One of my biggest malingerers

[MHDNURSE]

just got diagnosed with abdominal migraines She is a second grader who has been high maintenance since Kindergarten. Her mother totally babies her and I think enables a lot of the behavior. She was diagnosed with ADD in 1st, but Mom against medicating. She will frequently come see me and complain of random thing- stomach aches, headaches, "breathing problems", "just not feeling well". In every instance she is fine upon exam, happy and distracted and playing in my office.

About a month ago, she was jumping on the couch and fell and bumped her head on the coffee table. Suffered a mild concussion. She came to see me several times per day the next few days c/o stomach aches. Every single time she came, once I was paying attention to her she was smiling, playing, etc. Stomach aches were non-descript, a 5-10, no nausea, no vomiting. Would happily walk back to class after 10 minutes of rest. I called mom to discuss because it was frequent and she is low academically and was missing a lot of instruction time. Mom would rush to school to pick her up

So I just arrived at work and there is an email from our Second Grade Team Leader that I was looped into from the mom saying she was "just diagnosed wit abdominal migraines so she is not faking. Please let's make her time at school as pleasant as possible" . Insert giant eye roll here. I am waiting for a doctor's not to confirm.

Mom is one of those super strong personalities, pushy, etc. You know the type. Overanxious about everything to do with her kid. And the kid, unfortunately is not winning in the likeability department herself.

Anyway, I just had to vent as I am sure you can all understand where this situation is going. It is going to be a long 6 months until the end of June!!

[Flare, ASN, BSN]

Hopefully the dr's note comes soon. if not, then i'd feel free to lay out some sensible parameters that address the "medical concern" but also keep the child in school and in class. Since you've seen a pattern where she's been okay after a period of rest of about 10 minutes, i would advise mom that you will permit her about a 15 minute rest period before you will send her back to class or call to inform mom. Alternatively, a logbook can be established, as it is imporant for you to know in school what type of patterns are occuring at home as well (including time of onset, length of symptoms, treatment, effectiveness of treatment, etc. ) this puts responsibility back on the parent to show that this is not just a school related issue. (though me thinks that this could go one of two ways - mom will either love this and fill it out religiously or will completely ignore it. )

[NutmeggeRN, BSN]

Hopefully the dr's note comes soon. if not, then i'd feel free to lay out some sensible parameters that address the "medical concern" but also keep the child in school and in class. Since you've seen a pattern where she's been okay after a period of rest of about 10 minutes, i would advise mom that you will permit her about a 15 minute rest period before you will send her back to class or call to inform mom. Alternatively, a logbook can be established, as it is imporant for you to know in school what type of patterns are occuring at home as well (including time of onset, length of symptoms, treatment, effectiveness of treatment, etc. ) this puts responsibility back on the parent to show that this is not just a school related issue. (though me thinks that this could go one of two ways - mom will either love this and fill it out religiously or will completely ignore it. )

Oh Flare you are so smahht today!!! (and everyday!)

[ruby_jane, BSN, RN]

I'll believe it when I see the doctor's note and treatment guidance.

Oh wait...did I say that out loud? I'm sorry.

Abdominal migraines come with vomiting. It's a real dx (had a kid here last year) and no fun at all. The good news is that there will be a medical management plan in place AND she can stay at school (unless of course, she cannot).

Hang in there!

[OldDude]

Ugh. I hate these kinds of situations. Anyway, when I run across them I start off with having a witnessed conversation with the parent unless I can get some kind of written information like a response to an email. I ask the parent if they want to be notified every time the child comes into the clinic or if they want to be notified only if there is a sign of illness like fever or vomit. Many of these parents will try to avoid committing to an answer because it removes the Munchhausen variant from the equation by relinquishing control and allowing you to do the job you are there to do as a school nurse. But I don't back off and tell them it has to be one way or the other; usually it ends up being call them every time the kid comes in. Regardless, don't let them set up a residence in your head. According to the parent wishes, either call them every time and let them make the decision or tell the kid, "you know the drill' when they come in and minimize interaction with them; fill in your log as Flare mentioned, or whatever documentation, and move on. Eventually they'll move up in grades or move away.

[MrNurse(x2), ADN]

Have friends whose children suffer. Research Cyclical Vomiting Syndrome. I dealt with them as a nurse and deal with one as a Assistant Scoutmaster. It is anxiety driven, probably why our friends are familial. I see what you see, periods of wellness when life is fun and what appears to be selective avoidance with symptoms. I struggle with this, I try to remember that the anxiety loop is absent with fun activities and exaggerated with mundane or non desirable tasks. Most outgrow this. Parents of these children are anxious, because most anxious students have anxious parents, it is where most anxiety is learned.

