How do you...

I usually talk with the child first to see if I can figure out why he/she is coming so often. Then I confer with the teacher to get their input. Teachers usually don't want the kids to be missing so much classtime.I often find out the child is coming without permission. For instance when ostensibly going to the restroom. We have sometimes initiated "nurse visit passes" to be sure the child is coming with permission. If this doesn't seem to help, I do sometimes speak with a parent. I stress that I'm not trying to prevent a child from coming to me and I don't want the parent to forbid it but if it is for something other than a real illness (stress for example or to get out of class for a quick break) then that is what I need to know. And if it is frequent somatic complaints, I do sometimes suggest it is time to see the pediatrician to be sure there isn't something going on. I usually enlist the cooperation of the school councelor too. We work very much together on these cases.

I had some cranky parents call my principal and complain that I was not listening to the child, or that I was not...I don't know... the result is my policy that I eval (temp, BR needs, breakfast, when is lunch)and "treat" with crackers, a 5 min rest (ONLY!), BR, water and then back to class.

On the 2nd visit if the child still says they "just can't make it" I will repeat temp and allow them to call home.

I will only give clinical data, like temp, # of visits today, if they said if they had breakfast and when lunch is. I believe it is up to mom and dad and student to choose what happens next. I have been known to say "student has not coughed in my office" "student says that they vomitted, but has not in my office and is not pale or doesn't appear to have"

It works in that I don't feel stressed or like I have to make the big choice.

If parents want kids to stay, I will encourage them and return them to class with cracker or br pass and a little go get 'em tiger! kinda cheer!

***for reference, I have 5th and 6th graders only.***

I do like the "why do you think you are feeling like this? thing, I may try that.

If I feel a child is just trying to get out of class, I will tell the teacher to call for me to come to the classroom. If I am available, I will bring my thermometer and basic supplies to the classroom, ask the student to step into the hallway, check him out (just in case) and let him return to his seat.

He has lost very little class time and hasn't gotten the satisfaction of wondering the halls. I have listened to him and checked him out--just in case. It takes the fun out of a sickroom visit.

Of course, often I am not available to do this immediately, so I make an "appointment" to see him within a reasonable period of time. Sometimes it works, sometimes it doesn't.

I make sure I am not missing anything. I do a very thorough history, repeat assessment and talk to the child about what is going on to warrant the return again and again. I will call mom then and see if anything is going on at home because she will know if there is another issue the child is dealing with, including in school issues. I will then talk to the teacher about it, get input about how the child is behaving in class and give her the information he/she needs to know when the child should come if there is a question about that. Sometimes I come right out and say, "this is what to look for. If you are not seeing it, consider letting the child stay because I don't think all of these visits have been necessary". Or I will fill in on issues at home that are affecting school. Having a good relationship with the teacher is important because together, you really can put the puzzle together. I always ask for a written pass with a time and teacher signature and ask the teacher to check for the same from me with these kids. We can usually limit the visits if Mom, Teacher and Nurse have a plan and are on the same page.