touchy subject

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Student suddenly having urine accidents (twice in one day).

Discussed urine accidents with parent, including possible causes (bubble bath/uti, constipation, stress, not taking restroom breaks, distraction (not wanting to come in from playtime), or potential abuse.

Parent is livid and defensive at the subject of abuse being merely brought up.... not suggested or accusing....just included in the list of potential causes...can't believe that a school nurse would even think this way.

After assuring parent that I only have child's best interest at heart, parent calmed. I just feel like this isn't the last of this though.

I guess I'm looking for how you might handle an irate parent on such a sensitive subject.

What about little ones touching themselves in class? Is this something for the nurse to discuss with parent, or refer to counselor or someone else?

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Specializes in kids.

If approached again by parent, I would just reiterate that I am doing my job as a professional. And hopefully there is no abuse as the cause of this issue. But if in fact it was, and the parent was not aware of it, would they not want me to have made them aware if the possibility?

Sometimes people just way overreact,. A little space and time will probably let things settle down. Hopefully there is an answer to this child's sudden urinary incontinence. Best of luck to you.

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How old is the student? I actually agree with the parent and would have not brought up possible abuse. At any age if this became part of my concern I would have questioned the student or had the social worker explore that possibility. I would have stopped with notifying the parent and simply state since this is sudden in onset and frequent, if it were my own child I would see the pediatrician.

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Specializes in School Nurse, past Med Surge.

As Accolay kindly corrected, the quote I was trying to think of on another post...

"When you hear hoofbeats think horses not zebras."

I also would not have brought up possible abuse at this point. Although I do think any of us would have it in the back of our minds. Investigate the more likely causes first. How old is the child? Is s/he able to give any insight? Are they describing pain or do they acknowledge they're busy and don't stop? If the accidents keep happening and you see other possible signs...sure...maybe enlist the help of the counselor to talk to the child.

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Specializes in school nursing, ortho, trauma.

It is possible that the parent is over reacting simply due to the "oh my gosh, my kid shouldn't be wetting themself" factor. But keep this on your radar. Depending on the age kids can and do still have accidents - they get involved, don't realize they have to go and the bladder sometimes beats the legs to the bathroom and of course the age of self discovery varies in all children, so neither one is a definitive marker for abuse. Looking from this side of the glass I probably wouldn't throw that flag yet, but then again, you have a lot more info.

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How old is the student? I actually agree with the parent and would have not brought up possible abuse. At any age if this became part of my concern I would have questioned the student or had the social worker explore that possibility. I would have stopped with notifying the parent and simply state since this is sudden in onset and frequent, if it were my own child I would see the pediatrician.

This.

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Specializes in CPN.

I don't know, sexual abuse isn't exactly a zebra. Statistically, we know there are likely dozens of children in our schools who have been or are being abused.

I wouldn't bring up potential abuse as a possible reason if the student was 4 or 5, but if they were 9 and it happened more than once in a day I might in a nonchalant, "running down the list" sort of way. It would really depend on the situation though. To be honest, the more I type about this, the more I'm inclined to say wait until you notice an unresolved pattern and then report your suspicions to your state's child protection agency.

Anyway, it sounds like you handled it well and that their initial response was just a emotional reaction. Shoot, I still remember stressing out and swearing up and down that we didn't abuse my kid when a doc mentioned a possible greenstick fracture on an xray (ended up being an artifact and the kid just had nursemaids). It can be scary for parents, even innocent ones, to think about child abuse.

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My reaction, as a parent, to the nurse, would be, "are you effing kidding me!!?"

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