Simply Frustrated

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We have 1st grade little girl who is extremely obese and is continuously wetting her pants and being sent to the nurses office. This has been an on-going situation since last year. The last nurse, principal and teacher had several conferences with the parent to discuss the accidents as well as her behavior and refusing to do most classwork last year. The mom works for a urologist and said last year that she would have the student looked at- no medical indication of a problem by a physician was ever turned in. Fast forward a year and nothing has changed. Her parents hardly ever send extra clothes and she has had 4 accidents this week alone (2 yesterday and 2 today). I have had to call her dad each time to bring her clothes.

A few months ago she sent in paperwork from the place she works at, electronically signed by a NP, that stated the student needed to be sent to the bathroom every 2 hours and have access to water. No medical indication of anything wrong. She is still continuously having accidents. No matter if the teacher sends her to the bathroom or not. She has even peed on my bathroom floor right in front of the toilet. I have asked the mom if she had been tested for diabetes and she said that she did but she does not have it (I highly doubt she was tested).

I am wits end with all of her accidents. I feel it is more of a behavioral issue and not necessarily a medical problem- if it was I would hope her mom would have taken care of it. She just sits in her classroom and does not do her work, she cries hysterically when she is not getting her way and has also wet her pants when she does not get her way. We are supposed to have another conference next week with her parents. I am not sure what to say or do anymore. I get so frustrated each and every time she comes in to my office for an accident and has to sit there for at least 45 minutes until new clothes arrive. What can or should I do?

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Specializes in school nursing, ortho, trauma.

Can you get either of the parents to sign a release to allow you to speak to her doctor directly? It could be that she may have taken her child to the urologist she works for, but was a little too close to the situation to explain everything that was going on with her child to her colleagues.

Is a similar type of behavior happening at home? Was she ever accident free? If so, when did the accidents begin? How do mom and dad react when they finally get there with a change of clothing?

90 minutes a day out of class when she already isn't working is just making a sinking ship go down faster.

I've mentioned in other posts the idea of making a student own their behavior, particularly in an incontinence situation. Perhaps it would be appropriate in this instance to have lend a hand in wiping up the mess she has created by choosing to urinate in front of the toilet rather than in the toilet.

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Hello, it sounds like she does have a medical issue going on, but it seems like her parents don't really care if they didn't bring anything in for their child. I would hope that someone else would try to get their parents out of denial and help her child if she does have an medical issue. Especially if she was normal at one point. Also, what if it's a uti? Or, diabetes like you said, then what? You never know. It's scary also that you mention she doesn't do her work, maybe there is other issues that are coming from the wetting her pants. Maybe she is getting made fun of for it? What if she pees her pants when she is older how embaressing would that be for their child.

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Specializes in retired LTC.

All her out-of-class-time has got to be adding up cumulatively. Is she meeting the required mandated class hours??? Could she be in jeopardy of not having the hours-in to continue on to the next grade?? Perhaps that info could be the impetus for the parents to spur positive action. Also, how are her grades??? She may be failing and her parents need to know of that possibility - maybe that'll nudge them?

PS - Boy, you school nurses have my utmost respect for the problems you face! I know folk always say that about specialties not their own. TY

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I have an older student in similar (not so extreme but she was wearing pullups to school because of her accidents). Anyway, at a recent Dr. Appt the Dr. Tested her blood sugar and viola she is a type 2 diabetic! Looking at her records, she has had incontinence and extreme fatigue for several years! She is doing much better these days.

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I can almost bet money that she had type 2 diabetes and I really do not think the mom had her checked. She even has the markings on AN on her neck which can indicate type 2. It is just so frustrating for me and her teachers that nothing we attempt to try and do is working...even having her go to the bathroom every 2 hours, because if she thinks she does not have to go to the bathroom she just stands in there. It is not like we can go in there and make sure she goes. UTI is possible, in her chart she had 3 last year alone- but I still think it is something more.

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She def has some signs of DM. maybe also it is a functional problem with the bladder. Ask the mom if she can bring in proof of the Dm testing or a letter from the physician. I also agree with asking permission at the meeting, in front of others, if you can speak to her physician to rule out DM or any other medical conditions.

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2 accidents again today. They sent in one change of clothes so when I called for the second accident her mom just came and picked her up from school and took her home. We had set up a conference for after school today and she called a half an hour before and cancelled it. She said that she won't be able to meet in person again before winter break but might be able to do a phone conference. Would it be wrong to start doing behavioral consequences from the teacher at this point? The mom was supposed to bring in medical papers last school year and never did.

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Not a school nurse here, but a mom. If you truly suspect type 2 is the culprit and mom isn't doing anything could you call DCFS? See if they can make mom take care of her medically? If there is a medical issue and you've told mom to take her to the dr and she's not doing it, it's abuse.

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In our district we would ask the parents to sign a release of medical info and speak to the drs directly to find out about tests. If she wouldn't sign the papers or we found out she hadn't really been seen for the problem we would send home a form that stated what the issue was and not permitting the child to return until the form was filled out and signed by the dr. If she went too long without returning the truant officer would become involved and eventually human services if it went that far ( which it has before). It's a shame you have to play hardball with some parents to make them do what they should've already done! If the child has a medical issue- you can go from there and if she doesn't then you know it's behavioral and the right people can become involved! Good luck!

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2 more accidents today (her mom just had a baby this morning too). Some of the teachers had mentioned that they think it is a sign of abuse. What do y'all think about that?

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Had a similar situation last year with a male student. He was having several bowel accidents each week. He would not even tell the teachers when he did, he would just continue on playing at recess, working in the classroom, etc., until the staff could smell it and then he was sent to me to be changed. He was in first grade and had done the same in kindergarten. His dad refused to come to meetings, see a doctor an so on. I sent home information on the diseases caused by fecal matter and called him every week for a while. He finally stopped answering the phone. Eventually, I called CPS because I feared abuse. The student was an only child and was being raised by a single dad. After one phone call I saw improvements and so far this year--no accidents!! Some parents just need a kick-start or an eye-opening experience. It's truly sad that we care more for them than their own flesh and blood sometimes. Good luck!!

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