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underweight kid

Posted

Has 5 years experience.

dear school nurses,

im new to school nursing and have a question and hope i can get some answers please. a teacher brought down a kid to me who is 37lbs and has a BMI of 14.6. now this is in the 5th percentile which means the kid is underweight. now will u handle this situation. call the parents, send a letter home? what? any info is very much appreciated

Flare, ASN, BSN

Specializes in school nursing, ortho, trauma.

it all really depends on a lot of factors. how old is this child? Children can grow and change drastically in the span of a year - a severely under weight child may catch up by the end of the school year. Is there anything else going on in this child's world that may throw up a red flag? does the child refuse to eat or make statements about worrying about gaining weight? Is there a concern that the child does not get enough to eat at home?

We do heights and weights annually here in school - students with a BMI above 95% or below 5% get a letter per state law stating that their child was found to have fallen in this range. I have gotten in the habit of waiting until the end of the year and re-measuring the children that fell into the "alert zones" as many of them will have caught up or leaned out.

If you want a copy of the letter i sent home, i'd be happy to send it to you.

As the parent of a young child who is in the 10th percentile in regards to height and weight for his age group I would be smoking hot if I had ANYONE from the school stick their nose where it doesn't belong. As long as the child is showing no obvious signs of abuse there is no reason to to insinuate anything is not right.Maybe the child has a high metabolism, maybe the child has a parent who is small and petite. There are many reasons why some kids are obviously smaller and not developed as others their age. That's why they have those graduated scales right? So 95% of kids that age are bigger, what's the big deal?That's just my thoughts on your post so please don't take it personal.

CT Pixie, BSN, RN

Has 10 years experience.

My child is 'underweight' according to her percentile score too. Both myself and her peditrician are fully aware of that. Other than weighing less thn 95% of children her age, she is perfectly healthy in all aspects (physically, mentally and developmentally).

She was born at a weight not even on the chart. she was little . Took her a long time to make it on the charts. Her peditrician is very happy with her progress over the years and while she is still 'underweight' he has no cause for concern considering all the other factors (she is just as active, bright and healthy as any other child her age).

I, myself, am 'underweight' according to the charts (for that matter I am much shorter than the 'average' woman). My height/weight are that of the 'average' 11 year old, my sister a bit taller is still short as is my mother and her mother. My child's chances of being within the norm are very slim.

I'm not sure about laws in my state regarding yearly weight checks and mandated letters that go out, I've never gotten one. Nor has the school nurse ever addressed my child's weight with me or my husband.

I think before I'd be overly concerned and send a letter or whatever...take into consideration other factors. Other than weight, does the child appear healthy? Is he/she dressed in dirty clothes or are there signs that the child is fatigued or anything else that might lead you to think the weight is an issue. Does this child have siblings who are also on the lighter side, are mom and/or dad light also?

schooldistrictnurse

Specializes in School Nursing, Public Health, Home Care.

I don't think a call to the parent would be out of line. Just an FYI. If the parents says I am aware and my child really has no health problems, then that's the end of it. I don't feel like it's interfering. I recently called a parent to report that her first grade son eats next to nothing at lunch. Same deal, just an FYI. Mom replied that he eats a good breakfast and is hungry and eats a snack at the end of the school day. Partly it's due to medication. No problem, thanks for the alert.

Flare, ASN, BSN

Specializes in school nursing, ortho, trauma.

As the parent of a young child who is in the 10th percentile in regards to height and weight for his age group I would be smoking hot if I had ANYONE from the school stick their nose where it doesn't belong. As long as the child is showing no obvious signs of abuse there is no reason to to insinuate anything is not right.Maybe the child has a high metabolism, maybe the child has a parent who is small and petite. There are many reasons why some kids are obviously smaller and not developed as others their age. That's why they have those graduated scales right? So 95% of kids that age are bigger, what's the big deal?That's just my thoughts on your post so please don't take it personal.

This is where a nice chunk of the aggravation in my day comes. The state makes well meaning laws that i have to follow or I'm not doing my job, but then i'm just trying to do my job and am accused of sticking my nose where it doesn't belong and have to deal with a parent flying off the handle. sigh... What's a school nurse to do?

oh, and for the record, i can think of 1000 things that would be a better use of my time than send the parents of the kids that are under/over weight a letter. I am pretty sure they've looked at their kids recently....

I don't see any reason for the parent to be "smoking hot" over getting a letter that your child is in the 5-10% percentile for weight. It's not like we are "insinuating" anything or sticking our nose where it doesn't belong. Our JOB is to make sure that children are healthy and doing well. Part of that is yearly health screenings that include height and weight and BMI. I would think that parents would be more upset about getting a letter that your child is OVERweight than they would be getting one that your child is UNDERweight. If you're already aware of the situation, great. Just take it as note that your school nurse is doing her job and watching out for your child. If you aren't aware, well maybe it's something that needs to be checked out. I don't think any school nurse would automatically assume abuse because a child is underweight. There have been many other reasons listed that the child may be underweight. I would rather send 100 letters home to parents who are already aware than to stop sending the letters and miss a child who has a health problem that no one at home is aware of.

My twins are in the 3%. I hv tried everything to get them to eat more & even went to a dietician - nothing has worked. They are activate 12yr boys, shortest in there class. My 10 yr daughter is also underweight, but she eats. Idk what to do, so I stopped forcing the issue.

dfs1961

Specializes in Medical Surgical Telemetry. Has 5 years experience.

