Self harm situation

[littleINlpn]

This isn't totally nursing related but I have a 7th grade student who gets upset and then bites herself on her arm. It is a newer thing, I believe, and she states she has never broken the skin. She seems to have a lot going on in her life but she isn't very open to talking about everything. She was seeing a counselor previously but said they just gave her a notebook to draw in when she became upset and that did not help her, she started to cry when talking about her mother (says mother yells at her often) but when she started to tear up she told herself not to cry over and over and then was "fine." She says the only thing she likes to do is sit in a chair and spin, that's all she does at home. Are there any strategies you guys know of that could possibly help? I haven't worked with students like this before. I do not want her self harm to go deeper. She has an independent study to do for class and she wanted to do it on suicide, so that makes me worry a bit.

[grammy1]

At our school, this would go to the guidance counselor.

[littleINlpn]

We don't have one, unfortunately.

[kidzcare]

I do not want her self harm to go deeper. She has an independent study to do for class and she wanted to do it on suicide, so that makes me worry a bit.

The time for intervention is NOW. This girl is whispering for help- if no one listens, she may not decide to ask louder. Get the principal involved. I wish you had a guidance counselor. Big hugs to you and her!!

[Farawyn]

Are you THE person at the school for all health related issues? Because mental health falls under this. If you do not have Guidance, Psych or Social Work, I would escalate it to the Principal ASAP.

Is this new behavior for the student?

Please keep us posted.

[littleINlpn]

I wish we had a guidance counselor also. I am not "the" person for all health related issues, she was sent to the office this morning because of the bite on her arm and teacher wanted her to see me. I was told all of this information from the office staff, I work part time and wasn't here during the time she came down. Office staff talked with her, principal knows and is involved. I am not sure if this is new behavior, she came from another school but she has not done this while she was here until now that I'm aware of. I am wanting to sit and talk with her with admin, I will keep you all updated. I really dislike these types of situations, breaks my heart.

[Farawyn]

I wish we had a guidance counselor also. I am not "the" person for all health related issues, she was sent to the office this morning because of the bite on her arm and teacher wanted her to see me. I was told all of this information from the office staff, I work part time and wasn't here during the time she came down. Office staff talked with her, principal knows and is involved. I am not sure if this is new behavior, she came from another school but she has not done this while she was here until now that I'm aware of. I am wanting to sit and talk with her with admin, I will keep you all updated. I really dislike these types of situations, breaks my heart.

Yea, it is the worst part of school nursing, but may very be the MOST IMPORTANT thing you have a part in with any child's life.

[RNNPICU, BSN, RN]

I realize that I am not a school nurse, but the scenarios you are describing are a huge cry for mental health care. It almost sounds like schizophrenic or even some paranoid behavior - the rocking, talking to self and telling herself she is fine. Are you able to contact her PCP. If she escalates you could always call 911. There must have been some trigger either at home or something at school that re-ignited her behavior. See if anything has happened in any of her classes, or see if you can look at her notebooks.

Wish you the best of luck

[hppygr8ful, ASN, RN, EMT-I]

I realize that I am not a school nurse, but the scenarios you are describing are a huge cry for mental health care. It almost sounds like schizophrenic or even some paranoid behavior - the rocking, talking to self and telling herself she is fine. Are you able to contact her PCP. If she escalates you could always call 911. There must have been some trigger either at home or something at school that re-ignited her behavior. See if anything has happened in any of her classes, or see if you can look at her notebooks.

Wish you the best of luck

OK psych nurse here - I wouldn't go so far as to call this schizophrenia. She is definitely engaging in behavior that helps her to sooth herself such as rocking, spinning in a chair etc. These can suggest some form of high functioning autism we often see autistic children and adults bite or pinch themselves to relieve stress. The first step would be for a meeting with the parents to suggest the child have a through neuro/psychiatric evaluation. Such evaluations can be costly however (most are not covered by insurance) and many parents are reluctant to have them done as they fear the worst (a psychiatric diagnosis) . Behaviors such as this can indicate many things and it is never a good idea to rush to judgement. If you are in a public school evaluations can often be done for free or at a reduced cost so the first thing to do is it get the parents in the office and sit down with person trained in child psychology to explain the problem and see if the parents 1 agree there is a problem 2- are willing to seek out a diagnosis and solution.

I am not a big fan of sending these kids into inpatient settings because they often learn more self destructive behaviors there. What this child most likely needs a therapist traine in CBT to help this child develop less destructive ways to express her pain.

Hppy

[Farawyn]

OK psych nurse here - I wouldn't go so far as to call this schizophrenia. She is definitely engaging in behavior that helps her to sooth herself such as rocking, spinning in a chair etc. These can suggest some form of high functioning autism we often see autistic children and adults bite or pinch themselves to relieve stress. The first step would be for a meeting with the parents to suggest the child have a through neuro/psychiatric evaluation. Such evaluations can be costly however (most are not covered by insurance) and many parents are reluctant to have them done as they fear the worst (a psychiatric diagnosis) . Behaviors such as this can indicate many things and it is never a good idea to rush to judgement. If you are in a public school evaluations can often be done for free or at a reduced cost so the first thing to do is it get the parents in the office and sit down with person trained in child psychology to explain the problem and see if the parents 1 agree there is a problem 2- are willing to seek out a diagnosis and solution.

I am not a big fan of sending these kids into inpatient settings because they often learn more self destructive behaviors there. What this child most likely needs a therapist traine in CBT to help this child develop less destructive ways to express her pain.

Hppy

This. Thanks, Hppy.

Also, we try to avoid calling 911 unless there is imminent danger to the child, or unless it is a true physical emergency.

[kidzcare]

Thank you for the input Hppy

[canigraduate]

Sounds like kiddie PTSD, almost.

I used to do a lot of the same things as a form of ineffective coping when I was younger.

Totally agree with Hppy. This child needs an evaluation, stat.