Got a repeat offender...

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I have a 3rd grader who has consistently been in my office about once every month/every other month, complaining of a stomach ache that leads to vomiting in the bathroom. Never a fever. Rarely a witnessed episode of vomiting. Always happens after PE. Usually 2 hours post, but they always say the stomach ache started during PE.

Last month's visit he was able to produce some "regurgitated food". I'm labeling it like that because it wasn't a true vomit. Very controlled. Small amount. Mucous-y. Not your typical "I have a stomach virus that's causing projectile vomiting". Sent kiddo home. Again.

Fast forward to today, kiddo comes in on their way back from....you guessed it, PE...and they tell me "we were playing a game in PE and the other kids started yelling and all of the yelling made my stomach and my head hurt". Had kiddo drink some water, gave them a peppermint, and told them to go back to class so they can cool down from PE. Kiddo walks away and I tell my admin assistant "I guarantee they'll be back later saying they threw up in the bathroom".

30 mins later...I was right. They're currently sitting in my office with the sad puppy dog face.

I refuse to send them home today. And we're going to talk about better coping mechanisms when situations make us uncomfortable.

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Specializes in Med-Surg, Oncology, School Nursing, OB.

So what class is after gym they don't like? LOL! Also, I'd quit giving them candy. It's like a reward esp when you suspect he's making himself sick on purpose. When kids repeatedly do this, I ask the parents to take them to the dr because it's not normal and maybe there's an underlying issue. Either they take them to the dr and find out there's something wrong (rarely but has happened), find out there's nothing wrong so parent and I agree it's a behavioral issue and that they can't go home for it anymore unless fevered, or the parent gets onto the kid and the kid realizes it's not getting them anywhere and it stops.

Also, here they don't go home for vomiting up just mucus unless fevered or obviously feeling bad but if they are able to play in gym then they aren't usually truly sick. With repeat offenders, I also must witness it or a teacher does or they stay. It's amazing how young kids are that learn to play the game!

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I was going to say, it's time for LD parent's to receive a phone call from the nurse ;)

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Specializes in School Nurse.

I send back to class with a plastic grocery bag. IF the LD does throw up you will have proof. No throw up = stay in class dear heart.

I had an autistic student that knew dad was home on Thursdays, he could throw up on cue.

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Oh, dad definitely received a call today about all of these visits and I made sure to let him know that I feel it is more related to behavior as opposed to an illness. The dad was very understanding and appreciative. I also had a good talk with the teacher to let her know the specific criteria for this LD before he's allowed to be come see me for stomach aches/vomiting. My teachers like to panic when a kiddo is able to produce ANYTHING out of their mouths. Many have been shocked to know that everything that comes up isn't always vomit and that I have a few that can vomit on cue. Which is where this kiddo was headed I'm sure. Luckily, they've all been very receptive to the requests I've made regarding claims of vomiting!

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24 minutes ago, Blue_Moon said:

So what class is after gym they don't like? LOL! Also, I'd quit giving them candy. It's like a reward esp when you suspect he's making himself sick on purpose. When kids repeatedly do this, I ask the parents to take them to the dr because it's not normal and maybe there's an underlying issue. Either they take them to the dr and find out there's something wrong (rarely but has happened), find out there's nothing wrong so parent and I agree it's a behavioral issue and that they can't go home for it anymore unless fevered, or the parent gets onto the kid and the kid realizes it's not getting them anywhere and it stops.

Also, here they don't go home for vomiting up just mucus unless fevered or obviously feeling bad but if they are able to play in gym then they aren't usually truly sick. With repeat offenders, I also must witness it or a teacher does or they stay. It's amazing how young kids are that learn to play the game!

Ha! It's ELA and Math that he comes to me during! Math gives me a headache too! But in all seriousness, I spoke with their dad today and he seemed very receptive to my opinion that it's behavioral as opposed to actual illness. It takes a lot for me send kiddos home and 1 episode of unwitnessed vomiting isn't going to make the cut! All vomiting has to be witnessed unless you present looking awful and have a fever. Every year I'm shocked with how early they're learning to try to get out of class! It's just crazy!

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Please consider that this child may have GERD which PE class activity aggravates causing mucus production/upset tummy/"vomiting". [lease keep log so parent can take to doctor for discussion re need med, or having cracker prior to gym class . ;)

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Specializes in school nurse.

When is lunch in relation to PE class?

I'm with you on the vomit thing, by the way. If I don't see it, it didn't happen.

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Specializes in ICU, ER, RESEARCH, REHAB, HOME HEALTH, QUALITY.

Sounds like the child is afraid of something and seeking attention, the great mystery is trying to figure out what that is, and not making it fun to come to your office..

When I little my mother use to make me stay in the bed all day if I was sick of course this was before cell phones and electronic phones..

Needless to say I was never sick..

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On 4/4/2019 at 10:47 AM, Jedrnurse said:

When is lunch in relation to PE class?

I'm with you on the vomit thing, by the way. If I don't see it, it didn't happen.

PE is before lunch ?

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Specializes in school nurse.
36 minutes ago, KeeperOfTheIceRN said:

PE is before lunch ?

Well, there goes THAT theory...

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Yesterday I, in a low moment, bribed a child to not vomit. She can make herself vomit at the drop of a pin. She's in kindergarten and already knows that 2 vomiting episodes sends you home. I told her that if she went the whole day without vomiting I'd leave 3 stickers in her locker for her to have the next day. It worked, but mom also agreed to get a pediatrician consult.

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