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non compliant diabetic family

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IrishFLRN IrishFLRN (New) New

I have a new juvenile diabetic at the private school where I am the only school nurse. I am new to school nursing. I am in touch with the county health nurses about this, but would like more suggestions. This is the third school in as many years for this child for the very things that I am encountering now.

She is 11 and was dx'd when a toddler. Her mom is young 30's divorced, with a new boyfriend, is a sales rep who doesn't always answer her phone or return messages.

The child carries her "bag" which half the time doesn't have a carb source, expired glucagon (2 years ago!!!) , no cake gel, sometimes no money for lunch. I have started buying things to stock the clinic for her. Several notes /calls to mom concerning this. Still hasn't filled out the emergency card w/ dr. name etc. on it. Says she has an appt with him in a few weeks. Have given ther the medical health care plan w/ protocols specific for this child for DR. to fill out. HAve spoken w/ principal and ast. prin. about this and if nothing is corrected after the dr. meeting, they will tell mom that child is not allowed back to school until everythin is up to date. have given instructions to all her teachers, coaches, etc. for s/s of hypo/hyperglycemia and instructions to call 911 if she does passout.

I am at my wits end!

Any suggestions???????

Marie_LPN, RN, LPN, RN

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

Maybe i'm reaching in the dark here, but the parent is neglecting this child.

And just because the school syas they won't allow the child back if things aren't corrected, that's no guarentee that anything will be done.

moonchild20002000

Specializes in OB/GYN,L&D,FP office,LTC. Has 36 years experience.

I agree with the above poster...this is neglect.

Could it be that the mom just dosen't understand about the seriousness of the diabetes? Could you have a conference with the mom and do some education? If that approach dosen't work I think child protective services needs to be involved.

I don't see how banning the child from school will help,if she is in school at least there are adults monitoring her. It would be a good idea to involve the child in diabetes education as well.

Both of them "voice" their understanding about the necessity of having supplies, glucagon,etc. BUT they don't ACT on it. She's had JD over 10 years. In the previous post I said that she was new..I meant new to our school!!! The Asst. Principal also told me that the child said that her mother hits her with a belt as punishment sometimes. They suggested parenting classes.

I will pursue involving child protection if she doesn't send in things next week and DEMAND the doctor's name and number. she says that he won't give her a script for glucagon until he sees her. Sounds fishy.That is ludicrous to me!

Situations lke this are frustrating. I have no experince as a school nurse but do have experience in adolescent/child psych. In that role we encountered neglect often. Based on what you have written here I would not put much hope in the mother takng appropriate action. I would contact DHS OR Child protection services IMMEDIATELY.

Noney

Specializes in Critical Care.

Poor child. To have such a disease and no responsible parent....

You do need to report this for your license sake and for your own state of mind. If something happens to the child and you've not reported it you are responsible. Even though the child has had this disease for most of her life and verbalizes understanding that doesn't mean she understands. I've seen alot adults with diabetes that say they understand, but do not understand.

It sounds like this child has alot to overcome: frequent moves, poor parenting, physical abuse?, and to top it of she has to deal with diabetes!!

Can't to school waive lunch fees for the sake of safety?! Whether the mother is able to pay doesn't mean diddly squat if she won't pay!\

Noney

The school never lets a child go without lunch..especially this one! There are IOU's piling up for her. but in the long run..lot cheaper than an emergency and lawsuit.

MomNRN, BSN, RN

Specializes in Emergency.

Have a good paper trail! Document everything!

If nothing else works, I agree with above posters: contact your state's equivalent of DCFS (Dept of Children and Family Services). At our facility, sometimes just the threat of being reported gets the parent moving!

Good luck to you. Let us know how it works out!

As the mother of a diabetic child here are some suggestions I would make. Sometimes it's not neglect, (although in this case it very well may be). Sometimes it's just a lot of work to keep up with and remember all the time. I would suggest having the mom send a month's worth of snacks to the school at a time. I know for me I quite often don't realize the school has run out. I just lose track and sending a month's worth in at a time really helps with the frustration level. My other guess is that if she has been dealing with this for 10 years she probably overestimates her child's ability to take care of this herself. Being a young mother she may just have a lot on her plate to take care of and just gotten distracted from what needs to be done. I know for myself I quite often forget how important the paperwork is. I would suggest both the month's supply and trying to tap her into free lunch program if she is eligible and any other community resources. Just my thoughts anyhow.

Teresa

The assistant principal should have contacted child protective services long ago. This mother is neglecting her child. This is enough grounds for you to contact authorities, and as a nurse, you are required to do so! This child will suffer more the longer this continues. Good luck.

