Disturbing incident in triage .....

Yvette Acute ER RN · Jul 19, 2007

Keep in mind that the parents get a monthly check if their child is bipolar....This happens all the time around the inner city....You get welfare and then you have a disabled child....WHAM! a bigger check. Sad........

Kidrn911 · Jul 19, 2007

Keep in mind that the parents get a monthly check if their child is bipolar....This happens all the time around the inner city....You get welfare and then you have a disabled child....WHAM! a bigger check. Sad........

Wow, were does that check come from? My nephew has 2 brain tumors dx when he was 17, and his parents never recieved a monthly check. Now that he is 19 years old, he can't even collect SSI or recieve medicare and his insurance is dropping him because he can't go to college because he due to have a Stem cell transplant, brain surgery and more chemo and radiation. So what check are you reffering too for disbaled children? I would like to know, so would my family who is $100,000 deep in debt.

Dixielee, BSN, RN · Jul 19, 2007

Ouch, that hurt.

I certainly had no intention to hurt anyone by my post, but just to point out something that I am seeing as an ER nurse with increasing frequency. I am not discounting true medical or psychiatric conditions that need treatment and may qualify for disability.

What I am seeing in many cases though should constitute fraud, and those are the cases I am talking about.

I worked in one ER where we routinely asked patients what level of activity they were capable of, what type of work did they do, etc. Of the many who said they were disabled, I asked what was the nature of the disability. Some of the answers were as follows:

"I don't get along well with others".

"I don't read very well"

"I drink too much alcohol"

"I have a sleep disorder"

" I don't take directions well"

My favorite was a man who was on disability because he had open heart surgery as a baby. He has no problems with it at all now, but went on disability as a child and never came off. Now he has 2 kids who get the same amount of money monthly he does (half each). He said, "yeah it's a pretty good deal, I get $1800 and each kid gets $900, every month for the rest of our lives." NOW that is just wrong.

Those are the ones I am talking about.

UM Review RN, ASN, RN · Jul 19, 2007

Thanks for clarifying, Dixielee. :)

48RVRN · Jul 19, 2007

It's profoundly disturbing that a three year old is diagnosed as bipolar. I see that as an agenda on the part of the parents to avoid their responsibility or on the part of the psychiatrist for whatever bizarre reason or a combination of the two. Diagnosed and on medications at three years of age does not bode well for this child. You're looking at a life long consumer of health care services now.
I don't know what the solution to the problem is, but it isn't more of the same. At some point, people have to start saying "Enough!".
Joe

Man! do I agree with you! 'Nuff Said

Altra, BSN, RN · Jul 19, 2007

Keep in mind that the parents get a monthly check if their child is bipolar....This happens all the time around the inner city....You get welfare and then you have a disabled child....WHAM! a bigger check. Sad........

Wow, were does that check come from? My nephew has 2 brain tumors dx when he was 17, and his parents never recieved a monthly check. Now that he is 19 years old, he can't even collect SSI or recieve medicare and his insurance is dropping him because he can't go to college because he due to have a Stem cell transplant, brain surgery and more chemo and radiation. So what check are you reffering too for disbaled children? I would like to know, so would my family who is $100,000 deep in debt.

These two posts describe two different approaches to discovering a child has a disability, and they hinge largely on family function / dysfunction present before the child is born.

Approach #1: immediately seek governmental assistance, or indicate to the medical professionals treating/diagnosing your child that you are unable/unwilling to pursue aggressive treatment without assistance.

Approach #2: immediately seek the suggested medical therapies for your child.

Kidrn911 · Jul 20, 2007

These two posts describe two different approaches to discovering a child has a disability, and they hinge largely on family function / dysfunction present before the child is born.
Approach #1: immediately seek governmental assistance, or indicate to the medical professionals treating/diagnosing your child that you are unable/unwilling to pursue aggressive treatment without assistance.
Approach #2: immediately seek the suggested medical therapies for your child.

That isn't the problem. The problem arises when a family is high middle class and still have outrageous bills because of a drastic medical condition. Basically in the case of my nephew, his father has insurance and makes too much according to the government or recieve financial help, but not enough to truly survive in the real world. My nephew is 19 and obviously can't work because of his condition, but can't gain in support either

ernurse1993 · Jul 22, 2007

I am also amazed at the number of young children on psychiatric meds. I think the children need discipline at home and a routine. When my children were school age they had a bed time of 8PM and we stuck to it. We told them no and that was the end of it. I do believe that there are some children who are ADHD, but the majority of the children on these meds just need a set routine, playing outside and not watching TV or playing video games till all hours of the night, and a normal bedtime.

