Ridiculous things. This is a new one one me.

ixchel · Feb 25, 2016

I don't think it has even been in question here that ADHD med can be very helpful. The question was the timing of the meds. I have a lot of students with ADHD, and none of them take 3 doses in just over 6 hours.
The issue in the OT was whether this was the best option for the CHILD rather than convenience for the adult.
I can't imagine anyone who is a school nurse not seeing the value of medication for ADHD. We have seen it work.

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100kids, BSN, RN · Feb 26, 2016

And school nurses always think about what is happening at home. It can keep me up at night sometimes - especially when I can do nothing about it despite really trying and know is it interfering with a child's life and ability to learn. Because unlike other situations, I get to see its effects every day.

This is so true! I worry about "my kids" all the time, do they have food to eat at home on weeklong vacations? How can I get mom some education so she can help little Jimmy manage his diabetes more effectively? Why does this darn doctor insist that little Janey doesn't need a spacer for her inhaler? How can I keep Mikey out of the hospital so he can stay school? Why was Emma so quiet today is something going on at home?... and on and on and on. Being with these kids 180+ days/year for 7-8 years in a row means they really are "my kids". My job is to help balance their health, school life and home life and find ways for them to receive the education they deserve while still remaining safe and healthy. I am their advocate with their teachers, their doctors, and their parents. Most parents are wonderful but working in a school setting has really opened my eyes about too many of them.

SnowyJ, RN · Feb 26, 2016

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Ok, I knew that but I thought they were off topic? I missed it.

NutmeggeRN, BSN · Feb 29, 2016

Most kids don't eat breakfast at school, hence the 3x a day questions.
And your profile says pre nursing student. Better fix that.
What's an ADVICER?

Mic drop!

NutmeggeRN, BSN · Feb 29, 2016

I am going to be the Debbie Downer here, forewarning. If you are going to hate me then you can always stop reading...right....about...now...
I don't see what the fuss is about. This is a medication with a 3 hour duration of action and it is given for an illness that doesn't just stop when a kid gets on a school bus. I feel like there is a lot of judgement being made on the mother when I am not sure any of us know what the home situation is like. I think these medications are used more than they should be, but that's between the child, guardian, and prescriber. It's also used for conditions other than just ADHD. Does the child have ADR symptoms that are concerning to you at school? Clenching, TMJ, weight loss, appetitie loss, etc?
Stein, M. A., Blondis, T. A., Schnitzler, E. R., O'Brien, T., Fishkin, J., Blackwell, B., ... & Roizen, N. J. (1996). Methylphenidate dosing: twice daily versus three times daily. Pediatrics, 98(4), 748-756.

Im guessing the OP has knowledge of the family/parent inquestion that may not be shared here, but impacts her feelings on this issue.

OldDude · Mar 1, 2016

I got an order this morning to give Focalin to a student at 10:00 and 1:00, with a 7:00 am dose given at home. I'm seeing a trend of treating the more severely impulsive kids like this instead of extended release medicine.

canigraduate · Mar 2, 2016

OT but related:

The ADHD injuries seem to run in families! My brother and his son have the exact same scar on the lip from biting through it after falling. The nurses at the children's hospital ER know my family by their first names. My nephew has had more stitches in his 6 years than I have had in my entire life. My brother is a mess of lac and burn scars.

I knew my nephew was part of the tribe when he was 2 1/2, but it took nearly failing out of kindergarten to get him help.

He owes a large part of his current success (he is actually getting awards in his first grade class -- real ones) to nurses like you all.

Thank you for what you do. It really makes a huge impact on the children's lives!!

OldDude · Mar 4, 2016

Got another one!! Ritalin, 10mg, at 3:15 - school dismisses at 3:20.

kidzcare · Mar 4, 2016

Got another one!! Ritalin, 10mg, at 3:15 - school dismisses at 3:20.

Another issue with this is forgetful students. What if you are busy with a bunch of other kids or a serious injury and the kid forgets. Then mom or dad are calling the next morning "How come Timmy didn't get his RX??" If they are taking all doses at school, then they wouldn't have any (or much) extra at home.

I had that happen once. I was assessing a student who collided with another student in PE. Her teeth broke off in his forehead. It was lovely. A kid came down for his daily med and I said "come back in a little while" and he forgot and so did I. Mom sent a stern email saying her kid's needs shouldn't be shoved aside because of another kid's needs.

SchoolNursey · Mar 8, 2016

Cattz,I am curious, I even looked at your original post to clarify. What is the school hours for the student mentioned? I have a feeling that either that breakfast or afternoon does is outside of school hours? I ask because if school lets out at 2:30 and the student gets in his car at 2:37, well that makes a difference doesn't it? Or does school start at 8:00 and student gets out his car at 7:45 and mom expects you to give it? Either of those scenarios seem to be a parent responsibility and not necessarily the school nurses. Does he ride the bus a long way to and from school because that means something entirely different.I think non-school nurses think in terms of the 24 hour hospital time and we work on a different schedule. If the doctor orders a 6:00am med in the hospital, it has to be given by a nurse. If he orders it for a student at same time, well hello - the reason I took a job as a school nurse is so I don't have to be to work at 6:00AM or 6:00PM. Yes, yes and yes on us having to also balance missed class time and disruption to the learning environment. These are specific to our specialty and nowhere else!! 15 minutes possibly of missed class time for each medication administration x 3 = 45 minutes. That is like missing an entire class everyday. Our medication policy strictly states "only medication that can not be given at home be given at school." Do we make exceptions for kids that get themselves ready because their single mom has to be at work early, you bet we do!! Do we maybe stand strong and not give in to the mom who is there daily, feeds him breakfast at home, drives him to school then loiters in the front office for 4 hours to make sure her darling is ok? You bet we do because due to all of those circumstances , it is more appropriate to be given at home. Every student that comes in my clinic has a physical assessment but I also look at their attendance, their grades, what class they are coming from, time of day, what their parents said and did. Heck, what teacher said and did too (only a school nurse will understand my meaning on that one.) That times 12 because they are walking in 10 deep at a time while someone is calling you on the radio saying someone is hurt in the gym, a parent in waiting to yell at you about not treating their kid that the PE teacher never sent down and the teacher waiting for you to hand her the field trip bag in which 2 diabetics, 3 peanut allergies and 4 asthmatics are going on and you only found out 12 minutes prior and the bus is waiting to pull away. That was a giant run on sentence but school nursing in a nutshell. So, forgive us if we want to get her and leave here at our contracted time so that a parent is relieved of their resposibilty.

Great summary of school nursing in a nutshell!

Macropsia · Dec 24, 2016

I'm living on both sides of this fence. My son requires these meds and I'm a prudent nurse.

Regular Ritalin is short acting. If the child needs that much I'd suggest an extend release product in the morning and short acting for mid-afternoon homework or team activities.

Of course it can become a crutch to parents but there are kids that genuinely need these meds to slow their chaotic minds. After going to the ends of the earth to exhaust all non-med interventions with little to no improvement and my 1st grader being expelled; I agreed to try meds and with such a drastic improvement evidenced by his less fragmented thinking, actual learning and retention of info. and lessening negative behaviors led to him having friends when he was too hyper and scary before.I'm sharing this because there is a place for this med when it is given and used properly.

SunnyPupRN · Dec 25, 2016

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