Fake illness

[Keepstanding, ASN, RN]

Need your help school nurses,

Help me out here...I have a young student who I believe is faking headaches.

Mom believes him and is going back and forth to the doctor for expensive tests for these so called headaches. I do not see a sick child when I assess him. They tend to come at a time when he does not want to do certain work in class.

When I talk with mom, I am almost to the point of telling her that he is pulling her leg on this, but I hesitate in doing so.

Please someone, tell me how you would handle this?

Thanks to whomever responds.

[neneRN, BSN, RN]

Mom doesn't sound like she would react well to an implication that the child is faking if she has had numerous doctor visits...I would just objectively describe the child's complaints and your assessment findings and let the mom go from there.

That said, my daughter seemed to LOVE going to the school clinic last year, especially on days that she knew I was home from work; took me a couple times to catch on to what she was doing...We had a long talk about crying wolf, and she cried and cried about how she really was sick all the time. I told her I would bring her Motrin to school but would not bring her home anymore because the numerous visits had made it so that I was unable to tell when she was really sick and when she was faking. I told her that one day she REALLY was going to be sick and feel bad, but she would have to stay at school because I would assume she was faking it. She hasn't called me from school since.

On the other hand, you may not know whats going on in this child's personal life; i.e., family life, stress at home, bully in the classroom, lack of time/attention from parents/teachers that is causing this child to engage in attention seeking or avoidance behavior.

[edgwow]

You can only report your objective findings, mom needs to do what she needs to do to feel better. You are not the physician. Your job is to relay the findings to her and she will follow up as she feels fit.I try not to offer up my opinion about what the parent should or should not do with their child.

[guest83140]

That is a problem I encounter a lot with the Junior High (middle) students. Half are faking it but they are good at knowing what symptoms or complaints to act out or say. You can't always see pain so you can only go by what they tell you. But the problem comes in at the point where you want to send them back but you call mom and she either wants Johnny or Susie to be babied as she does or she just wants you (the nurse) to just fix it so she doesn't have to deal with it or leave work. It's a parenting thing, which as the previous nurse said, must be dealt with by the parent telling the child that crying wolf is bad. The nurse can say not to cry wolf, and it might get some reaction but if the child knows mom/dad will give in or be upset if baby was scolded or not believed, I would try to stay out of it. Some parents don't want the help and don't want to deal with growing up baby right now until it gets inconveint later on. Like when they enter High School and College and faking won't help them. Some parents are really growing some big-time monsters who may be dangerous to society because they were used to getting their way all the time.

[DDRN4me]

First, I would assess the time and frequency of the headaches . Is there a pattern? one specific class that is "provoking" them? is the student eating breakfast ? are there any other symptoms? are there issues at home that are upsetting to the child? has he /she had a vision check?

before i begin to look at the crying wolf theory i try to look at all of that. do you keep data on what time you see each kiddo? see if you can track a pattern; and then discuss with child and parent. have the child do a headache diary; and then discuss with mom and child. sometimes just the fact that you are recognizing the pattern will either make them feel better or actually bring out another issue. I try not to go to the cry wolf theory or the babying parent theory until i have exhausted all others. good luck!

[KJRN79]

One thing to add, I don't know if this works in other communities, but we have a form where we write our assessment out FOR THE DOCTOR TO SEE. We don't have to know which doc the family is seeing, but we ask for a return note (on the the bottom of our assessment form) from the doc, with "any recommendations for school" written on it. In this HIPAA age, we aren't getting much back from docs, but at least we feel like the doctor is seeing an RN's assessment and not going with only the subjective "but it hurts at school". It can make a lot of difference if the medical people can actually communicate and we leave it in the hands of the parent to bring the note to the doc and back to us. If we don't get it back we can't exclude the child, of course, but we can ask the parent in a way of "we just want to do what is best for your child and would like a little guidance from his doctor." That usually makes sense to mom/dad. Good luck!