What's the Pay Off?

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Specializes in School.

I have a Little Darling who moved to the district last year. Mom explained she has "seizure like episodes" on her emergency care form. States they have been trying for years to figure out whats is causing it. Student will have a variety of s/s. In the beginning she would have feet swelling and her feet would get pale according to their report. They said they lay her down with her legs elevated and let the episode pass. We had one episode that lasted long enough that mom came up here and wanted us to call 911. Still no diagnosis or treatment plan.

Now the student will have these episodes where she will come and rest with legs elevated and have an "episode" for about 5 min or less, get up and return to class. Well, she came into the nurse's office had the look (depending on the severity of the episode, she may not be able to talk), so I laid her down with her legs elevated. Almost as soon as I had her laid down her legs began to twitch and her arms began to jerk. This behavior is new for the episode, so I had my boss watch her. As I tended to another student, she witnessed the LD look when I walked out of the room and the "activity" decreased quite a bit, but became more frequent when I returned to the room. This episode lasted for approx 10 min. I spoke to the LD and told her I was going to go call mom because of the length and how it was different. I stepped out of the room into my office and then turned around to go back in the the room. And surprise, she was lying there with her eyes opened and talking to me. She felt good enough to return to class.

I did call mom after student went back to class and informed her of student's visit.

What could the payoff for this LD be? I'm glad I can be here for her and an ear to listen, but it is frustrating when I can't fix it.

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Specializes in Pediatrics Retired.

This kind of thing is a can of worms and usually involves some parent munchausen variant which manifests in the child adopting the behaviors encouraged by that parent (subconsciously in most cases).

How old is this child?

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Specializes in School.

Little Darling is 15. She does come from a parent/step parent home. Seems to be "normal" (I use the term lightly). She is needy. She will come in the office at the end of an elective just to talk. Mom states this has been going on for 4 years and drs cannot figure out what is wrong.

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Specializes in School.
This kind of thing is a can of worms and usually involves some parent munchausen variant which manifests in the child adopting the behaviors encouraged by that parent (subconsciously in most cases).

How old is this child?

How odd it is you used that term. I was just talking with one of our diagnosticians about another possible case of this. It's amazing how many LD we have that could be labeled under this.

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Specializes in ED, School Nurse.

The payoff is that she gets all kinds of special attention when she has one of these "episodes".

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Specializes in ICU/community health/school nursing.

I'm with Ohiobobcat....even if we don't see the "payoff" (and even if you're giving minimal attention), the student's receiving something. It is super frustrating, I know! This probably belongs in a psychiatrist's office.

I had a kid "seizing," called EMS, and the seizure-like activity stopped when they got her onto the (little tiny, not very wide) gurney...

Probably too late for that, right? Good luck.

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Specializes in School.
The payoff is that she gets all kinds of special attention when she has one of these "episodes".

On the upside of this, she doesn't have one every day or week. I have gone 2 weeks without seeing her. She is a pleasant LD and is always cheerful when she sees me sans episode.

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Specializes in Pediatrics Retired.

That's about the right age for this arena of involvement. That's why I stick to elementary where most of the kid's imagination hasn't developed that much. You are being shoved into the role of the facilitator and that's tough because you know what is going on but there's always that teeny tiny remote chance otherwise.

First order of business. Considering the "progression" of this activity and no diagnosis or action plan this girl must be removed from your campus upon any symptom, or sign, of an "episode" or whatever they are calling it. You have no idea of what you are dealing with so you can't possibly predict the progression and intervene accordingly. The possibilities are endless for you to be accused of negligence for not calling 911 unless you have specific instructions from her PCP. She could develop a hangnail and it could be your fault because she was having an episode and you didn't call 911. Or you called 911 and she "didn't need to be taken to the ER" and now has to have counseling for the emotional trauma.

This is like a ship without a rudder; flows whichever the wind or tide is pushing it. You can call the 504 committee and make a plan without any MD paperwork but I would recommend the action be to remove her from campus until further instruction from her MD.

Please keep us updated. Rotsa Ruck.

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I had a student many years ago who would have a "seizure" in the hall or class, be fine in the clinic. Leave, have another "seizure" and be sent right back. Tried and tried to get a plan on file. Student always alert, oriented, good vitals, etc. Only teachers ever "witnessed" the seizure as he never had one in front of me. This was daily for months. Finally, mom told him she would not buy him a new toy unless he stopped having seizures. Lo and behold, miraculous cure - he never had another one.

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Specializes in kids.
I had a student many years ago who would have a "seizure" in the hall or class, be fine in the clinic. Leave, have another "seizure" and be sent right back. Tried and tried to get a plan on file. Student always alert, oriented, good vitals, etc. Only teachers ever "witnessed" the seizure as he never had one in front of me. This was daily for months. Finally, mom told him she would not buy him a new toy unless he stopped having seizures. Lo and behold, miraculous cure - he never had another one.

Bwahahaha!!!

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Specializes in Adult and pediatric emergency and critical care.

There are four primary functions of behavior: access, escape, attention, and automatic (for automatic think sensory feedback in autism or what the 12 year old boys like to do with their spare time).

Without having personally seen her I would be guessing based off of past cases, but I bet that this is escape/attention. I would try to talk to the teachers and see what she is missing when she is in your office (are there tests, a subject she doesn't like?). She is without doubt getting no shortage of attention for this, and I would place a wager that this is a huge reinforcer for her.

What you do about it is much more difficult. I don't think that leaving the liability on you is a great option, and there is the very remote (but real) possibility that this is medical and not psych. I do think that she needs to be cleared and have a plan put in place by her primary before she comes back, what if she has a seizure and falls down the stairs? She probably needs to be evaluated by a psychiatrist and ultimately seen by the district's psychologist.

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