Really not sure how to handle this one...

[KKEGS]

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?

[RatherBHiking, BSN, RN]

I love when other non nursing staff try to "diagnose" students based on one symptom. No you shouldn't check blood sugars without an order. Does he look malnourished to you? If he's eating breakfast and lunch at school and gets food on the weekends he's not starving to death (but he could still be hungry or not getting enough). I agree with the possibility of a growth spurt. You could always check his height and weight and see if they're in the normal range for his age and if so I wouldn't be too concerned. You could always just ask him what he had for dinner last night and see if he feels he's getting enough. My brother and I looked anorexic growing up but we ate well. Our mother was the same way. It was just our metabolism. (Yes it caught up with us in our middle age! LOL). Definitely do a little more investigating before calling. Sometimes staff jumps to worst case scenario without getting all the facts. If the school nurse called me and said you're child looks like they're losing weight without any other symptoms I'd be a little offended and embarrassed. Just sayin.

[BSNbeauty, BSN, RN]

I would start off with a phone call with mom. If you get no where with her you can always contact social services or make a CPS report just so they can investigate and provide services if needed. May seem a little extreme but you never know. I've seen it all.

[fawnmarie, ASN]

I love when other non nursing staff try to "diagnose" students based on one symptom. No you shouldn't check blood sugars without an order. Does he look malnourished to you? If he's eating breakfast and lunch at school and gets food on the weekends he's not starving to death (but he could still be hungry or not getting enough). I agree with the possibility of a growth spurt. You could always check his height and weight and see if they're in the normal range for his age and if so I wouldn't be too concerned. You could always just ask him what he had for dinner last night and see if he feels he's getting enough. My brother and I looked anorexic growing up but we ate well. Our mother was the same way. It was just our metabolism. (Yes it caught up with us in our middle age! LOL). Definitely do a little more investigating before calling. Sometimes staff jumps to worst case scenario without getting all the facts. If the school nurse called me and said you're child looks like they're losing weight without any other symptoms I'd be a little offended and embarrassed. Just sayin.

I absolutely, 100% agree with Blue Moon here. OP, your health aide does not have the education, nor the experience or insight to suggest that the child may be diabetic. I would firmly tell your aide that you are not authorized to obtain an Accu-Check without a clinician's order. Unlicensed personnel do not understand that we, as licensed professional nurses, are only allowed to perform procedures that we have a doctor's order for. My school health RN supervisor gave me some very good advice when I was brand new to school nursing and wanted to help every single child with every single issue...remember that the child's parent is ultimately responsible for his health and well-being. Teachers and unlicensed helpers do mean well, but don't forget that YOU are the licensed, professional nurse, and you must use your own professional nursing judgment here.