Not potty trained

Posted
by blueiwahine blueiwahine Member Nurse

Has 7 years experience.

Here's a question...have a child 2nd grader, coming back to school after being homeschooled last year. He is not potty trained, still in pullups. Here's a little history... autistic, speech impaired, also had a grand mal seizure first time this year. He is being put in resource. The school will test him...so thinking he will be put in life skills eventually. So who is responsible for changing him daily, since he is not potty trained. This is my first year of being a school nurse over the entire school...was a life skills nurse before and the aids in the Life skills class changed them or I would if they came to me for meds and needed changing.. I know this is trivial...but I have over a 1000 kids and heard that it stays very busy throughout the day. Just curious what others have done or experienced. I know teachers can be abusive and send kids for every little reason, because they don't want to deal with them.

schooldistrictnurse

schooldistrictnurse

Specializes in School Nursing, Public Health, Home Care. 400 Posts

You could write a bowel management plan into his IHP.

blueiwahine

blueiwahine

Has 7 years experience. 203 Posts

Thanks for the info...Any advice is great...when I got previous life skills position started mid year...all plans had already been written...so I really have no experience with the IHP writing.

schooldistrictnurse

schooldistrictnurse

Specializes in School Nursing, Public Health, Home Care. 400 Posts

Can you use some previous plans as a template? You'll have to figure out how to write them sooner or later. Just like anything, you'll get better with experience.

Jolie

Jolie, BSN

Specializes in Maternal - Child Health. Has 36 years experience. 6,375 Posts

This child's toilet training is part of his education in life skills, and not a health issue per se. His toileting needs should be addressed by the educational staff. You may be included in his overall IEP planning and implementation. That would certainly be ideal. But writing a health plan for toilet training independent of his overall educational plan would probably be a waste of time.

Unless his lack of training can be attributed to a physical problem (gi abnormalities, medication side effects, etc.), then it represents an educational need, not a health need. No disrespect intended, but educational needs are best addressed by the educational staff, who spend time with the child, know his schedule, habits, cues, etc. Bringing this child to the nurse's office for toileting would also be an unnecessary disruption of his routine, which is not tolerated well by students with ASD.

Your role is to teach proper handwashing, infection control, safety and risk management (2 adults present to prevent accusations of inappropriate contact), as well as help the staff to identify and prepare a private area for toileting/diaper changing of this and other special needs students.

Enjoy your year!

abcnurse77

abcnurse77

29 Posts

I had a similar situation. I had the teacher's aide change the pull-ups and keep a log of diaper change. Also, I assessed if the teacher's aide knows how to do the pull-ups and encouraged her to call mom/me as needed. Hope it helps.

blueiwahine

blueiwahine

Has 7 years experience. 203 Posts

Thanks all...this is great info. I know with time I will adapt what works for my office and incorporate all the other things I have to learn. I'm excited about the year. I know with nursing...it is always a new learning experience where ever you go.

amoLucia

amoLucia

Specializes in retired LTC. 7,735 Posts

Not a school nurse here. Just thinking - what if he were an adult in some kind of ADL therapy or DDD training programs? Who would be assisting him?

Wave Watcher

Wave Watcher

Specializes in Community Health/School Nursing. Has 7 years experience. 751 Posts

Potty issues are not my concern. I will not spend my time changing pull ups or wet/soiled clothes. We have a Kindergartner who has at least 3 accidents a day and it takes probably 20 min. each time to get this student cleaned and changed. That is an hour out of this students educational time and it takes away our staff who should be doing other things. I don't even offer to help. I would never get any of my work done or be able to take care of my students who have real medical needs.

sfajctxnurse

sfajctxnurse

13 Posts

I have a student on my campus in Kinder that is not potty trained. They do have a medical diagnosis of encopresis per mom (she has not supplied us with anything written from the doctor). Mom comes up once a day to change the child, (her suggestion). My principal said that legally we cannot change a child without documentation from the doctor and a written plan from the doctor. This mom is now angry saying that we (the school) are refusing to work with her and that I didn't offer any assistance when she was in my office changing her daughter. Why should I offer assistance if you are here? That was my thoughts. But anyway, this student is not 504'd or sped ed, although we are currently gathering data to begin the sped ed testing process. I understand the enco as my daughter has it, but it does not explain why the child is not bladder trained. She doesn't even acknowledge when she is wet, that she needs to go, or anything. I do not mind changing the student but we have to have documentation from the doctor first. I also do not believe this child knows how to change/clean herself

blueiwahine

blueiwahine

Has 7 years experience. 203 Posts

This child has been an angel, the issue was overexaggerated. The child comes occasionally...he has never been wet, just wants to change his pullup because one side has broken....he basically changes himself, I may have to assist occasionally. If they were all that good...school seems to have a lot of babied children...or soft...totally different world than my previous war zone school. lol