[JenTheSchoolRN, BSN, RN]

I'll believe it when I see the doctor's note and treatment guidance.

Oh wait...did I say that out loud? I'm sorry.

Abdominal migraines come with vomiting. It's a real dx (had a kid here last year) and no fun at all. The good news is that there will be a medical management plan in place AND she can stay at school (unless of course, she cannot).

Hang in there!

i was about to add the vomiting piece - which is interesting given student's report of no nausea. Yes, I suppose each kid is different, but it is still odd. I've seen a kid with it and they were just flat out miserable. No fun indeed.

But limits are good things! With any migraine kid I do set a limit of rest and a plan of follow-up if no improvement in that time frame (i.e. call home, send home, etc.).

[WineRN]

Abdominal migraines come with vomiting. It's a real dx (had a kid here last year) and no fun at all. The good news is that there will be a medical management plan in place AND she can stay at school (unless of course, she cannot).

I have a little one here with them currently. When they hit, there is no playtime or smiling. He rests in the fetal position in my back room with extreme nausea. Sometimes he gets to me in time to treat so he avoids vomiting and can go back to class after resting, but it is awful to watch. Most times I do end up just having him go home because if I do miss the window for treatment it's a few hour ordeal before he's back to himself.

[Amethya]

Last November, this student would come to my office all the time for constant vomiting and no fever. I wasn't sure what it was, and I would call his mom all the time to come get him, because I thought it was a illness based vomiting.

Mom called me yesterday and told me he was diagnosed with CVS and will bring paperwork for his condition to see what we can do to accommodate the student (Too many absences).

I do believe in this though because I think I had this a child. I used to get really bad migraines after eating lunch in my middle school as a kid and I didn't know what the cause, so I thought I was sick with a illness or something. I remember I would get the worse headaches ever, would be light sensitive, noise sensitive and completely nauseated. I would sit in class with my head down, then run to the restroom to throw up, every day. Then come back feeling super tired and with chills. My Texas History teacher was so amazing and would take me to the nurse and try to advocate for me, but I guess my nurse was tired or frustrated (I understand why now) and would send me back to class. But I would just not feel so good and when I would get home I would just sleep until the next day.

This kept going on for two weeks! And I went to doctors and no one knew what was going on. Then one day, I thought, what if it's something I eat? Because it only happens after lunch. I usually ate chili cheese fries for lunch with Gatorade and a cookie, (middle school diet) so I changed my lunch to the lunch tray and a milk and wouldn't you know it? I didn't throw up. I then went back to what I would eat, one food at a time and what I came to find out, it was the chili cheese fries. I was allergic to them. I told my mom and didn't eat chili or any chili cheese foods until I was in college, when I got up the nerve to eat it again at a restaurant and I was so prepared to get sick again, but I didn't. I'm not sure if I grew out of it or not, but I can eat all the chili cheese foods now. But that was my trigger. (Of course, it could also be because of my insulin resistance that I didn't know I had until I was 15, and was basically consuming like 63g of sugar in 30 mins. When I eat more sugar than I'm used to, I will have a mild version of this symptoms/)

The student's trigger is apparently stress. He causes himself to be super stressed because he worries too much and has anxiety. The mother told me they prescribed him to anti-anxiety medications, but is worried about the side effects or what they would do to him. I explained to her that with psych medications, they are considered trial medications until you get the right ones that works for you. I told her that she keeps on eye on his behavior and other things like side effects on him for a few days or so, and I can do the same here in school, and if there's something she doesn't like or what not, she can tell the doctor to try something else. But hopefully this medication actually works and keeps him from missing school, feeling better.

[kidzcare]

And the kid, unfortunately is not winning in the likeability department herself.

Hahahahahaha! this made me laugh!

[MrNurse(x2), ADN]

And the kid, unfortunately is not winning in the likeability department herself.!

This is exactly what I was discussing with my son yesterday. Other children see the child as lazy and ducking work. This is the perception from everyone around them. It is extremely difficult to not view it this way. This boy has few friends because of it, and it is sad.

[chacha82, ADN, BSN]

Please let's make her time at school as pleasant as possible" .

This attitude from parents...it makes me not want to work full-time in schools again, which is sad. I loved working with students!