Word.

This is where a nice chunk of the aggravation in my day comes. The state makes well meaning laws that i have to follow or I'm not doing my job, but then i'm just trying to do my job and am accused of sticking my nose where it doesn't belong and have to deal with a parent flying off the handle. sigh... What's a school nurse to do?

oh, and for the record, i can think of 1000 things that would be a better use of my time than send the parents of the kids that are under/over weight a letter. I am pretty sure they've looked at their kids recently....

Nascar nurse, ASN, RN

Specializes in LTC & Hospice. Has 35 years experience.

I am not a school nurse but my first thought was "What does your policy say to do in this situation"? because that is how you should handle the issue.

Maybe just ask the parents. They may have a reasonable explanation. My oldest child had an appendectomy when he was 8 he weighed about 55 lbs before and when he finally could go back to school he weighed only 35lbs. He was very under weight for over a year spanning two different grades. Both of my boys are under weight and it is because of the medications they take. I agree with the others, as long as the child doesn't seem to be neglected or abused then the parents probably have an explanation for the weight.

Jolie, BSN

Specializes in Maternal - Child Health. Has 35 years experience.

Flare's response is accurate for my state as well. Public health regulations require school screenings of height, weight, BMI, vision, hearing, dental and scoliosis at prescribed intervals with "norms" written into law, and specifying deviations that must be reported to the parents.

With approximately 2000 students in 4 buildings, I was fortunate to encounter only 1 irate parent, who became much more reasonable after a discussion.

Weight is understandably a sensitive issue and must be approached as such. Parents don't get ***** over a note home about a failed vision screening because they don't feel personal blame if their child has a vision problem. Obviously the same is not true for weight, hence the heated reactions.

We send a notice home prior to all screenings, including the parent's right to opt their child out. At the middle school and high school levels, we will allow a child to opt him/herself out, but will notify the parent. Screenings are done in private and all data is held in the nurse's office. In the event that a parent is notified of results out of range, we explain that the information is for their purposes only, to be shared with their health care provider if they so choose. We reassure them that we do not share the information with anyone, not even the student, unless the parent requests it.

And even though our state law sets limits at which notices are to be sent to parents, we still use discretion in doing so. If a child is well known to the nurse and known to be under the regular care of a health care provider, we may opt not to send a notice, if doing so would just be "piling on." For example, a newly-diagnosed diabetic student for whom we are in regular contact with the parent and doctor. Or a student with celiac disease for whom we have just participated in a care planning session with the parents, student and teaching staff. In these cases, a brief note in the students' records will explain that notification was not deemed necessary at that time due to recent/regular contact with the parents and health care provider.

I'm curious with the parents here who have indicated that they would be irate if they received a note from the nurse about their child's weight...would they be indignant over a note detailing a possible vision problem? What about a note from the teacher about poor classroom performance in math? Why would they view objective information about their child's weight or BMI any differently?

Morganalefey

Specializes in ccu.

I'm the parent to a peanut-kiddo. At 8 years old, and in 3rd grade, she is smaller then her 1st grader brother, and a decent number of the kids in his class. She has been in the 5th percentile for height and weight since she was 4mos old.

I don't understand why anything needs to be done? Does he look malnourished?

I don't know that I would be mad, per-sey, if the school called me about her size, but I would probably be irritated....I don't know, the whole thing sounds odd to me, but maybe that's because I'm not a school nurse?

NutmeggeRN, BSN

Specializes in kids. Has 25 years experience.

Our job is to observe assess and formulate a plan....would you prefer the nurse NOT notice and advise? If you know your child is underweight for whatever reason, it is ok to advise the school what is up....then you as a parent have addressed it and no one will bother you. I have found out very interesting things in my conversations with parents, sometimes really important health information that they just assumed I knew, that they assumed the doc had sent etc.

Sometimes the school nurse will be the first to notice something that needs to be addressed, a lump a rash and pustule that turns out to be MRSA.

Feel free to call me any time, I, as a nurse appreciate a heads up. I don't appreciate being disdained for sharing a observation in a profession and nonjudgmental manner.

NurseDirtyBird

Has 8 years experience.

Speaking of sticking my nose where it doesn't belong, I'm not a school nurse but did want to add this: I was raised in a single parent home, and some things got missed. The school nurse at my elementary school was the person who noticed my symptoms of a common autoimmune disease, and brought it to the attention of my parent who immediately got me into the pediatrician. Thanks to that school nurse noticing my weight disparity (among other sx), I was able to get early treatment. Weight problems in kids are not always "you're not feeding them enough," sometimes it's a real health issue nobody's picked up on yet.

kingsmiley

Has 5 years experience.

Thanks for all your responses especially to you Flare. I appreciate it. Im surprised at all the people who are just about ready to cut my head off. Maybe u need to read my post again. i was just asking if there is anything to be done. geez people seriously.... in case u were wondering this is the last thing i wanna be dealing with. my day is full enough and im new to this so i still have alot of learning and organising to do. if i dont have to do anything, i wont. do u think i care. just trying to stick to the job description thats all. i did speak to my manager who asked me to just get some info from the parent and see whats going on with lil man(sthing i dont even wanna do) but i guess i didnt get hired to what i feel like. still waiting for mom to call me back. in the meantime, take it easy people. its not even that serious. no where in my post did i say i thought the kid was abused. y,all hav a blessed day