Parents keep medicating their febrile kids in the morning

This was screaming in my head- Students with a chronic condition are totally different and working closely with the parent is a must to help the student be successful.

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Dempster said:

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I completely get the sending kids to school sick ordeal from both perspectives. My oldest has had to do "credit recovery" for four years to go on to the next grade despite A average in AP and Duel Credit classes. He has problems though and has to see his NP monthly. Sure you get a note, but that doesn't cover the last week of hell or what the side effects of his med change will be this time.

 My youngest has GI issues w a history of Pancreatic Insuf. Was treated for Crohn's, but IDK. It could be a bowel tick. Tics and Tourette Syndrome (tics run in the family, but only myself and cousin have Tourette's (not bad at all right now). Between being ashamed and depressed because of his teachers telling him to stop disturbing the class (not as nice as that though), plus his seizure med that zombied him and made us late, he missed school. The youngest with bowel disorder goes to the bathroom 3-5 times on a good day. The most I've counted was 19.

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On 3/1/2018 at 9:01 AM, Cattz said:

This was screaming in my head- Students with a chronic condition are totally different and working closely with the parent is a must to help the student be successful.

I had two complicated kids with chronic issues that had to be “excused” by their pediatrician—

Kid #1

B. was one of those kids who just “ran hot”... never had a documented temp under 99.5 — and more often than not his “resting” temp (meaning he was just chilling indoors, not just coming in from playing outside, or PE or recess...) was over 100... ?.

Doc said it was because he had a high metabolism (definitely true— keeping weight on that kid was a nightmare... and on top of it he was an extraordinarily picky eater, even requiring tube feeding for nearly 2 years fron age 2-4! Crazy, I know...).

He was also a Bigfoot vomiter (learned that one here on AN ?)... I think he was nauseated a lot, and somehow figured out “I feel sick to my stomach” doesn’t get the same reaction as “I got sick to my stomach”, and started saying he puked anytime his stomach was bothering him. He was dx’ed with several GI issues in late elem. & middle school.

Anyway, doc wrote a letter that was essentially a “vomiting action plan” — so if he went to the nurse saying he vomited, there were meds to be given, and only if he had a witnessed vomit after the action plan was followed did he get sent home. Or if he had a fever— which the pedi defined as above 101.5, taken after at least 1/2 hour in air conditioned space, and drinking at least 8 oz of cold water (we lived in Tucson at the time). Actually the pedi said two temps of >101.5 taken after 1/2 hour in cool room and taken 1/2 hour apart. So the nurse usually sent him back to class in between with a cool compress [frozen paper towel] for his head/neck (if he came for something not GI) and most of the time he never came back for the re-take of his temp.

I think he got headaches and even some of his GI complaints from overheating, and the sx went away when his temp came down... my evidence: I got a call from SN telling me B. was there and his temp was 102.5 and he was flushed and stated severe headache and nausea after immediately following lunch and recess. I said I’d come get him ASAP, but I was about 30-40 mins away... by the time I got there, his temp was 100.x and his headache and nausea had vanished— of course, he still wanted to come home... but meanie mom that I am, I made him stay...

This sort of thing happened more than once — thus the ‘two temps 1/2 hour apart’ rule given by the doc.

Kid #2

N. wasn’t nearly as complicated as B., but he did need a variance from the usual policy for vomiting— or he would never have been in school... This kid puked at least 4-5 times a week.

After keeping a vomiting journal, (something I *never* thought I’d have to do.... ?) we figured out he rarely puked on weekends. He was dx’ed with school anxiety and a “nervous stomach”. He was put on Prilosec and a small dose of reglan (to be given prior to high-stress occasions, like benchmark or state testing, etc.) He was also allowed to carry up to 10 tums with him (as young as 3rd grade) and we took him to a therapist to learn guided imagery/biofeedback/ self-hypnosis -type techniques to calm himself and overcome his body’s stress reaction (churning out too much stomach acid, and regurgitating it’s contents). He did take something for anxiety, but I can’t remember what it was— just that the SN could give him a small “rescue” dose during the school day if needed.

So basically, N. had a “vomiting action plan” of his own, along with an “anxiety action plan” (and because of a bee/wasp/hornet allergy he also had an allergy/anaphylaxis action plan, and an epi-pen)

———————————————-

Sorry this got so long....

