Ridiculous things. This is a new one one me.

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Have any of you EVER had dr. orders to give Ritalin 3 times a day at school? To be exact--- before breakfast and lunch (7:45 and 11:45) and at 2:30? I am still shaking my head on this one. :no: :sarcastic: Just to explain a little further-- the 2:30 dose is at motherdearests' request so the kids aren't sooooo wild and crazy when they get home!!! pullleeeeez

Specializes in IMC, school nursing.

I do think there is a lot of bias when dealing with these type of medications, which I don't feel is appropriate from members of the health care team. For example, do you have the same concerns about dosing insulin at breakfast and at lunch? There is a stigma about mental health in general, and IMHO, a stigma on the parents of children with ADHD.

Though I can not speak for everyone on AN SN, most agree that medical management is the preferred treatment. I deal with insulin every weekend at my acute setting position. I will never give short acting insulin within 3 hours of each other, I know the duration. The increased risk of side effects is too great. The real question, should you prescribe these meds, should be to check with the teachers to see if the child is overly distracted/ hyper. Too many parents, and trust me, I have dealt with both ends of the spectrum, don't take teacher's input at all and request based on what they experience at home. By your own posts, the duration has changed from 4 hours, down to 3 hours to justify the 150 minute gap in the last two pills. This whole thread just reeks of parent driven convenience and we have forgotten the real principle, the poor child's education. To drag a kid out 3x/day from class is disruptive to both the child and classmates. The real part that is being overlooked is an 0700, 1000, 1300 schedule would cover his school hours and have less disruption.

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Specializes in Pediatrics Retired.
Calling to verify that a order is correct is fine, and often appreciated. I am not sure that's what the initial post was about though. I don't think having concern is a "bad thing", don't get me wrong, I would be happy if someone called and verified it, or if a med was held due to concern for an adverse effect.

I do think there is a lot of bias when dealing with these type of medications, which I don't feel is appropriate from members of the health care team. For example, do you have the same concerns about dosing insulin at breakfast and at lunch? There is a stigma about mental health in general, and IMHO, a stigma on the parents of children with ADHD.

When I first started school nursing I thought ADD and ADHD was the biggest bunch of malarkey I had ever heard of; definitely just an excuse for bad parenting. After a few years of witnessing objectivity I started swallowing pieces of humble pie and then when I realized I had spawned a child with ADD I had the whole humble pie shoved down my throat. It is definitely a difficult subject to introduce to parents who are in denial about their child with ADD or ADHD and even more difficult to get across to those who don't have affected children.

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I have no issue at all with giving Ritalin or any similar med. However, as licensed nurses, we MUST follow appropriate practice standards and question if we feel dosing deviates from the standard of care, or could potentially cause an adverse effect.

Bottom line, if it seems wrong, question it.

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Specializes in critical care.
3 doses in 6 hours? I've read up on it since you've posted, and that still seems close.

I would at least question it, like Cattz did.

Am I totally wrong here? I can take it if I am.

I would question the timing, maybe instruct mom that the first needs to be given at home if the spacing is too close per the MD.

I understand there are some psychosocial concerns with mom. It's possible his ADHD is so severe that rapid acting in multiple daily doses work well for him.

If anyone would like a little anecdotal story regarding the importance of the ALL day and night coverage of ADHD symptoms.... My son (my lovely little womb nugget who inspired a semester long independent study on this topic my final year of undergrad) was unable to sleep last night and managed to give himself a laceration on his knee that required stitches at 10:30 last night. We forgot his stimulant on one day, and this madness happens. (In our defense, my other kid was vomiting bile, throwing off the whole morning routine. We are not having a good week.)

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I would question the timing, maybe instruct mom that the first needs to be given at home if the spacing is too close per the MD.

I understand there are some psychosocial concerns with mom. It's possible his ADHD is so severe that rapid acting in multiple daily doses work well for him.

If anyone would like a little anecdotal story regarding the importance of the ALL day and night coverage of ADHD symptoms.... My son (my lovely little womb nugget who inspired a semester long independent study on this topic my final year of undergrad) was unable to sleep last night and managed to give himself a laceration on his knee that required stitches at 10:30 last night. We forgot his stimulant on one day, and this madness happens. (In our defense, my other kid was vomiting bile, throwing off the whole morning routine. We are not having a good week.)

"Womb nugget'!!!!! BEST PHRASE EVER!!!

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Specializes in critical care.
When I first started school nursing I thought ADD and ADHD was the biggest bunch of malarkey I had ever heard of; definitely just an excuse for bad parenting. After a few years of witnessing objectivity I started swallowing pieces of humble pie and then when I realized I had spawned a child with ADD I had the whole humble pie shoved down my throat. It is definitely a difficult subject to introduce to parents who are in denial about their child with ADD or ADHD and even more difficult to get across to those who don't have affected children.

I was stubborn for a little while. My husband still resists it sometimes (and he has ADHD). I'm all in. Treat all the kids! My poor son was terrified of talking to adults because he was afraid he'd say the wrong thing. His MD wanted us to get through kindergarten before starting meds. His teacher (who stressed me out to no end) begged me to get him on meds (sooooo inappropriate). He ended up anxious because he lived in a world where people kept telling him to stop what he was doing. It took me awhile to recognize that. He's a lot better now. But things were rough in the beginning.

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Specializes in Pediatrics Retired.
I would question the timing, maybe instruct mom that the first needs to be given at home if the spacing is too close per the MD.

I understand there are some psychosocial concerns with mom. It's possible his ADHD is so severe that rapid acting in multiple daily doses work well for him.

If anyone would like a little anecdotal story regarding the importance of the ALL day and night coverage of ADHD symptoms.... My son (my lovely little womb nugget who inspired a semester long independent study on this topic my final year of undergrad) was unable to sleep last night and managed to give himself a laceration on his knee that required stitches at 10:30 last night. We forgot his stimulant on one day, and this madness happens. (In our defense, my other kid was vomiting bile, throwing off the whole morning routine. We are not having a good week.)

The joys of parenthood. Just when you think you got it - you don't. Good luck on getting this episode turned around; until the next chapter. Having 4 boys (and the GIRL), I think I know to what you reference.

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"Womb nugget'!!!!! BEST PHRASE EVER!!!

I think that's an Oodism.

(WellThatsOod)

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Specializes in critical care.
"Womb nugget'!!!!! BEST PHRASE EVER!!!

I give credit to WKshadow!

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Specializes in critical care.
I think that's an Oodism.

(WellThatsOod)

I thought that was WK? No?

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I give credit to WKshadow!

One of them. Ood, Shadow... :roflmao:

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I was stubborn for a little while. My husband still resists it sometimes (and he has ADHD). I'm all in. Treat all the kids! My poor son was terrified of talking to adults because he was afraid he'd say the wrong thing. His MD wanted us to get through kindergarten before starting meds. His teacher (who stressed me out to no end) begged me to get him on meds (sooooo inappropriate). He ended up anxious because he lived in a world where people kept telling him to stop what he was doing. It took me awhile to recognize that. He's a lot better now. But things were rough in the beginning.

My ex has been asking me to talk to my son's teacher about ADHD for a year or more (why he can't contact the teacher is a whole nother topic). I finally did a week or so ago and she said that he is definitely more active than the other boys in the class but that she does not feel that it is affecting his learning at this time, but that it may in the future. So we will readdress as he goes through school. But if a medication would help him focus and not become frustrated, then it would be worth it!

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