Hygiene

Did you ask why they smell of urine? Sounds like Neglect or poverty (water service shut off?) that's Def something that should not be swept under the rug.

I did and mom has no explanation other than the girl doesn't clean herself up well , but that doesn't explain for that amount of urine smell

Sounds like neglect and they need probably social services to come and evaluate. I don't think you said how old these children are but perhaps they are bed wetters. Sounds like a sad situation and sure they are picked on in school.

Although it's very true that some little girls don't wipe very completely, many of them also wipe incorrectly...as in back to front. If this family is coming back into the office very soon I would take the opportunity to discuss wiping from front to back, bathing on a daily basis, and wearing fresh underwear daily just from the standpoint of good pt education for a female in particular to learn how to keep her "privates" or whatever age-appropriate expression you use clean and free of irritation.

If it becomes clear through that discussion that they do not have water, a means to wash their clothing, or have a mother who will not assist them in bathing then there is definitely an issue for social services. You do not mention the ages of the children or whether they are old enough to bathe or even wash out their undies independently.

If the children are school aged I would be surprised if someone hasn't already spoken to SS on their behalf...but maybe the school is waiting for their primary care provider to tackle the situation.

They are school aged, I discussed general hygiene on visits, SS has been involved before but that went nowhere. I imagine I will have to contact SS /DCFS in the morning.

Having taken care of adults in the hospital who are hygiene challenged, I've come to the conclusion that cleanliness simply doesn't matter to all of us.

You can teach and preach and teach and preach until you collapse, and it changes nothing. We have the same women who are admitted to the hospital over and over with open sores, that simply won't stay clean. Usually, not always, they have low IQs. They're lower income. Their peer groups are people just like themselves.

My daughter is developmentally disabled. Being clean, tidy, and maintaining a socially acceptable appearance doesn't matter to her. We fought and fought. Body wash became the cudgel I beat her over the head with. (figuratively speaking:)) She'd wear dirty clothes. Stink up the spare bathroom. And her bed linens absolutely reeked. I did daughter teaching. Bought buckets of hygiene products. Rewarded clean behavior.....

Everything I could think of to encourage her to just stay clean.

Then the light bulb went on in my head. It doesn't matter to her. It's just that simple. She doesn't fear social disapproval and censure. It doesn't bother her that she's looked down on because she smells. SHE JUST DOESN"T CARE. Whatever mechanism that exists that keeps the rest of us within the norms of social behavior, is absent in my daughters head. God help me if she ever has children, because she'd probably be just like the mom the OP describes.

I'm going out on a limb here, but I think I'd let the hygiene issue slide. Not to say I wouldn't teach, teach, teach. You simply can't change another persons core values easily. Maybe the best thing to do is to simply aim your efforts at teaching the children, instead of the mom.

It sounds like you've tried to do some education with this family to no avail. I have NO LOVE for social services. I've had some bad experience in the past where children were obviously in danger and social services was called in (not by me and prior to my being a NP) and were LESS than useless. However, we are not responsible for the outcome but we are responsible for reporting situations where we believe there is abuse or neglect.

In many instances when children are physically dirty and smelly, they also live in a home that is dirty, unsanitary, and even dangerous. Perhaps there is some mental illness on the part of the parents -- which was the case in a family I knew of when I was a child myself. The children were always dirty, didn't have clean clothes, they had no basic items which they could use to clean themselves in the home, etc. Kids made fun of them all the time until we got to high school when some of us finally realized what the problem might be and we anonymously got together grooming items, fresh clothes, and talked to the school about allowing these kids to keep grooming items in the locker room and have access to showers on a daily basis.

Could be a wet wash issue. If the clothes have been washed & left in the washer overnight or not hung to dry or put in the dryer. They will take on a sour pee-pee smell. Try speaking to the mom about that. See what she says about it.

Maybe you can talk to the children about it.

Definitely inquire more about it. Sounds strange. I had a similar incident but it was because the family's water system was not working for a week and they had to dump urine into containers and bottles and they left it in their rooms forgetting to dump it or throw it out.