Any help or suggestions would be greatly appreciated!
I have a first grade little girl that is hurting herself almost daily and it is escalating in severity. It started at the end of last school year with minor things, like picking her nose till it bled and picking at an insect bite or scab till it bled, etc. Now she is putting stuff in her ears, biting her tongue till it bleeds, cut her ear lobe with scissors, gaging herself till she vomits, and so on. There is an injury involving blood daily. The teacher, myself and counselor have all talked with her and tried to give her other ways of coping and dealing with stress. I was just informed that yesterday, during a meeting the teacher had with the mom (I was not invited to this meeting), she told the teacher that before the little girl started school she had pulled out her toe nails several times and has pulled out 14 teeth before they were ready to come out. I think the mom is in denial that there is a problem that needs to be addressed. She needs constant supervision but of course in a large class room and one teacher that is hard. I am so scared and worried for this child! Admin is aware of this child and what she is doing but, still noting is getting done! I want to get her help but don't know where to turn.
Has anyone dealt with something like this before? Any suggestions would be great!!
That was my kneejerk, surprised your counselor was unphased. Harm in school can elicit a 911 call whether or not she is under care.
As of right now, she is just covered under a 504 plan and has a BIP, and the counselor has given her "other" ways to cope when she gets upset, like a squishy ball, smelly soap, head phones, etc. Obviously these are far from helping at this point. We are a small town school and don't have recourses on campus as you might in a larger city. And, I am pushing my admin to do something more for her but not getting anywhere quick with them. I feel like my hands are tied.
The more I hear about this the more I tend to think CPS would be route to go. They have the umbrella of authority over all the entities and, hopefully, can decipher what is best for the child. It seems there are a lot of "buts" being offered up by the involved parties. Just remember that if you "suspect" the girl is being neglected you are required to report. It's CPS' responsibility to investigate and make a decision. Even if CPS ultimately says there is no neglect, it changes the entire complexion of all those involved and will ratchet up their interest and enthusiasm. So, don't beat up on yourself. You are being the child's advocate. There has been valuable insight from savvy nurses offered to you here. You are an experienced nurse and "mom to many"...let your intuition be your guide and act on it. Please keep us informed.
I had to call 911 for self harm. It changed things for the better in this child's life. It is an emergency as much as a cardiac arrest. I don't have a counselor, but I had one when this student started to escalate. It was my day off when the student self harmed, no call. I told her and my administrators that I would HAVE to call because my license made it so. I questioned the counselor, I think they believe they can fix everything. You need to help this girl, it will be a positive in the long run.
This makes me so sad I saw the title "self harm" on the side bar, (not seeing which forum it was in or anything) and thought it would be a post about how someone can't understand why patients would harm themselves, and can someone explain why one would do this to themselves, etc.
Did not see it coming it would be these type of behaviours in a 1st grader I agree this is very serious, and needs to be addressed ASAP with a multi-disciplinary approach. I am not a school nurse, but I would try to arrange a meeting with the mother, the teacher, the counselor if possible, and even see if you could get input from the pediatrician (obviously consents and such will be needed for all of this). This child needs evaluation from a psychiatrist imo.
It could be mental illness presenting very early, it could be an outward manifestation of severe trauma. We don't know what is causing this, but there is clearly something major that needs to be addressed. A 6 year old doesn't cut their own earlobe with scissors for no reason. This is escalating and this child needs intervention ASAP.
The more I think about it, honestly, in my opinion as a pediatric nurse, this child really needs to be admitted as an inpatient to a pediatric unit, or if possible in your area: a pediatric mental health unit for the best chance of full evaluation, figuring out what is going on, multi disciplinary involvement and treatment. I really think this is probably beyond a school nurse approach in what you are able to accomplish with the resources you have. I imagine it would be quite difficult to arrange meetings with all the involved people on a school basis, where in hospital we are able to coordinate meetings involving the physicians, counselors, etc. We always try to involve the school as well in young children (although I have never dealt with these types of behaviours in a child this young..).
Perhaps you could start out by meeting with the mother and explaining how concerned you are and how you feel the child needs to be seen by a psychiatrist and perhaps be admitted to hospital. If she seems in denial/unwilling to seek help, I would call CPS...
I used to be a milieu therapist in an inpatient child/adolescent psych facility and never had anyone close to the amount of self harm that she is doing- this is including our 16 and 17 year-olds.
