24 hour vomit free before returning to school?

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Do you have a statement in your student handbook that states that a student must be 24 hours without vomiting before returning to school? If so, is there a common sense factor built in that helps to weed out those students who may have vomited due to something they ate or phlegm, etc.? So that the ones that stay home, are the ones that are truly sick?

This may be a crazy question, but this has come up in 2 of my schools this past week.

Happy Tuesday to all-

a.

Pale skin, glassy eyes, vomit on clothes (haha) is a dead giveaway, some kids just get that look.

beyond that, i give it the 20 minutes and some water factor with some kids. With first time visitors that tell me they vomited and feel lousy and want to go home, i'll just make the call, especially if it's March and their first visit all year or all previous visits have been bandaid or something else that barely blips the radar.

Ow! Can we sign your cast?

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Specializes in school nursing, ortho, trauma.

No cast, just a sling 23.5 hrs a day and another x ray in a few days with a stern threat of a cast. fractured radial neck ice skating...Nancy Kerrigan I am not...

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Specializes in critical care.

So, general pallor, and the kid's pattern?

I've gotta give it to you full time school nurses - it's not easy. I have to keep reminding myself of my scope of practice, while also remembering it's my call on clinical judgment things, like do I call home? Or just let this work itself out? I'm flying solo, which gets scary sometimes! School nurses are pretty freaking awesome!

My full time job is critical care. So when someone at that job tells me they have a tummy ache, I assess for acute issues like appendicitis, splenic rupture, liver issues, stuff that I could just grab a phone and call the MD (who is in the building) for. Early elementary kids? "When's the last time you pooped? Wanna go sit on a potty?" So far, it's worked every time. Totally different world. ☺️

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I got the Gollum reference right away! :) My favorite books as a kid.

We do the 24 hour symptom-free thing too. It hasn't really been a problem with fake vomit-ers . . . .:scrying:

I did have a 7th grader purposely fail his hearing test last week. I tested again on Tuesday. Failed. His file reads like a mini-mental health horror story though and he fakes stuff all the time. Talked to mom . . . who called me later from the backyard to say that she told him she had spoken to the school nurse and because he was having hearing problems, he would have to be taken off the computer and have someone sit with him every day to help him with school work. He would also have to be fitted with hearing aids.

He came in today to be tested and . . . passed! He said "I cleaned my ears out in the shower this morning".

Umm, right buddy. I looked in your ears each time and there was no wax, dirt, or ear infection. :sarcastic:

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Had a first grader come in five minutes after the bell this morning saying her stomach hurt and she "puked all over mommy and daddy's bed last night"… Mother seemed surprised when I called her at work that she would need to come and pick up the child. Handed her a copy of district policy on when to keep your child home…. Common sense is in much shorter supply these days.

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Very, very sad, but true. Thanks to everyone that chimed in with their thoughts and helpful ideas on this. Happy, Happy Tuesday!

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Here's what my district handbook has to say:

  • Each case should be looked at individually. One episode of vomiting does not necessarily mean the student needs to be excluded. If a student vomits the nurse will need to make a professional judgment as to the need to be sent home. The student should be sent home if they are uncomfortable and unable to concentrate.
  • If student has two or more episodes of vomiting within 24 hours, they need to be excluded until vomiting resolves or health care provider determines that the underlying cause is not communicable.

So that has it built in for kids who see something gross, get motion sick, puke after running around, etc. It also means that when a kid comes to me and says "I threw up in bed last night" I have a little lee way -- especially with the younger kids, time is kind of malleable, and when I ask the parents they usually say "no that was two weeks ago" or something like that! And when a parent brings one in first thing and says "hey Susie threw up last night but never ran a fever, is she okay to be here today?" I can use those other assessments - pallor, behavior, etc - and maybe let her try to be in school. But one vomit at school = 2 in 24 hrs and back home she goes.

I'm sure I complained about it before, but at the start of the school year the 5th graders were playing a gross-out game at lunch trying to make each other puke. And sometimes they did puke. But they didn't go home for it!

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We do have that in our handbook as well, but also have a statement "at the discretion of the Nurse". Most issues are from teachers who want them out, even if they vomited while running on the playground/gym or emesis during a cough.

It makes me crazy!!

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Specializes in School Nurse.
We do have that in our handbook as well, but also have a statement "at the discretion of the Nurse". Most issues are from teachers who want them out, even if they vomited while running on the playground/gym or emesis during a cough.

It makes me crazy!!

Heck! I have teachers who freak out when a student threatens vomit. I get "Mrs so-and-so sent me here because she does not want me to puke in her class".

My district policy has the 24 hour rule, but I use my nursing judgement. I love the look on some of the kid's faces when I inform them that vomit is not a get-out-of-jail free card, especially when it was not witnessed. Although the look they give me is not nearly as entertaining as the student who "reminds" me of the vomit policy, and then invents more serious symptoms on the spot when they realize they are not getting anywhere with just vomit.

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Specializes in kids.
No cast, just a sling 23.5 hrs a day and another x ray in a few days with a stern threat of a cast. fractured radial neck ice skating...Nancy Kerrigan I am not...

So, no points for style, eh?

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Specializes in school nursing, ortho, trauma.
So, no points for style, eh?
no... but maybe i get points for stubbornness - i waited the 2 hours until open skate was over so the my kid and niece and nephew didn't have to have their time spoiled. I'm back to the life of the 2 armed again - just no firefighting until this summer
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So this morning (at 9:10) I sent home a student who had vomited twice. The parents just called and asked if they can send the student to school tomorrow at 9:15 (BC then he will be free from vomiting for 24 hours)!!!

Countdown is on for the end of the school year! :arghh:

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