Toileting Accidents at school

Flare, ASN, BSN · Oct 6, 2011

I worked for a few years in a school that was purely grade k. I kept a small cache of loaner clothes and students having accidents could change themselves and a call would be placed to home. Granted - I did have a few kids that could not have fit into my "average" sized clothes. In that case, what else can you do? It's a health office, not Gap Kids and you certainly can't be expected to have clothes in all sizes. A call to home, have the student clean up as much as possible, and hope that someone gets there soon.

In the case of a student that needs help cleaning up themselves, my protocol was to reserve for only absolute necessities and have another adult (preferably same gender as student) in the room with me when I helped them.

On a somewhat related note: now that i'm in a middle school, i don't keep any loaner clothes, but am astounded how often I get asked for them. Mostly due to inappropriate dress on the kids, but also for accidents on occasion. Still not going to keep any - though it may be a use for my old scrubs....

Purple_Scrubs, BSN, RN · Oct 6, 2011

I do not disrobe a student under any circumstances, even with a witness (only exception is the student I cath twice daily, and that is a medical procedure for which I have parental permission and doctor's orders). I will hand the student clothing and baby wipes and point them to the bathroom, but that is the extent of it. This is the policy of my district, and even if it was not, in today's society I would do the same to protect myself from false accusations.

It is also our policy that if a student is soiled with feces, they must be taken home to be changed and showered or cleaned up. They can return after the parent cleans them up. For soiling with urine, the student can simply change pants and underwear and return to class.

Flare, ASN, BSN · Oct 6, 2011

oh, please don't get the idea that I have taken extreme measures of disrobing and assisting a student lightly. In fact I think I have only done it once in the span of my career with a student that had so much of a mess they literally couldn't move without it being an issue. Needless to say, a call to parents was made and a verbal ok to get him somewhat cleaned up while they were enroute.

mc3, ASN, RN · Oct 8, 2011

We don't have an official policy. I was told by the District RN training me that, if a change was necessary, and a child couldn't do it by themselves, to go ahead and help them with a witness present. This happens occasionally with the Pre-K and Kg kids. The first graders and up can take care of themselves. I always have a witness of the same sex with me, and I always document what I did, and who was with me when I did it. IIf the child is too soiled, I call the parent and tell them they need to pick up their child because they need a shower/bath and change of clothes. We also have donations from families for things like socks, pants, shirts, underwear, etc.

Now I'm uneasy..... :eek:

mc3:nurse:

ColleenJune · Oct 8, 2011

I don't change a student's clothes under any circumstances. If they are only wet and I have clothes in a size that will fit (I keep up through size 8-10 around; the fifth grader who wet her pants this week was out of luck) I send them into my office bathroom to change. If they are soiled I give them wet wipes and send them in to clean up as well as possible, but I call the parents to come and get them so that they can bathe properly. This has been a bad year for accidents so far...

lissaq10 · Oct 13, 2011

We have had a student that is having accidents almost daily. Is supposed to be on Miralax for supposed blockage. I have asked parents to get a note from the MD for a medical diagnosis, since this is a daily issue. The health assistant has been going in to clean her up each time, but she does not feel she should have to do this all the time. Parents have not followed through on going to MD. (MD also wanted a follow-up). Parents blame autism for her accidents as well, but there is not a diagnosis and I don't really see it. She wears pull-ups the majority of the days. I refused to give her any more of our stock supply of underwear. I don't really know where to go with this?

Flare, ASN, BSN · Oct 13, 2011

@ Lissaq10 - had a student in a similar situation. Had the principal send a letter advising of the importance of MD follow up with the intended threat (that we never had to f/u on) of me sending him home every time he had an accident. We started to solve the issue by frequent bathroom visits with focus on any patterns in time of day accidents. We even used a timer for a short time that was jus for the student - set for q 30 minutes and he learned quickly to get up when his timer went off. A big part of it is also consistency at home - unfortunately that's obviously more difficult to establish

This type of plan also lend itself well to autistic individuals, especially when paired with a strong reinforcer for going when scheduled and/or keeping themselves clean. I used it many times when i was working in the autistic school.