Really not sure how to handle this one...

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Specializes in School Nursing.

A little background: 5th grade boy, single parent household, low income (free and reduced lunch and weekend backpack program where we send food home for the weekend), not very well controlled asthma, anxiety about his not very well controlled asthma.

Our school psych and my health aide approached me yesterday afternoon very concerned because they feel like he has lost quite a bit of weight since we returned from Christmas break. My health aide brought up the possibility of Type I DM (although I don't know if he has exhibited any other symptoms besides the weight loss such as increased thirst, increased urination, fatigue, vomiting, etc.) and our school psych is concerned that he is not getting enough to eat at home. There are many other health issues that could also cause weight loss so my suggestion is for the kid to go to the doctor and get a full head to toe physical but if there is a lack of resources I don't know if they will.

My health aide wants me to test his blood sugar. My gut tells me, "No way!"

My question is: how do I bring this up with a parent? I feel like this is the social worker hat that we sometimes have to wear and I'm really not great at it. Advice about how to start the conversation?

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I would not, repeat, NOT check this child's blood sugar with no order. Accucheck is considered an invasive procedure (I think) since it breaks the skin.

Maybe start with a call home? Ask the kid if he is having other symptoms.

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Specializes in School Nurse.
I would not, repeat, NOT check this child's blood sugar with no order. Accucheck is considered an invasive procedure (I think) since it breaks the skin.

Maybe start with a call home? Ask the kid if he is having other symptoms.

Agreed...We were always told we could not do BS checks without an order for that very reason. I am sure Mom would really appreciate a call home about your concerns, also have a few resources ready to provide her.

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Do you, by any chance have a previous height and weight on him, from earlier this school year? I'd probably talk with the student and ask the pertinent questions before calling home. Even if he has no sx, one of those, "We're concerned" calls is definitely in order.

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Specializes in school nursing, ortho, trauma.

Yes - i would not check the child's blood sugar without an order, but a call home with hard facts like Joey has lost 20 lbs since his last weigh in with suggestion to go to primary md or local clinic right away if they don't have one. I would even ask about the accompanying symptoms if mom notices anything unusual at home.

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Specializes in school/military/OR/home health.

Agree with everyone else. I even got rid of my "extra" glucometers because unless a kid is dx DM, I have no use for it. No orders, no bg. Definitely call mom and mention facts only, and concern for the weight loss. Maybe some numbers for local food banks? Numbers for local clinics? Even just an inquiry in to what she needs as far as resources?

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Specializes in kids.

Is he on ADHD meds? they can often be a cause for wt loss.

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Is he on ADHD meds? they can often be a cause for wt loss.

Good call. Maybe ask mom if he has started any new medications (as opposed to specifically asking if he started stimulants)

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Specializes in School Nursing.
Good call. Maybe ask mom if he has started any new medications (as opposed to specifically asking if he started stimulants)

Good idea!!! To my knowledge he is not on ADHD meds but asking if he started any other meds is a great suggestion!

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Specializes in School nursing.
Good idea!!! To my knowledge he is not on ADHD meds but asking if he started any other meds is a great suggestion!

It can be a great pathway! And if he did, the appetite suppressant effect can be tough the first couple of months.

How have his eating habits been at school? Is he eating the breakfast and lunch provided by the school? Yes, it can't make up for a possible lack of food at home, but nothing his eating habits here can also provide insight with a conversation with a parent.

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Specializes in Pediatrics Retired.

5th grade boy...growth spurt? What does his teacher say about the subject? I'd start back at the beginning and ask the concerned ones to be more specific about why they "feel like" he has lost weight? If they can provide you with reasonable and objective rationale and if his teacher agrees, then simply be straight up with the parent and call with the concern. Otherwise, I wouldn't call.

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Specializes in School Nursing.

I also thought growth spurt! I see this kid on a fairly frequent basis and I didn't notice he had lost weight. He's always been a skinny, string bean and wears baggy clothes. I saw him yesterday and his color wasn't so good and today, lo and behold, we sent him home with a fever. I won't see him now until the 20th because we are on spring break next week.

I am going to talk with his teacher and get her take before I call mom. Thanks, OldDude! You always give great advice!

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