My point is that kids who have documented issues *can* be accommodated, if the doctor is willing to write the letter stating what the child needs to be able to stay in school. Even if the kid has unusual or uncommon issues. In my experience, pediatricians know very well that a child belongs in school— and they want to help kids and parents with whatever is necessary for that child to get back to school successfully.

And schools have a vested interest in keeping kids in school— boiled down: more kids = more $$.... They need as many enrolled students with butts in seats as possible every day, in order to pay the teachers and parapro’s and staff and, oh yeah, the nurses. So (again IME) a school will work with parents to help get a student’s needs met so they can be in class and be successful. (at least as far as mandated testing shows, ? But that’s a different topic, entirely)

Very interesting stories, thanks for sharing. I think the key here is that the doctor took the time to document Dx, Sx, and created action plans. SN want to keep kids in school if we know there is a chronic condition, and that the student may not be contagious.

Daily occurrence here...It usually starts around 11:30; tylenol/advil wears off and the kid feels like poo. I once had a student cry and tell me 'not to call his mom' because she threatened him with discipline if he came to the nurse.

I confronted mom, confirmed that she had given him a dose in the morning which masked his fever until it didn't, and let her know it was totally unacceptable. She called my direct supervisors, all three of them, to complain about me and essentially told on herself for being an a-hole. I can't.

On 2/16/2018 at 12:21 AM, NurseSpeedy said:

I was told a southern joke by a nursing friend a few years ago and I still remember the phrase and it's sarcastic meaning. After hearing about the Tylenol dosing I would have had a hard time not responding, "Why, How nice?!" Did that right after hearing her joke several years ago when our boss's boss was standing over my computer giving me a new pet project to do, spelling out exactly how he wanted each thing done. I just blurted it out, didn't even catch myself. Sent her and my other coworker out in the halls hysterical. Thankfully, he didn't catch on and was completely confused.

OMG! I do that ALL THE TIME! ?

On 2/28/2018 at 7:50 AM, rn4kiddos said:

The parents in my school seem to believe if they give their child tylenol/motirn and their fever goes down - they are no longer sick. I have made so many calls for a child not feeling well who has told me they took red medicine this morning - only to call the parents who say "she was fine when she left for school" and then of course their response is they are over an hour away and can't get to school to pick them up , nope no one else is available either. I have learned to respond " I would hate to have to call an ambulance - see if you can find someone to pick her up" - within minutes someone is their to pick up. works like a charm

Do we work in the same place? Very often we have kids here for an hour or more because the parent can't get here. sigh...

10 hours ago, Duranie said:

I had two complicated kids with chronic issues that had to be “excused” by their pediatrician—

Kid #1

B. was one of those kids who just “ran hot”... never had a documented temp under 99.5 — and more often than not his “resting” temp (meaning he was just chilling indoors, not just coming in from playing outside, or PE or recess...) was over 100... ?.

Doc said it was because he had a high metabolism (definitely true— keeping weight on that kid was a nightmare... and on top of it he was an extraordinarily picky eater, even requiring tube feeding for nearly 2 years fron age 2-4! Crazy, I know...).

He was also a Bigfoot vomiter (learned that one here on AN ?)... I think he was nauseated a lot, and somehow figured out “I feel sick to my stomach” doesn’t get the same reaction as “I got sick to my stomach”, and started saying he puked anytime his stomach was bothering him. He was dx’ed with several GI issues in late elem. & middle school.

Anyway, doc wrote a letter that was essentially a “vomiting action plan” — so if he went to the nurse saying he vomited, there were meds to be given, and only if he had a witnessed vomit after the action plan was followed did he get sent home. Or if he had a fever— which the pedi defined as above 101.5, taken after at least 1/2 hour in air conditioned space, and drinking at least 8 oz of cold water (we lived in Tucson at the time). Actually the pedi said two temps of >101.5 taken after 1/2 hour in cool room and taken 1/2 hour apart. So the nurse usually sent him back to class in between with a cool compress [frozen paper towel] for his head/neck (if he came for something not GI) and most of the time he never came back for the re-take of his temp.

