I need ya'lls help. I apologize up front for this being so long.
I have a student (grade 5, female) who has been diagnosed with "growing pains" - I put that in quotations because, at this point, I'm not convinced that is what is going on.
Last year this student had a PE activity restriction ALL year with no end date. Apparently, anytime the nurse or HA asked for an end date, the doctor's office just sent a renewal of the restriction. Of course, the child was seen running around at recess with no issue.
This year, she came in to the health room once, first or second week of school, for this leg pain. Walks without limp, flat affect. I think mom came and picked her up. I encouraged mom to get us a doctor's order for IBU at school (it's what mom gives at home) for exacerbation - as of yet, no meds and no order.
Thursday before last she slipped and fell down the stairs. I watched the video - her foot slipped on the edge of a step and she fell onto her bottom and slid down a couple of stairs. She came limping into the health room and after sitting down said she could no longer weight bear d/t pain. Mom came to pick her up and she has not been back to school since. I talked to mom yesterday and she said the child has been in so much pain, she couldn't get out of bed until this past Friday. Mom says she took her to the doctor and the x-rays were negative. Mom also says she had her seen by rheumatology and they said her blood work was good (she was worked up by rheum last year d/t this pain).
Have any of you dealt with this with a student (or yourself or your own child)? Do you have any resources for information ? (doctor google isn't much help) Any ideas? Am I crazy - is this how growing pains work? I thought they were more prevelent in the evenings, but, per mom, this child's pain is worse in the mornings. (chronically tardy and > 20 absences last year).
It really doesn't sound like growing pains. My daughter was diagnosed with growing pains a few years ago. It affected her in the middle of the night. She would wake up in tears from the pain, she could hardly walk. This would go on for a few nights and then nothing for awhile, and then it would happen again. The frequency started to decrease now she has no problems. Of course as we all know we can't say always or never because there is always an exception that is discovered.
As other posters have said I think it is a good idea to have a cancer diagnosis ruled out. Leukemia, Lymphoma, and Sarcoma can be sneaky sometimes and present like this.
Specializes in School Nursing, Ambulatory Care, etc..
As an aside, how long has this girl been there? In other words, was she there before this pain episode?
She was here last year for grade 4 and this year up until now. She does have 8 absences for this incident plus two more earlier in the year. She is out again today.
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I talked to mom and she said they were "on the way to radiology" as the child "woke up screaming" with back pain last night. Mom did agree to sign a ROI so I can talk with the doctor's office. Mom did say she has already had a 2nd opinion with an MRI and the MRI was negative as well.
She was here last year for grade 4 and this year up until now. She does have 8 absences for this incident plus two more earlier in the year. She is out again today.
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I talked to mom and she said they were "on the way to radiology" as the child "woke up screaming" with back pain last night. Mom did agree to sign a ROI so I can talk with the doctor's office. Mom did say she has already had a 2nd opinion with an MRI and the MRI was negative as well.
I have seen serious conditions be the underlying problem in similar cases before...BUT, there is something here that just doesn't fit. I'm not trying to be a fly in the ointment but this could very well be one of the many Munchhausen variants we see as school nurses; especially since your history with her is such that you've never seen this girl without some type of physical restriction or problem yet your observations indicate otherwise.
Specializes in School Nursing, Ambulatory Care, etc..
I have seen serious conditions be the underlying problem in similar cases before...BUT, there is something here that just doesn't fit. I'm not trying to be a fly in the ointment but this could very well be one of the many Munchhausen variants we see as school nurses; especially since your history with her is such that you've never seen this girl without some type of physical restriction or problem yet your observations indicate otherwise.
Mom keeps saying she wants to go back to work and is frustrated with the situation. I don't want to be the person that says, "there is nothing wrong with your child" only to find out there is a more serious issue later. With that being said, it may, or may not, be an opinion floating out there that there is some school avoidance/manipulation on the part of the student....
Mom keeps saying she wants to go back to work and is frustrated with the situation. I don't want to be the person that says, "there is nothing wrong with your child" only to find out there is a more serious issue later. With that being said, it may, or may not, be an opinion floating out there that there is some school avoidance/manipulation on the part of the student....
No you can't share such an opinion but just stand by and watch. And it may not be an individual effort from the student but a scenario that has developed from the mom/daughter dynamic of what I referred to as a Munchhausen variant. I've seen it a few times.
Or she could have some serious condition.
Like I say, all you can do now is just stand by and watch.
Specializes in ICU/community health/school nursing.
She was here last year for grade 4 and this year up until now. She does have 8 absences for this incident plus two more earlier in the year. She is out again today.
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I talked to mom and she said they were "on the way to radiology" as the child "woke up screaming" with back pain last night. Mom did agree to sign a ROI so I can talk with the doctor's office. Mom did say she has already had a 2nd opinion with an MRI and the MRI was negative as well.
My spidey senses are tingling. I hope it's neither a Munchausen variant nor anything really, really wrong. Keep us posted?
Any pain out of prepotion to the injury also has me squirmy and think something like complex regional pain syndrome.... esp w/ pain hx. Does the student happen to be hyper mobile
My daughter had "growing pains" and would pull herself to the bathroom on her elbows because it hurt to walk. After pushing the docs and having them accuse me of munchausen syndrome she was diagnosed with Juvenile Idiopathic Arthritis. I made her move and she hated me for it. She didn't get to take time off school (unless she really was sick). When I began to homeschool her, we put her in horse riding and made her move even more - which actually helped her. When it was cold out, it took her longer to get going and she hurt more, but it was never an excuse to not go to school or the barn. We explained that this was her life and she couldn't just let it pass her by. So many others have much bigger difficulties and they over came them and she could too.
Sometimes I feel like we let our kids be marshmallows because we are too afraid to push them or upset them. No one wants to discipline their kids or actually parent them so it seems.... Maybe I am the mean mom...
Now that my daughter is an adult and in college - she doesn't miss class because she is in pain. She wakes up early, gets herself moving, dresses properly and goes to class. She is however finally looking into long term symptom management with medication.
Specializes in Surgical, Home Infusions, HVU, PCU, Neuro.
My oldest had growing pains a couple times (that she complained of) and my youngest has complained of them approx x1 a month or 2. Both was always at night and was both legs and x1 arms, usually subsided without further complaints the next morning. Of course this is not a DR. DC, but a mom that's a nurse, which is super fun when the youngest is a drama queen and gets tired of hearing "walk it out" for her various "ailments ".
Something isn't adding up, kiddo has either got something seriously wrong or is good at playing mom. And I don't understand why DR would write a restriction note without an end date. Are you sure the note is true?
I hope answers come quickly for all parties involved
This thread is scary. Great advice that I cannot add to.
As an aside, I clearly remember being little and having "growing pains" at night. They hurt.
me too! i have vague memories when i was probably 4-7 and i woudl just HURT all over! It was chalked up to growing pains. Which for me is prob true as im tall now.
Glitternurse, LVN
357 Posts
It really doesn't sound like growing pains. My daughter was diagnosed with growing pains a few years ago. It affected her in the middle of the night. She would wake up in tears from the pain, she could hardly walk. This would go on for a few nights and then nothing for awhile, and then it would happen again. The frequency started to decrease now she has no problems. Of course as we all know we can't say always or never because there is always an exception that is discovered.