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Discussion

Help!!!

Ok school nurses! I need some creative thinking here. I have a 1st grader that was known for coming into the clinic all the time last year (I wasn't here then). Tummy aches, sore throat, stuffy nose, vomiting... The school nurse last year told her to eat an apple a day to keep the doctor away. I think it worked for the most part. ;) A few months ago she would come in several times a week and say she threw up in the bathroom but she flushed to toilet. My rule is, if you vomit, I have to see it. If you flush...it doesn't count. So we came up with vitamin c. Builds your immune system, keeps you from getting sick...you get the idea. It worked for about a month. Now we are back to the same thing. Except now she is really vomiting, I see it. But she smiles, no fever, eats normal, plays with friends as usual. I have talked to mom on several occassions. She said she does this at home, when she doesn't want to do something then she gets "sick". So I am trying to think of another way to "build her immune system" ;). Any ideas would be greatly appreciated. :clown:

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    Hmm, I'm thinking maybe tell her you're concerned about her teeth, because vomiting so much could cause the enamel to wear away? Lol, maybe she is vain enough that it might help if the vomiting is self induced.

    As far as immune building, you could suggest meditation! Teach her to sit quietly and take deep breaths...in through the nose...out through the mouth...and to quiet her mind. I bet her parents would thank you for this one :D

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    Maybe some probiotic yogurt each day for digestion along with her apple :)

    I have a 2nd grader who "vomits" periodically, really it's more gagging and mucous - he has history of reflux and anxiety, mom sent in some Tums to give when it happens and it seems to help calm him and makes him feel like something's being done.

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    Consider also what is the child "getting" from this behavior? Attention? Removal from an undesired task? Power? Whatever you come up with as "her" benefit, treat her in a way that you don't further feed the behavior.

    A tough one!

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    • Author
    Hmm, I'm thinking maybe tell her you're concerned about her teeth, because vomiting so much could cause the enamel to wear away? Lol, maybe she is vain enough that it might help if the vomiting is self induced.

    As far as immune building, you could suggest meditation! Teach her to sit quietly and take deep breaths...in through the nose...out through the mouth...and to quiet her mind. I bet her parents would thank you for this one :D

    I like the teeth one! And the yogurt one! Great suggestions! I have been sending her back to class everytime. I don't call mom with her in here. I don't want her to think that everytime she vomits I am going to call mom. We will see! :)

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    Has the vomiting been worked up by the child's pediatrician? What is the pediatrician saying?

    Does your district have a school psychologist, a school based clinic or are one of the school nurses a mental health clinical specialist? The research shows that ff typically have anxiety problems.

    See the Journal of School Nursing article about frequent visitors:

    Shannon, R. A., Bergren, M.D. & Matthews, A. (2010). Frequent visitors: Somatization in school-aged children and implications for school nurses. Journal of School Nursing, 26, 169-182. http://jsn.sagepub.com/content/26/3/169.abstract

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