I think he got headaches and even some of his GI complaints from overheating, and the sx went away when his temp came down... my evidence: I got a call from SN telling me B. was there and his temp was 102.5 and he was flushed and stated severe headache and nausea after immediately following lunch and recess. I said I’d come get him ASAP, but I was about 30-40 mins away... by the time I got there, his temp was 100.x and his headache and nausea had vanished— of course, he still wanted to come home... but meanie mom that I am, I made him stay...

This sort of thing happened more than once — thus the ‘two temps 1/2 hour apart’ rule given by the doc.

Kid #2

N. wasn’t nearly as complicated as B., but he did need a variance from the usual policy for vomiting— or he would never have been in school... This kid puked at least 4-5 times a week.

After keeping a vomiting journal, (something I *never* thought I’d have to do.... ?) we figured out he rarely puked on weekends. He was dx’ed with school anxiety and a “nervous stomach”. He was put on Prilosec and a small dose of reglan (to be given prior to high-stress occasions, like benchmark or state testing, etc.) He was also allowed to carry up to 10 tums with him (as young as 3rd grade) and we took him to a therapist to learn guided imagery/biofeedback/ self-hypnosis -type techniques to calm himself and overcome his body’s stress reaction (churning out too much stomach acid, and regurgitating it’s contents). He did take something for anxiety, but I can’t remember what it was— just that the SN could give him a small “rescue” dose during the school day if needed.

So basically, N. had a “vomiting action plan” of his own, along with an “anxiety action plan” (and because of a bee/wasp/hornet allergy he also had an allergy/anaphylaxis action plan, and an epi-pen)

———————————————-

Sorry this got so long....

My point is that kids who have documented issues *can* be accommodated, if the doctor is willing to write the letter stating what the child needs to be able to stay in school. Even if the kid has unusual or uncommon issues. In my experience, pediatricians know very well that a child belongs in school— and they want to help kids and parents with whatever is necessary for that child to get back to school successfully.

And schools have a vested interest in keeping kids in school— boiled down: more kids = more $$.... They need as many enrolled students with butts in seats as possible every day, in order to pay the teachers and parapro’s and staff and, oh yeah, the nurses. So (again IME) a school will work with parents to help get a student’s needs met so they can be in class and be successful. (at least as far as mandated testing shows, ? But that’s a different topic, entirely)

This is fascinating reading!! What a great collaboration between a parent who cares and a school nurse who gets it!

I want to shake these parents. I used to work in an all walker district. I had 1 nervous teacher that used to send me a lot of kids. I didn’t think much of this one student coming in a 9am (school started at 8:30). 101 degree fever. I called dad.

Guess what dad said?

”He shouldn’t have a fever. I gave him medicine over 30 minutes ago.”

uhm, yeah. We don’t allow that. I’m going to need you to go ahead and pick him up.

Took dad 30 minutes to get there.

The reverse corollary, Kid comes in claiming they feel poorly, temp 99.5, rest, return to class. an hour or two later they are back, now temp is 100.5 so I send them home, grandma's house usually, and they are sent to school the next day with motrin on board, do fine until noontime then back, feeling poorly, 99.8 or so...so I call the parent and the parent says that lo was fine last night, up and playing. Grandma gave motrin and mom did too, and according to them lo is fine. I explain the policy and they grudgingly send grandma back, who says "I told her not to send lo!"

Adding to what Duranie said:

I have a student with CVS and at first we had this type of situation where he always came to my office and vomited, with headaches happening. Mom and I collaborated on this and I kept a log on how many times he came to my office. She took the log to the doctor and from there he was found with CVS, which is caused by stress. He is currently on anxiety medication (I don't know which one) and so far he has had a good year, no visitations and is feeling better!

22 hours ago, Amethya said:

Adding to what Duranie said:

I have a student with CVS and at first we had this type of situation where he always came to my office and vomited, with headaches happening. Mom and I collaborated on this and I kept a log on how many times he came to my office. She took the log to the doctor and from there he was found with CVS, which is caused by stress. He is currently on anxiety medication (I don't know which one) and so far he has had a good year, no visitations and is feeling better!

Yes, sometimes it is the records kept by the heath office on the ff kiddos that really help the doc figure out what’s up. If not for the log of sometimes daily temps on my son, we wouldn’t have had such a clear picture of what was happening. It was a crucial piece of the puzzle, even if it was frustrating and patience-trying for the nurse.