My role is Child Health/Child protection (CP) in the UK.

Here - if the stated problem was emerging one would usually check with previous schools to determine health history, & patterns of care. Any CP issues would be highlighted in this laison.

However I agree with the majority of replies. Info in this instance appears to be CP matter, in which nurse role should be protecting the child. 'Social Services CP Agency' role is investigation.

Two issues; Child has divulged 'physical abuse & 'Neglect' - appears to be obvious unless proven otherwise

i have a new juvenile diabetic at the private school where i am the only school nurse. i am new to school nursing. i am in touch with the county health nurses about this, but would like more suggestions. this is the third school in as many years for this child for the very things that i am encountering now.

she is 11 and was dx'd when a toddler. her mom is young 30's divorced, with a new boyfriend, is a sales rep who doesn't always answer her phone or return messages.

the child carries her "bag" which half the time doesn't have a carb source, expired glucagon (2 years ago!!!) , no cake gel, sometimes no money for lunch. i have started buying things to stock the clinic for her. several notes /calls to mom concerning this. still hasn't filled out the emergency card w/ dr. name etc. on it. says she has an appt with him in a few weeks. have given ther the medical health care plan w/ protocols specific for this child for dr. to fill out. have spoken w/ principal and ast. prin. about this and if nothing is corrected after the dr. meeting, they will tell mom that child is not allowed back to school until everythin is up to date. have given instructions to all her teachers, coaches, etc. for s/s of hypo/hyperglycemia and instructions to call 911 if she does passout.

i am at my wits end!

any suggestions???????

at a school where i worked, the kid - an extremely unstable diabetic, ran out of glucose test strips. we had to go out and buy some, at the school's expense, and try to get the parents to pay the school back. this child really needed to do her bg a minimun of 3 times a day on a good day. on a bad day, we'd get a bg 5 times which should really be overkill. but diabetics really don't die of high blood glucose itself, complications yeah.

the parents who seemed to understand the disease process would not supply a reliable glucose source - this kid would be 380 in the morning, she ate choco-something cereal and then 37 after lunch, because she ate only junk food. at 37, she was barely symptomatic and that was really scary. i went out and bought a couple of bags of smarties - a very cheap, empty, reliable, rapid acting carb source - about 6 gms per roll. i didn't always know about smarties. but, i found that about 2.5 packs, 15 or so grams, would knock her bg up really quickly. so, i know this is really bad but think about it, diabetics usually don't really die of high blood sugar, it's the low bgs. and 37 would have me cold and clammy. and the child had an automatic insulin pump so this was happening with the insulin on board. did i say extremely unstable? but the child was otherwise, well cared for. and very manipulative - children with chronic illnesses often are.

so not a pretty story at all but there it is.

Did you get the records forwarded from the previous school? What do they tell you? You may at least have a doctor's order that can cover you and shed some light. FERPA allows those records to be shared with your school without mother's consent. You can call that school, FERPA would allow them to share information with you, but you cannot share information about the current situation with them other than to say you need information. The FERPA exception for parental consent only goes one way.

It sounds like a lot of things might be going on: mom overwhelmed and depressed and not fully understanding the dangers of diabetes = neglect.

How is the little girl handling this transition?? This must be tough for her to start a new school and hav e everyone miffed at her mom.

frann

Specializes in medical/telemetry/IR.

After 4 years of dealing with this D thing, I think I have finally got the beginning of year paperwork down. maybe you can offer my method to this mom.

I just filled out everything this year and left the dates blank, made copy as my master to keep then I fax that one out to the docs and emailed a letter out to all my dd's teachers.

I don't really understand her not bringing in her supplies. maybe her insurance is terrible? I wasn't able to bring my insulin in until I can get a refill in week or so. Some of my friends have to pay over 100 for glucagon refills , mine are free.

Did she just move to your area? could you ask one of your other diabetic moms to befriend her? In my area we try to keep a network of us moms/kids together. and we do share between us. I usually tell my school nurse that if there is a new dx or old she can give my number to them and they can call me.

crap gotta go to work

"could you ask one of your other diabetic moms to befriend her? In my area we try to keep a network of us moms/kids together"

Good idea, but be careful. You need written consent to share a child's diagnosis with anyone outside the school, including other parents who have a child with diabetes. You cannot even include a child in a diagnosis related support group with other students with the same diagnosis - asthma, diabetes etc, without a parent written consent because it reveals personally identifiable health information to those without a "legitimate educational interest". Makes putting together support groups tricky.

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