What would you have done?

[LACA]

here's what happened: on monday, a 2nd grade girl bumped her head into the back of another child's head. she came to the clinic and was not crying or upset. her eye/upper cheek was red, and somewhat bruised. i applied an ice pack and sent a note home saying she might end up with a black eye because its bruised. i figured this covered me on letting the parents know. she wasn't upset, crying, or anything. her teacher said that she kept the ice pack on her cheek for a little while and then got rid of it and was playing and laughing and acting completely normal.

the next morning, my principal tells me that he got a call from the parents and they took her to the er (no way had i even thought it would require anything--especially not a trip to the er--a bit dramatic to me) he said that dad was upset and would i please call him? i called the number that the principal gave me, got no answer, and left a voicemail asking him to call me. i never heard anything from him. (she was absent that day- tuesday)

wednesday- heard nothing. the little girl was back in class, her eye looks completely normal.

this morning, the girl's teacher brings back the signed copy of the note that i sent home (i usually ask for signatures so i know the parents seen it) with a note on the bottom from mom that she was very very very upset, she had to take her child to the er, why didn't i call her, and that she is sending the bill to me.

if i thought this was a serious injury, i would have dropped everything and called. the child was fine. she wasn't even crying. the only reason i even mentioned black eye on the note was because i wanted them to be prepared in case it did bruise. the principal and teacher both agree that it wasn't a serious injury and that she was fine, and acting normally. the teacher says that both parents are over the top protective and have given her trouble in the past over seemingly non-issues.

**i just showed the note to the principal--he backs me and the teacher up 100%. he said that we are in no way responsible for paying the bill, the injury was not severe, and the note home was sufficent.**

[bergren]

Yes, but did mom know all that? Think of how differently this would have gone down if you had called her while the little girl was in your office. Mom would have been able to get all her fears assuaged by you and she would have been able to talk to her daughter. It would have been a non-event.

I consider a facial injury resulting from bumped heads a head injury. Especially one hard enough to cause a black eye. Albeit, this was a minor one.

In any event, facial injuries are also something to call parents about.

You asked the group what would we do? I would have called. It is never a bad idea to call. The worst that can happen is they are irritated for being bothered, pulled away at work. As someone said above, it is good CYA policy. There is so much in the news right now about not blowing off head injuries in children. Try to put yourself in mom's place.

Great that you sent a note and great that you signed with your credentials. And especially great you are checking in with your peers. We all learn by sharing these dilemmas and experiences. We work in isolation and this sharing is so important.

[mustlovepoodles, RN]

I ALWAYS call parents about head or facial injuries. Always. It may seem minor to me, but I don't want somebody's child going home looking different than when they left home this morning and the parents know NOTHING about it. What a great way to make parents mad! When it comes to parents and their kids, it doesn't really matter what I think. I give them the facts of the injury, tell them how they're acting and what I've done about it. Some parents want to come get their kids and some are content to let me handle it. I have to force a few of them to pick up their kids for suspected concussion. I always leave the decision up to the parents with a caveat that if things don't get better or even get worse, they should seek medical attention right away.

I'm the mother of 3. I am not ruffled easily, but I want to know if there's been a questionable injury. I have a child who is very off-balance, so he gets hurt fairly often. I don't care if they call me 3 times a week(or even 3 times a day!) I want to know every time he gets more than a minor scrape or bruise. In the end, it's a parent's responsibility to assess their child and seek treatment if THEY deem it wise, not some nurse that barely knows my kid's name.

[abreezies]

I follow this procedure every time, especially on the younger children - it's policy. If there is a head injury- no matter how minor, must do thorough assessment, including pupils and many questions. Rest with cold pack for at least 10-15 min. We have a standard minor head injury letter that we must send home and I make sure all the teachers have one too- lists s/s on it of when the child would need to be taken to get medical help. On the bottom of the letter is an area that says- Was/ Was no able to reach parent/guardian by phone. I have to try to reach someone to let them know what happened (and mostly that the child is completely fine) and let them know that I am sending the child back to class and the note is going home and the teacher will continue to keep an eye on the student and send him/her to me if she notices any of the s/s. My district started doing this no matter how minor the head injury bc the head nurse told us of this case in the US where a K child hit her head on the slide, no bruising, no bump....was fine for the rest of the day-----so they thought...went home and died- she had a slow head bleed....very sad..........

