I would appreciate any advice on how to best handle this student.
Student quite dramatically holds his chest and starts breathing heavily claiming he has chest pains. Comes to me clutching his chest and when I assess him, his pulse ox is good, breath sounds are clear, vital signs are within normal limits. Once I explain this and get him breathing slower, he is quickly back to normal and heads off to class. This has happened multiple times a week in the last three weeks. Student has been doing this in classroom more frequently than I realized as the teachers have somewhat figured him out and only send him to me when the symptoms persist. In addition to chest pain, sometimes it's his nose tickles or he's "allergic to the classroom."
Mom is aware and tells me it has started happening at home and she is the one that told me "he is becoming a hypochondriac and something is ALWAYS wrong." PCP ruled out any medical issues and getting into some sort of counseling is in progress.
In the meantime, any ideas? He is missing quite a bit of instructional time and being disruptive to the classroom with his frequent "episodes." The teachers are at their wits end, I was thinking maybe have him come see me daily on the way to recess which is before lunch for a quick check out and talk to try to prevent disruption to the classroom but don't know if that will help feed the issue?
I honestly don't know if these are true panic attacks or a bit of acting on his part as yesterday he was fine and everything had subsided and when the assistant principal popped her head in to ask me a question about something else he immediately clutched his chest again.
Specializes in Psych, Addictions, SOL (Student of Life).
Sorry, but I just have to ask -- is this kid having any peer group or social interaction problems that would lead him to seek out positive attention at school? I know, I know, but humor the little voices in my head!
This type of behavior when no medical problem exists always has a psych component. It is not normal for 3rd graders to express this type of anxiety. A psych consult would be in order. This type of Axis II behavior is learned from somewhere. I once had a 10 year old patient who could have a very convincing heart attack right down to the clammy sweat and color changes. Turns out the family had just moved in a grandmother with early dementia and it was causing a lot of stress for the whole family. The question is what kind of secondary gain does the student achieve through this behavior. Maybe because I am in psych I see this a bit differently. I would try to find out if there is a learning disability, bullying, problem at home before I would just dismiss the behavior.
hppygr8ful, ASN, RN, EMT-I
4 Articles; 5,212 Posts
This type of behavior when no medical problem exists always has a psych component. It is not normal for 3rd graders to express this type of anxiety. A psych consult would be in order. This type of Axis II behavior is learned from somewhere. I once had a 10 year old patient who could have a very convincing heart attack right down to the clammy sweat and color changes. Turns out the family had just moved in a grandmother with early dementia and it was causing a lot of stress for the whole family. The question is what kind of secondary gain does the student achieve through this behavior. Maybe because I am in psych I see this a bit differently. I would try to find out if there is a learning disability, bullying, problem at home before I would just dismiss the behavior.
Hppy