policy on throwing up

Jolie, BSN · Nov 27, 2010

I'd be surprised to read a policy that required students to be sent home for vomiting, in the absence of any other s/s of illness.

Our district has a policy that students will be excluded from school on a day to day basis for evidence of an undiagnosed/untreated potentially communicable condition. This may include vomiting, fever, undiagnosed rash, undiagnosed eye redness or drainage, uncontrollable cough, lethargy, etc.

It is not uncommon for a student to vomit a small amount following vigorous physical exercise, when exposed to unpleasant smells/sights/tastes, out of nervousness, or even deliberately. In our schools, the nurse would assess the child, observe for a time and make a determination as to whether or not the student appears to be truly ill or not.

On occasion, a child has "issues" such as not liking a particular teacher, being fearful of a bully, etc. that need to be jointly addressed by the parent, teacher and nurse in order to keep the child in school. Sounds like this may be one of those times. I'm surprised that the school seems unwilling to look into this, but the parent might have to insist.

mustlovepoodles, RN · Nov 27, 2010

It is not uncommon for a student to vomit a small amount following vigorous physical exercise, when exposed to unpleasant smells/sights/tastes, out of nervousness, or even deliberately. In our schools, the nurse would assess the child, observe for a time and make a determination as to whether or not the student appears to be truly ill or not.
On occasion, a child has "issues" such as not liking a particular teacher, being fearful of a bully, etc. that need to be jointly addressed by the parent, teacher and nurse in order to keep the child in school. Sounds like this may be one of those times. I'm surprised that the school seems unwilling to look into this, but the parent might have to insist.

I'm an elementary school nurse and I can attest to all of the above. My first question to the child is "Why do you think you threw up?" I mean, vomiting can have a lot of causes.And most of the time, the kids can tell me exactly why they threw up. When I was in the middle school it wasn't unusual for kids to throw up at lunch because they saw someone eating with their mouth full. Or they dissected owl pellets in Science. Or they watched the Childbirth video in Health. All vomiting is not equal.

In my school system, we are required to call a parent when a child vomits, for whatever reason. However, if the parent and the nurse can establish that there are no other symptoms(fever, abd pain, diarrhea) and it seems to be unrelated to actual illness, then we dont' have to send home. I have a great relationship with my admins, so when I"m in doubt I can always run it by them. If the child has vomited twice, though, he/she needs to go home.

Most of my students are genuinely sick when they throw up. However,I have a few kids who have figured out the system, the "magic words." I have talked with their parents & teachers and we have all agreed that if the child needs to throw up he/she must do it in the presense of an adult. None of this "I threw up in my mouth" stuff. If nobody saw it, it didn't happen. If the so-called vomiting continues then I make a referral to the PCP to see if there's some other thing going on .

NYnursejo · Nov 27, 2010

In our school if the child has issues with vomiting and it is not r/t to any type of health condition and it has caused a few absences we ask the parent get an MD note stating Child has "weak stomach" or something to that affect. I had a little girl that could not see or smell strawberries because it was a guarantee she would vomit, as long as they are afebrile, GI assessment is unremarkable and there is no rash, your covered if they don't go home.

SchoolNurseBSN · Nov 28, 2010

I would work on getting to the bottom of the problem and work out a plan to keep this child in school.

manjaNurse · Nov 29, 2010

My country (singapore) ministry of health advised children who has vomited 2x or more within 24 hrs to see a doctor. So only if they vomited twice, I'll send them home. Unless of course its accompanied by fever or active bowel sounds etc

Purple_Scrubs, BSN, RN · Nov 29, 2010

Here's my policy:

1) If I didn't see it, it doesn't count (exception if a reliable adult witnessed the vomiting, but none if this "I threw up in the bathroom" business

2) If it happened once and no other s/s of illness, you rest for 10-30 minutes depending on your assessment. If no further vomiting episodes, you go back to class

3) If you vomit twice or more and/or there are other signs of illness, you go home

4) If you are a PK kid and vomit a large amount (need a change of clothes, etc), and I am concerned that you will not be able to make it to the trash can if you have to vomit again, then you may go home (infection control situation and keeps myself on the custodians good side)

LACA, BSN, LPN, RN · Nov 30, 2010

I'm mostly just echoing what's already been posted, but this is my policy....

1. No witness? It didn't happen. Plain and simple. I'm not sending a child home for a vomiting episode that no one witnessed. Half the school would be out every day.

2. You threw up, no one seen you, but you want to go home?? Okay, well sit in my office for about 15 minutes. Typically, if you're throwing up because you're sick, it's going to happen again.

3. If you're okay while in my office, off to class you go.

4. Thrown up more than once? Nine times out of ten, they go home. But if it's a child who is asymptomatic and they've been told that someone has to witness it and the second episode isn't witnessed, they stay.

5. Vomiting, even once, with any other symptom (fever, lethargy, etc) go home.