Poopy Pants in PreK

[amnesiac1c]

So our protocol thus far is that SPED students may receive personal hygeine assistance from their classroom teachers & instructional aides if they have a toileting accident. But gen ed students (including those in PreK) who have poopy accidents wait for parents to come assist with simple clean up or go home for a bath.

For the first time ever, this week I had a foster parent take issue with this practice. I presume she is composing a letter outlining her complaints at this very moment. Does anyone clean up after BM incontinence in gen ed students?

[cayenne06, MSN, CNM]

I have to say, I would be LIVID if I found out my child had sat in poopy clothes for the 30-60 minutes (or MORE! If I was at work it might take me 90+ minutes!) it takes for me to get there.

What is the rationale for not allowing you, the RN, to assist the child in cleaning up? I can't imagine letting a child sit in poop for any reason.

[rbytsdy]

No. I do not touch children in that area. Let that woman compose a letter.

I have given children a change of clothing if I can't get a hold of a parent and let them change themselves. But I am not going to risk anyone coming back and saying I touched their child inappropriately.

Sorry - I hate this expectation that schools need to perform parental responsibilities. Parents need to have a plan of care or their children in emergency/urgent cases.

[JustBeachyNurse, LPN]

Special education it's defined in the IEP, IHP, or 504 who if anyone is responsible to assist with a change. Often classroom staff is trained/delegated to this task. They are instructed to call nursing if anything out of ordinary (rash, breakdown, irritation, bruising, notify if pattern change (loose BM, s/s constipation, increase or decrease in wet diapers)

Otherwise nurse may store spare clothing, wipes, etc. assist with buttons/zippers (so can classroom staff) , give a bag for child to store clothes, provide a private bathroom, and contact parent or designee. Before my sons IEP was enacted he was not fully capable to change independently nurse would assist as she could (use her bathroom, help with shoelaces zippers, snaps, buttons) give him a chance to clean up but alert me first so I could start coming in. Sometimes he would be successful with her promoting from behind the bathroom door & I would be cancelled other times I was needed to assist.

Once the assessments & evaluations the nurse asked to participate in the IEP meeting. She was awesome in adding to his plan & educating staff on the need for scheduled toileting as ordered by his physician team. Until he was forced to switch schools the nurse was his safe haven. There was an incident with an unprofessional para that nearly scarred my child (thankfully a precocious classmate told me what occurred) the nurse became a safe haven and had it so if he asked to see her he could not be denied. She started the increase in self confidence in school

[Farawyn]

I can't imagine how red the kid's hiney is after this.

That is just nuts.

[JustBeachyNurse, LPN]

Usually regular education or preschools require typical children to be fully toilet trained as a condition of admission/enrollment. It's a different scenario in a special needs classroom or student. Even then it's not the nurse changing diapers but the classroom paraprofessionals.

Policies for nursing in public schools are very different. I've seen a BoE written guideline that specifically state parents/guardians are to be called if a child soils/wets his or her pants and requires assistance with hygiene unless otherwise specified in an IEP, 505, or medical IHP. Nursing is to only offer a private area when possible to change, means to clean by self.

[Farawyn]

Yes, but Pre-K is age 4, yes? Accidents happen. I would call the parent and say I want you to know I'm going to help change and clean your child, unless you can get here ASAP.

[JustBeachyNurse, LPN]

Unfortunately BoE have policies against that because of past accusations

[rbytsdy]

I was reading that as K (rather than pre-K) so I was thinking 5 and up ( know - preK was even in the title!!!). Our general pre-K is run by an out of district company so those teachers need to assist children. I don't do that. Our in-district pre-K is SPED 3 and 4 year olds who are not necessarily toilet trained. Again, it's the teachers that assist those children.

It is amazing what parents will try to sue the schools over. I can see how pre-K kids would be prone to accidents. Unless you are specifically delegated to this task, I would not touch a child there. I've had kids tell me they hurt their bottoms, their genitals, itch, etc. I don't get anywhere near that area. If I can, I explain to the child what to do and send them to the bathroom. Otherwise, I call the parent.

[emv2008]

I have subbed in about 5 districts so far. One district has the RN clean the poopy pants. The aides are not allowed to touch the children. For the very young children, a parent must come get the child. Another district does not allow any staff to clean the child. The parent has to come and change the child and decide whether or not to take the child home.

[Farawyn]

I get what you all are saying, but it' so sad!

[Flare, ASN, BSN]

it is sad, but it's the litigious society we live in. To compound things, I often don't have clothing left - especially for small boys (i have a daughter -so most of my lend out clothing was hers) I will always call and explain the situation and offer to the parent that i could put their son in clean underpants, but they may have Cinderella on them. (It is amazing how quickly they can find someone to get to the school when that is offered as an option)

Our kindergarteners are supposed to all have a change of clothing in their cubbies at all times. The older grades are not required, but i tell the parents that it's okay to leave a change of clothing in a ziplock and put in the backpack if they have any concerns that their child may need it. It beats having to wait or wonder what my assortment may be.