Her treatment plan clearly isn't working and needs adjusted ASAP!! If the mom won't get her to the closet big city to see a child psychiatrist, then I would call CPS. She needs inpatient care!!
If money is any issue for the family, there has to be money somewhere out there from the state, feds or maybe even churches.
She is seeing a therapist outside of school several times a month and is being seen by her pedi. He has her taking Strattera and Abilify. Would you still report to CPS since she is seeing a dr?
Apparently, the current meds and therapy are not helping much. This child and family do need other/better help.
No one enjoys reporting, but not reporting doesn't seem good.
Can you talk with your supervisor first?
Are her basic hearing, dental, and vision functioning good?
I wonder if there is infection, or environmental toxicities (outgassing from carpet or other materials in the home, school, car, wherever), food allergy, vitamin and/or mineral deficiencies, or some other fairly obscure cause of this behavior, like mitral valve prolapse, which can cause tremendously varied symptoms.
Nervous system damage causing itching/burning/etc.?
I have read lately some books by Sherry A. Rogers, MD about the above issues.
Very interesting and eye-opening. Who would ever think of vitamin or mineral deficiencies or environmental issues, or something like Lyme Disease or fungal sinus infection, or other fairly unusual causes in such a case. It seems worth a visit to Infectious Disease and some blood or urine tests (like 24 hour urine for Magnesium) to rule out the physical causes.
And maybe there's radon, asbestos, lead, or other dangers in the environment that this child is unable to tolerate. I would want these ruled out in my child before going the psychiatric route, or do them simultaneously.
Holistic care doctors
Integrative Medicine doctors
Infectious Disease
Dental
ENT
Neurologist for physical exam and electromyelogram
I seriously hope the cause is not sexual or other abuse.
I used to be a milieu therapist in an inpatient child/adolescent psych facility and never had anyone close to the amount of self harm that she is doing- this is including our 16 and 17 year-olds.
Her treatment plan clearly isn't working and needs adjusted ASAP!! If the mom won't get her to the closet big city to see a child psychiatrist, then I would call CPS. She needs inpatient care!!
If money is any issue for the family, there has to be money somewhere out there from the state, feds or maybe even churches.
Perhaps local fraternal orders could help (Moose, Elk, Lions, Kiwanis), maybe a Veterans organization or the Veterans Administration (maybe there is a family member connected to the military and this child could receive benefits via that person), and various foundations (Clinton, Trump, Buffet, Gates, must be others) and a Social Worker or two could help with finances.
Shriners, St. Jude, a children's hospital should be good starting places for $$$ help, if that is the issue.
various religious groups in the community
Mom and maybe others in this girl's family might also need various types of help.
GoFundMe
celebrities
A homeless shelter might have some leads for this family to get some help.
Local or even non-local businesses might make donations.
You never know who might be willing and able to help.
This child's needs are WAY beyond the scope of the public school system! There is NO WAY a public school system can keep this child safe. She needs to be in a residential treatment program. If her parents do not already see this, they must be told. This situation has escalated beyond worrying if the parent's feeling will be hurt. The child is in danger and needs serious inpatient help.
Wow. I agree with many of the above posts. If it really is happening every day, it's waaaay beyond outpatient therapy, even 3 days a week. Your observations indicate that the present treatment is not working. This poor child needs inpatient evaluation and treatment. Meet with Mom if you can, get permission to speak with the therapist, and hopefully they will agree to sign the child in. If that doesn't work--soon--call Child Services. Please.
I would be calling our mental health crisis line and requesting an emergent eval of this student. I would then make the call to CPS as well. Please check and see if your state/county has a mental health crisis line. I live in a pretty rural state, and our entire state has one. Talk to your counselor at school, or even call a local ER and see what resources they use in a mental health crisis if you aren't sure. I used to work in an ER and that is how I became familiar with our state mental health crisis line. Still have the phone number memorized, actually.
I hope this student gets (more) help. It breaks my heart to hear of someone so young going through this. Please keep us posted.
I saw the title "self harm" on the side bar, (not seeing which forum it was in or anything) and thought it would be a post about how someone can't understand why patients would harm themselves, and can someone explain why one would do this to themselves, etc. 
MrNurse(x2), ADN
2,558 Posts
That was my kneejerk, surprised your counselor was unphased. Harm in school can elicit a 911 call whether or not she is under care.