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halohg halohg (Member)

Encopresis KG age

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I am trying to manage a 6 year old finally diagnosed with Encopresis under the care of a gastroenterologist however no parental consent given to discuss with MD. Parental involvement is still at a denial stage and somewhat view this as a “little” problem. However Mom states she is giving Ex-lax as prescribed by the doctor. After working with this child for a period of time, I am realizing he is constantly leaking stool. I shared my findings with Mom, she does not want to put him in a diaper, but I am wondering if anyone has seen a type of fecal Incontinent pad that could work in a pediatric size for his underwear? If so how do you see this playing out? Could the child be self directed to change the pad himself? How often? TIA

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Two questions...

Does he realize he is soiling himself?

What's the difference in a fecal incontinent pad and a pullup?

Reality check...it won't be long until his classmates are "participating" in announcing, "XYZ pooped again."

And yes, he is capable of managing it; keep all the supplies in your clinic and let him take care of it in private as needed. Pullup is a must.

Good Luck.

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I had a first grader in a similar situation whose mom eventually had him wear a thin maxipad.  He was capable of cleaning himself up and changing the pad on his own. 

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You absolutely need the consent to talk to the GI, or at the bare minimum, some kind of care plan with doctor's signature on it. Because I think it's bigger than just pads. Although I love Saltine's cost-saving suggestion!

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First of all, as the school nurse you do not have to have parental consent to discuss the health of a student with the physician:

"Yes. The HIPAA Privacy Rule allows covered health care providers to disclose PHI about students to school nurses, physicians, or other health care providers for treatment purposes, without the authorization of the student or student’s parent."

Leakage is an indication of severe and chronic constipation. Has the mother shared what is the GI's plan of care? How is it being addressed? Does the mother and the student understand what is happening?
https://www.youtube.com/watch?v=SgBj7Mc_4sc

Also, there is a pedi urologist that has quite a soapbox on this topic. I find his information to be compelling. His website does sell some products but there is a lot of info and resources for free. Check out the free downloads section. The physician's guide to MOP is 50 something pages and covers a great deal of info.
https://www.bedwettingandaccidents.com/

Hope you find some help in those resources.

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On 1/20/2019 at 10:00 AM, OldDude said:

Two questions...

Does he realize he is soiling himself?

What's the difference in a fecal incontinent pad and a pullup?

Reality check...it won't be long until his classmates are "participating" in announcing, "XYZ pooped again."

And yes, he is capable of managing it; keep all the supplies in your clinic and let him take care of it in private as needed. Pullup is a must.

Good Luck.

No, he does not realize it is happening and question 2: Mom is expressing a desire to not use diapers or pulls ups. I’m thinking a ‘pad’ would expedite the changing process.

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On 1/20/2019 at 1:07 PM, aprilmoss said:

If the leakage is small, these may work:

https://www.butterfly.com/

 

 

I actually printed those for Mom to use as a reference. They might be too large for his size, but yes this is what I was thinking as well. Thx

On 1/20/2019 at 1:07 PM, aprilmoss said:

 

 

 

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1 hour ago, bluebonnetrn said:

First of all, as the school nurse you do not have to have parental consent to discuss the health of a student with the physician:

"Yes. The HIPAA Privacy Rule allows covered health care providers to disclose PHI about students to school nurses, physicians, or other health care providers for treatment purposes, without the authorization of the student or student’s parent."

Leakage is an indication of severe and chronic constipation. Has the mother shared what is the GI's plan of care? How is it being addressed? Does the mother and the student understand what is happening?
https://www.youtube.com/watch?v=SgBj7Mc_4sc

Also, there is a pedi urologist that has quite a soapbox on this topic. I find his information to be compelling. His website does sell some products but there is a lot of info and resources for free. Check out the free downloads section. The physician's guide to MOP is 50 something pages and covers a great deal of info.
https://www.bedwettingandaccidents.com/

Hope you find some help in those resources.

Thank you, yes I am aware of the last resource. Mom has not shared, she is umm...challenging in many aspects. As far as the HIPAA privacy rule, that is interesting and would love this as a separate thread to discuss. We require as a district policy to gain consent but in this case Mom has given instructions to the gastro not to discuss medical findings...I know I know. The only part she states was part of the care plan was ex-lax.

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16 hours ago, halohg said:

Thank you, yes I am aware of the last resource. Mom has not shared, she is umm...challenging in many aspects. As far as the HIPAA privacy rule, that is interesting and would love this as a separate thread to discuss. We require as a district policy to gain consent but in this case Mom has given instructions to the gastro not to discuss medical findings...I know I know. The only part she states was part of the care plan was ex-lax.

Even if we legally CAN talk to physicians about students we share, there are a lot of front line staff who don't realize this and make it difficult.  So, given this extra info about your district practice: I would ride the ladder up in your district at this time because this has gone way above your pay grade.

And I might get mom involved every time. Every time the student comes in. If parent chooses not to provide adequate care then that opens up another avenue.

And I know you are documenting the pants off of this. Have faith and stay strong! Hopefully one way or another this resolves itself this school year.

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Oh what a long road you, mom and student will have together.  Student should also be following a diet.  Several changes of clothes & underwear on hand.  I would discuss fecal matter in the classroom.  My district and probably yours, the custodial staff has been cut to a minimum.  Maybe she can provide carpet cleaner &/or a pillow to sit on.  This is something that is not easily fixed and will continue throughout elementary.  Have you all considered a 504?  Student sent to nurse 2-3 times per day to change is easily an hour out of class time every day.  Student should be on a bowel schedule - an hour after arriving to school, after lunch/recess, after pe, before leaving for the day - more as necessary.  

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