[schoolnurse09]

I would have called, that is NOT to say that you did ANYTHING wrong. It is just that I am usually in a CYA mode. Especially about faces and heads.

[mc3, ASN, RN]

Yes, I would have called home and if unable to talk to Mom/Dad/grandma/pa, leave a detailed message. Then I would have written myself a nursing note detailing everything and/OR filled out a student accident report. Unfortunately, I'm learning that you can't be too careful, and like everyone else has mentioned, some parents are just LOOKING for an excuse...............One time I had a sick 1st grader. I called every - single - emergency and cell number that I had several times - to get in touch with someone. Nobody called me back (including Mom or Dad). The next morning I get a call from Mom SCREAMING that I never bothered to call anyone! I finally said to her "M'am, why would I not call you if your child was sick?

I have come to the conclusion that some people are just so miserable that the only way they can feel good about themselves is to make someone else unhappy.................and try not to let it get to me.

mc3:nurse:

[missfixit]

This is my third year and I have learned it is always better to call with any "injury". I have 4k-3rd, so I have the "babies". Usually, it is worth the few minutes it takes to make the call. If there are no visible injuries, I call if they return. Better to CYA AND make sure the child is safe as well.

I have called for things that I thought were silly, but the parents are usually thankful.

I always try to think, would I want to know about if it were my child. Now, do I think you were "wrong", no.

[Purple_Scrubs, BSN, RN]

I am another one who calls for any cut, scrape, or bump with the potential to bruise IF it is on the face. Parents seem to get much more upset about something when it is the child's face, and I can understand that. My district policy is also to call on any head injury and we send a note home detailing s/s to watch for in case of complications. In some cases I think the note is overkill and only serves to panic the parents, so I always explain verbally to them that I see no indication that the child might have complications, but send the note home just in case.

[lholland]

I am a high school nurse, but for any type of head/face/neck injury, I do an incident report and call parents. Any time there is an injury that is more than a scrape I do one and call. CYA. Most parents are appreciative and respond well, some are annoyed when I call but I document the call on the report. I think it is safe to say that we have all had our fair share of unhappy conversations with parents and what some want, others don't.

My feeling is that it only takes a moment to call and in the rare event that something arises later from the injury, I'm covered.

Just my 2 cents.

[DistrictNurse19]

I have to agree with the poster who said she would call the parent anyway...C.Y.A. We live in a society where someone has to be at fault for something...accidents just don't happen is the mentality. Don't take it personally...it is the position you have, not the person that you are. I have a family threatening to sue me because I called to have them pick up their children because I suspected scabies...I'm still waiting for their lawyer to contact me. Funny thing is they brought a note back from the doctor who actually documented that the children were being treated for "scabies" (good guess on my part?).

[LACA, BSN, LPN, RN]

You better believe I call for EVERYTHING now. I guess I learned my lesson...still haven't heard anything from those parents though....Guess that's a good sign! Oh well, you live and learn! I guess that's why they call them mistakes, you're supposed to learn from them....

[fantasia2400]

Hi...the district that I work in has this policy in place. If there are any noticeable bumps or visible marks on the face/head we are required to at the very least leave a message on the home phone number. It is preferred that we speak directly with a parent. We then use a head injury sheet printed off from the CDC website and send it home with the student.

Now for little bumps on the head area..with nothing visible or palpated...I just give them ice and send them on their way. Do you think I should send home a head injury sheet for that? It just seems overkill.

Cheers!

Melissa

[noreenl]

As a school nurse supervisor for agency subs I tell all my nurses that anything above the neck is a head injury and a parent must be called! Also, here in NYC Schools we have a head injury form letter that must be filled out and sent home to the parent in a sealed envelope. When we speak with a parent we review how thge child presented and it is written on the HI form letter so the parent has something to bring to the ER later if need be! If anyone would like a copy of this Head Injury form letter just PM me!!!