LME21 · Jul 23, 2007

I worked at a facility for handicapped children for several years and had a child of 4 with the diagnosis of bipolar and i found myself wonder how in the heck can they diagnose something like this in a 4 yr old. Hmm extreme ups and downs. i have yet to meet a 4 yr old that doesnt display this behavior. i worked with this child on a daily basis for several years and his behavior wasnt out of the ordinary for having the kind of parents he had.

paccookie · Jul 23, 2007

I may have to cross post this in the Psych Forum, if there is one ....
Last night, while doing time in Triage ...
I had a sweet 3 year old boy ...
I'm asking meds/allergies, etc. Turns out, the child was on Abilify and Risperdal. I give Mom the raised eyebrow ... "Why is he on these meds?"
She says, "Oh, he's bipolar...."
WHAT????
The child was 3 years old!!!!!!
Am I the only one who is FLOORED by these kinds of things?? How in the world could/would you diagnose a child that young with bi-polar disorder???
Dianna

I had a similar incident while doing my EMT clinicals. The patient was a six year old girl who had fallen at home. Mom was an CNA and was worried because her daughter couldn't catch her breath immediately after the fall. So we rush over there, lights and sirens, and find the girl lying on the floor, freaked out. While getting the history, mom says the girl is on Clonidine. The paramedic raises his eyebrow and asks why. Girl has ADHD, mom says. Paramedic writes this down and moves on with the assessment as we are en route to the hospital. We give report to the nurse and go back to the office to do the paperwork. He mentions the Clonidine to his coworkers and they all think it's a mistake. I remembered seeing something in the news about a mother whose daughter died of an overdose of Clonidine, which was also prescribed for ADHD. I borrowed a med book from the nurses station and there it is: Clonidine is prescribed for off-label, investigative use for pediatric ADHD. The paramedics had never heard of this before and honestly, I wouldn't have guessed it either if I hadn't read it in the news. I don't know how these sorts of diagnoses are made in such young children, but it's out there and we as healthcare providers need to be aware of these things.

Christina, EMT-I

33-weeker · Jul 23, 2007

No I didn't medicate him because I was a bad mom, but because my son was having a hard time functioning without his rituals and outbursts if his rituals couldn't be carried out. He now is doing fine, and I'm thankful for the medications that are available. No I do not know what the long term effects are, but the benefits definitely outwayed the risks. I do believe some kids are misdiagnosed, but I know in my heart of heart that my son needed and may again need meds. Oh and by the way I did tell the psychiatrist about he smack on the face and she told me that if that was the worse I'd done with his behaviors that he was lucky. I've never forgiven myself for that, but I also will never remember the blank look on his face. He was definitely in some type of psychosis when his OCD set in. Please if anyone has anything negative to say, don't, I live with my sons illness everyday and prefer not to be judged for doing the only thing that I could.

:yeahthat:

I have twin sons - one who is high-functioning autistic & one who is otherwise normal other than being exceptionally bright - that both have mood disorders. They have had significant behavior problems since they were preschoolers. They have been asked to leave more than one daycare center.

(FYI: I stayed home with them until they were 18 mos. before returning to work. They are otherwise healthy - 36 weeks, good apgars, 6lbs & 7 lbs., drug-free lady partsl birth, breastfed, etc... We have a loving, good home and we teach our kids right from wrong. No abuse, no smoking, rare drinking...)

We are 99% sure the 'normal' twin is bipolar. He would rage for an hour in his room, destroy property, was violent toward adults and at times had to be physically restrained. He had problems before but got to this point by about 5 yrs. of age.

The autistic twin is now also showing signs of bipolar disorder starting about age 6. His stimulant med, which once calmed his extreme hyperactivity, now makes him manic and we've had to d/c it. We've had to put him on Risperdal like his brother.

I'm sure there are many kids on unnecessary meds out there, and 3 is definitely a bit young (there's not many meds to choose from at that age anyway - 6 yrs. is about the lower limit for many), but from somone who's lived it - don't be too quick to judge until you find out the whole story.

33-weeker · Jul 23, 2007

I had a similar incident while doing my EMT clinicals. The patient was a six year old girl who had fallen at home. Mom was an CNA and was worried because her daughter couldn't catch her breath immediately after the fall. So we rush over there, lights and sirens, and find the girl lying on the floor, freaked out. While getting the history, mom says the girl is on Clonidine. The paramedic raises his eyebrow and asks why. Girl has ADHD, mom says. Paramedic writes this down and moves on with the assessment as we are en route to the hospital. We give report to the nurse and go back to the office to do the paperwork. He mentions the Clonidine to his coworkers and they all think it's a mistake. I remembered seeing something in the news about a mother whose daughter died of an overdose of Clonidine, which was also prescribed for ADHD. I borrowed a med book from the nurses station and there it is: Clonidine is prescribed for off-label, investigative use for pediatric ADHD. The paramedics had never heard of this before and honestly, I wouldn't have guessed it either if I hadn't read it in the news. I don't know how these sorts of diagnoses are made in such young children, but it's out there and we as healthcare providers need to be aware of these things.
Christina, EMT-I

Clonidine has been used for some time for psych - nothing new. It was one of the drugs we tried for my autistic son's hyperactivity when he was much younger (3/12, 4?). At that age, there are not too many drugs to choose from.

The problem was that he appeared to have nightmares. He was not very verbal then - so he couldn't tell me, but when a child who once asked to go to bed now clings to you and doesn't want you to lay him in his bed - nightmares are certainly one logical explaination.

The clonidine did help his hyperactivity some, but made him sleepy in the daytime and we changed meds not long after that. The stimulants - though they have more side effects to worry about, did a much better job of controlling the ADHD.