Just curious... children who vomit!!

[NurseCard, ADN]

What is your all's policy regarding children who vomit?

I'm talking, a child who has vomited, whom after vomiting seems just

fine, no fever, no other symptoms.

What about a child who vomits, who has vomited like this before,

and history shows that once the child vomits one time, he's fine

after that?

I ask because I've been called to school several times now over

the past year or two, to come and take my son home and make him

miss the entire day of school, because of one episode of

vomiting. Usually he vomits on the bus on the way to school,

sometimes he vomits as soon as he gets to school. He is

always FINE after that and I have told the school nurse this.

Doesn't seem to matter, I have to take him home for the

rest of the day.

1. I KNOW there is always the possibility of a virus that could be

spread around.

2. No I don't know why he does this. Possibly he is getting motion

sickness on the bus from the constant stopping and starting. Possibly

it has something to do with his medicine. Possibly he needs something

to eat. I am really not sure. Whatever causes it, he usually does it

just once and then he is fine the rest of the day.

3. No I don't mind having him at home, but I do mind him missing

more school than necessary.

I guess I just maybe need to get him to the doctor and explore

why this happens, and maybe get a note from the doctor saying that

it is unneccesary to excuse him every time it happens.

It doesn't happen more than once a month or so.

Anyway, I'm just curious, what are your policies on this sort of

thing? Totally curious as to your thoughts.

[JenTheSchoolRN, BSN, RN]

Policies may very school to school, to be honest. And sometimes, unfortunately, the school nurse doesn't get as much say into them as he/she would like. It is possible that her school may require her to send your child home because well, people freak out about vomiting. Again, every school is different.

I don't send home kids who vomit once and after observation have no further symptoms. Vomit can happen for many, many reasons. And a kid can tell me they vomited and lie to my face. Hence, observation. I have seen kids that vomit if they eat a food they didn't like, ran around too much during gym, classroom was too hot, from the bus ride to school, and from anxiety. I have to take the time to get know each kid and their pattern. But I do care for the older students (7th-12th), and elementary kids can be different.

My school supports my medical judgement and I cannot say how much I appreciate that, so I can with my judgement not send home a kid that vomits once. If this isn't within the realm of your school's policy, a letter from your pediatrician may be a good place to start so that your school nurse can use that data.

Edit: What OyWithThePoodles said as well - talk to your school nurse. We don't bite

[OyWithThePoodles, RN]

At my school, if the child is in preschool their policy is to go home regardless of the reason. One episode of vomiting and you have to go home and cannot return for 24 hours.

For the rest of the school I play it by ear, if the child pukes and then is fine I will keep them in my office for a while to make sure. If they puke and tell me they still feel bad I will call home.

Parents get really upset about this, because the child may act fine or say they are fine once they get home, but they may have "played" us by telling us they do in fact feel bad. We can't help if we get a different story that the parent and we have to consider all of the other students in the class as well.

I would suggest talking to the nurse at your child's school, he/she would be happy to tell you their reasoning.

ETA: I rarely send a kid home for a one and done puke. (Unless it's pre-k) which drives teachers crazy. But if the kid tells me they still feel really bad and there has been something going around in their class I won't hesitate to make the call.

[SaltineQueen]

Technically, the policy is they need to go home and stay for 24 hours after the last episode of vomiting. My principal gives me a little flexibility if I have an inkling that it was a one & done.

[OyWithThePoodles, RN]

I will also add that our K-5 does not have a fever-free, vomit-free policy. Parents should use their own discretion, if your child was sent home with a temp of 101.5 or above they should probably stay out the next day. If they have vomited several times, stay home kiddo.

[Flare, ASN, BSN]

unless there is a factor at play, most of my true vomiters go home. Occasionally, i'll have a kid say that they feel better after one vomit and they think maybe lunch was too heavy or if they are severely congested and they describe what they vomited as mucus then they probably don't have to leave, but i usually give a fyi call to the parent anyhow but won't require a pickup and let them know to be on guard and that i'll call if anything changes.

[ruby_jane, BSN, RN]

In high school, the reasons they vomit are legion.

Menses, migraine, coughing to point of emesis, that nasty Dorito-shelled taco from Taco Bell, Ghost Pepper challenge....

Rinse with mouthwash, temp check, rest, test with crackers. The majority of the time the kid can stay. If I know it's migraine, they usually go sleep it off. If the kid is insistent, I'll let them call the parent and the parent can decide. Most of the parents ask what I think. And I repeat the first two sentences above.

Also - unwitnessed emesis without repeat in the clinic...that's good to stay!

[BeckyESRN]

Yep to all of the above. Just an additional thought: Your "school nurse" may not be a nurse, not all schools have an RN, so perhaps it's an aide or office staff. I'd get a note from his doctor saying that, in the case of a single episode of vomiting, do -whatever intervention-, observe, and return to class.

[GetBackToClassRN]

I am in a K-5 Elementary school. Our county school board policy is very clear. If a student vomits, they go home and are instructed to wait 24 hrs from their last episode of vomiting before they return to school. It's not my personal choice. Even if a student has a documented medical history which explains why they may vomit, it's still possible that they have picked up a virus/illness that would cause them to vomit and be contagious.

I have had experience with a student repeatedly reporting vomiting throughout the school year and going home and seeming to be fine. It has undoubtedly caused a lot of frustration for all of us involved (teacher, parent, and myself). I feel that this is an issue that falls to the parents though and lucky for me, the parents in my situation agree. They are seeking medical and psychological care to get to the root of the problem and solve it. There have been MAJOR improvements since the doctor appointments started. The student was coming to see me at least 4/5 times per week and is now down to maybe once a month if that. Turns out the student was so worried about vomiting in class for some reason that he/she actually started going to the bathroom and making themself throw up to be able to go home.

Good luck figuring it out! Thank you for trying to be understanding of your school nurse' situation.

[ohiobobcat]

If I know a kids vomits because of anxiety, meds, etc, and I have spoken with the parent about it, I am not going to send them home every time they vomit. I even let kids stay if they vomit once and feel better, even without a known history. If a kid looks gray or glassy-eyed, states they don't feel better after vomiting, or is in my office for 20 minutes praying to the porcelain god, then they get to go home.

I know some of us have no control over current school policies, but a one size fits all vomit policy makes no sense to me for the reason lots of people have already pointed out. Vomit does not always = illness.

[OldDude]

PK-5...I decide who "must" go home regarding vomiting or other illness related stuff at school. Our policy has guidelines but leave the school nurses with the final decision.

[OldDude]

Let me add...we have a RN on every campus.