Need some advice re: homesick or emotional problems

[Purple_Scrubs, BSN, RN]

I am kind of at a loss on this one and could use some advice from you all. KG kiddo, this is her first year in school. Had no issues at the beginning of the year. In the last week or so, she has started crying in class, wanting mom, and generally not wanting to be there. She cries hysterically to the point that she starts coughing and eventually will vomit (after breakfast and lunch, go figure). Illness has been ruled out. There are problems going on at home (parents separation, figuring out joint custody, etc).

So, the first time this happened, I did not know about the problems at home. She had vomited and was crying stating her stomach hurt really bad. I give the little ones the benefit of the doubt usually so I called mom and sent her home.

The next day, same thing happens. By this time I have a little of the background about what is going on at home. I keep her in my office for a little while then send her back. Apparently she continues to cry throughout the day. The next day, same thing happens. I talk to her a little about what is going on, then I walked her up to the counselor's office and had the counselor talk to her for a while. Counselor finds out a little more about what is going on, fills me in, and she calls and talks to mom. This was Friday.

Today she comes to my office before the bell even rings, crying hysterically. Her foot hurts. Check out the foot, no sign of injury. Told her she can rest until the bell rings. She wants mom, wants to go home. When the bell rings I tell her it is time for class. She's still crying hysterically and refuses to get up. I explain the situation to principal. He says "make her go to class", no support or suggestions offerred. (Grrrrr) So, after 10 minutes of cajoling, I am able to walk her to class. Low and behold there is a sub. I find out her regular teacher may be out for a few days, if not longer. I tell the sub she has been crying/homesick to the point of vomiting and we are trying not to "reward" her by letting her come to the nurse's office unless absolutely necessary. I think she gets some kind of payoff by getting to come here and not be in class, and I know she is hoping she will get to go home again. The sub is supportive of this plan.

I can see this getting really out of hand quickly. I was thinking the next step is to ask for a meeting between the counselor, principal, myself, teacher (if/when she returns), and mom. Does anyone have any other ideas? Have you had a situation like this in the past, and how did you handle it? Thanks for your wisdom, ladies!

[llltapp]

I do agree with the fact that you cannot positively reinforce nurse-seeking behavior during the school day. However, as you have stated, the child needs some supportive counseling. There is a school-based program called "High Hopes." I am wondering if your school offers or has access to it. It is for elementary school students who are going through divorce. Your best bet, if this isn't available is to get mom to take child to counselor who specializes in childhood issues. We don't know all that is going on, but custody battles can be devastating on children. The fact that this has just occured after an entire semester of no problems is a red flag.

I always tell parents, love your kids more than you hate each other. Don't allow your issues to infiltrate your child's world. Sad, keep us up to date.

[mustlovepoodles, RN]

I think it's time to call a meeting of parents, counselor, nurse and principal so everyone can get on the same page. You're right, you can't allow the girl to be rewarded by a trip to the nurse's office. Another thing I would do is call her parents each and every time she comes to the clinic(after the child leaves, of course.) Believe me, they will get pretty sick of this pretty quick and then you can suggest that she be evaluated for these symptoms. Put it in the parent's court.

I do think if the child is complaining of a symptom like vomiting, hurt foot, stomachache, she needs to be evaluated. But if there is no physical problem she needs to be handed off to someone else. You can't cure this, so she probably needs to go to the counselor when she does this. You've got to get your admins on board too or this will continue to be a problem.

[bergren]

I agree. This child is really suffering and professional assistance needs to be sought. Are the parents in a position to pay for family counseling? The family is sick and the child is the one manifesting the symptoms.

[Purple_Scrubs, BSN, RN]

Thanks for the input, everyone. We have resource centers at our district that offer family counseling, so I am going to talk to the counselor and see if she already made a referral. If not I will make one. The student was absent day before yesterday, and I was out yesterday, so we will see what today brings.

[noreenl]

How do I find the High Hopes Program please!