politics"... The family of the student that is cutting is going through a pretty nasty divorce, but have brought in statements that the student is in therapy and have reached out to school counselor for information and support.

So the pedi called you because someone else told him about it? He didn't even see the girl in question? I mean, good on him for following up, but at the same time, a recommendation to get CYFD involved seems like a HUGE jump from a 2nd hand verbal report. If he was that concerned, he should have called.