School Nurse-need help

[kimmie79]

l really need some help. I'm a school nurse for a daycare part-time. Once a month I go and check the childrens chart to make sure they are up-to-date on their vaccinations and physicals. I go after hours because I work during the day. One day I had the day off my regular job so I went up to the school during the day when the children were there. The teachers ask me to observe an infant because they believe something is wrong with her motor skills. Sure enough this baby who is about 8 or 9 months doesn't use her left side. When she crawls, she crawls on the right side of her body.

Her history is that she is a twin and her sister was top of her in the womb and kind of "smashed" her up so to speak while they were growing inutero. This is common among twins but at this point it should have either resolved on its own or she should be receiving some type of physical therapy. The teachers have tried talking to the parents but they are in denial the teachers said. Because I don't see the parent, I was wondering if I should do one of two things: Write a letter to the parents letting them know what I've observed and suggest they talk to the pediatrician about their daughter's motor skills or write a letter to the pediatrician and let him know what I have observed. I don't understand why the pediatrician has not intervene yet. They have a doctor they see on a regular basis because the girls are up-to-date on their vaccinations and physicals. It could be because they are on public aid the doctor just give the babies their injections do a quick look at them and sign off on the forms.

Any suggestion?

[safarirn]

I am not sure what the correct thing to do is.

But I would definitely START by having a conversation with mom. Perhaps a home visit? Or a face-to-face conference. I would approach it as though you are the first person addressing this concern with her. Talk about the importance of early diagnosis & intervention if there is a medical issue. I would recommend she follow up with her physician & ask her if she would like you to write a letter to the physician that states your observations/ assessment/ concerns.

If mom seems receptive I would call & follow up with her to be sure she has made the appointment.

The problem is if she really is in denial, or acts like she doesn't care. My next step would probably be a call to her pediatrician's office.

Let us know how it goes!

[kimmie79]

Thanks! I'll give that a try. Have you heard of Child Find. I think what I'll do is talk to her and let her know about Child Find and they will come to her home to for an evaluation and make the referals. At least that is what someone told. The problem is that I don't like confrontation and I really hope this mom doesn't get upset at the school because we are telling her that something is wrong with her baby. I'm not a mom and the sound of me having a child with a possible disablity or needing some type of therapy puts butterflies in my stomach. I use to work in the NICU and parent don't like to hear when we have concerns about thier children.

[safarirn]

I have never heard of Child Find... but if that is a service offered in your area- GREAT!

As for 'telling her something is wrong with her baby' - if you approach it as a concerning observation you have made that needs to be evaluated, you aren't really diagnosing or labeling the child.

I am a mom & I definitely would want to know if there were concerns about ANY of my children. Even if I wasn't 'prepared' to hear what someone was telling me, I think the mere mention of a deficit/ problem would make ME more observant & quicker to go seek a second opinion.

Good Luck!

[bergren]

Call the local school district and find out what the early intervention services / outreach is in your area. Sometimes it is called ChildFind and sometimes it has another name. Then call that agency for some pointers on how to proceed. The research on physicians picking up on developmental disabilites is pretty poor, they are often late in suspecting something is amiss and the developmental screening tools used in this age group are not that accurate. But the benefit of getting services now are huge.

Call also the Child Care consultant in your state and find out the best way to do this and check your job description.

I have worked in early intervention and developmental screening about half of my career. It is a sensitive dance to alert a parent that the child might be developing slowly or that a disability might be surfacing. I'd try to be there as the child is neing dropped off or picked up. I usually start by asking them how they think the child is doing, how they are growing compared to other children, and in this case, the twin. If that does not elicit anything, I'd ask the mom if she had noticed anything about how the child is crawling. Try to get the mother to tell you what she is seeing. If the mother notes it, you can tell her that the child favoring one side is not what is typically seen. The Child Find or what ever it is in the area will take referrals from anyone, so then ask the mother if she would like you to put in a referral for this free service that will see if there is anything to look into. That they might suggest some specific play activities for the baby.

Good luck - get back to us with how this works out. I have had parents that resist getting evaluated, and in my younger years I probably pushed more than I should have. But now I realize it is a process that the parent has to go through until they are ready and that maintaining the trusting relationship with the parent is important. Make sure the staff at the center all have the information so that when the mom is ready, they know how to refer her to the resources. The Outreach / Child Find might even come into the Child Care Center to do an inservice for the staff