I am a school nurse AMA

[Nicebitofsquirrel]

I am an NHS school nurse, not to be considered with school first aiders.
Our service takes over from health visitors once children start attending school.

It is the parents/family’s responsibility. The buck must stop with them. They are the ones feeding their children until they can run or sit cross legged. I felt sorry for the children who could hardly run on sports day. If a child is underfed it’s consider abuse same must go for over fed children. Btw thank you for the job you do.

Yes it is the parents responsibility, but there also things like lack of safe open spaces for children to run around in, safe cycle paths, inexpensive sports facilities, lack of sports clubs - some families are really struggling money wise and to buy a crap meal is cheaper than a healthy one - ie you can buy a pizza for under a pound, lots of frozen stuff is on BOGOF, but rarely see offers on healthier foods. It’s too simplistic to just blame the parents, yes it is their responsibility ultimately but there are other factors to think about which contribute.

How common is it for children to wet and soil daily at the start of year 1 and would you recommend putting a care plan in place for them?

I’m a single mum to twins, no help from father, minimum wage and it is MY responsibility alone to ensure my children are not obese. The patents of the obese children in my school are middle class in “naice” house 4x4 cars !!

RideSallyRide76
Very very common. We would address the soiling first before even worrying about the wetting - you need to go to the GP who can feel is your child is impacted, and ask for a referral to the school nurse or continence service, whichever is used in your area. The child would probably be prescribed movicool, and a disimpaction regime recommended as soiling is due to constipation.
The school should be used to dealing with this issue and would usually have an intimate care policy and be able to do an intimate hygiene plan for the child.
We recommend ERIC
www.eric.org.uk
www.eric.org.uk/Pages/Category/bowel-problems

Hi Pinkgeorge
I understand your frustrations, but we cannot force parents of overweight children to work with us, a child would have to be extremely overweight before social services would look at it as a possible referral.

I understand I’m just venting. It’s such a shame. I’ll shut up now

Pinkgeorge
Vent away, you don’t have to shut up.
In our area we have healthy weight programmes running which parents and children attend, they teach about healthy eating on a budget, food groups, reading labels, physical exercise etc and have 10 weekly sessions. They are very hard to sell to parents of overweight children as they don’t want to commit to them.

When I say sell - they are free, I mean to persuade them to let me refer them!

My dd has one of the periodic fever syndromes. I've kept the school informed verbally but have now put it in writing as they keep mentioning a care plan. Is that something the school nurse is likely to be involved in? And as periodic fevers are considered rare would they likely have any understanding of it?

Do you get referred home educated children too, or is there a different system for them?

Runwayqueen
If your child is under a specialist or the GP they would usually be expected to lead the care plan, but in our area we would take a referral to liaise with school and professionals involved to facilitate a care plan if necessary.

PurdysChocolate
The school nurse service is for school aged children including those electively home educated and referrals would follow the normal process except they would come in to see us rather than us see them in school.

Do you deal with contraception/pregnancy/STIs in schoolchildren? Could you be a first port of call? How is that handled?

daisypond
We sometimes get these queries in our secondary drop in, we can only give basic advice and then signpost to a sexual health service drop in in the area. We have to assess if the student is Fraser competent and depending on their age and competence, this could raise safeguarding concerns.

Thank you for answering, much appreciated. Her consultant works at a large hospital 3 hrs away so hopefully they won't expect him to attend. Bit concerned about the gp being involved though as he initially decided she just didn't want to go to school. Thank you though, at least I can prepare now

Runwayqueen
The consultant won’t attend, a lot of our role is collating and taking information from different health professionals to the schools. The GP will abide by the consultants word, so don’t worry about that.
In our area, should a referral come in for a health care plan at school, we would first contact the parent to get consent to approach others for info and to share info with school, and also discuss the condition/symptoms/what to do with parents first, and also ask the consultant for guidance, this information is collated into a care plan and presented to school, and if the condition is serious enough also lodged with the local ambulance hub. There is normally a review and also we can get involved if the school are not following the health care plan, as there is statutory guidance for supporting children at school with a medical condition - latest guidance is here
www.gov.uk/government/publications/supporting-pupils-at-school-with-medical-conditions--3

Schools are also expected to make reasonable adjustments for medical conditions and disabilities - here
www.equalityhumanrights.com/en/publication-download/reasonable-adjustments-disabled-pupils

If you look through those documents, they will be useful if you are having to be assertive. I have to say most schools I work with go over and beyond to ensure children with additional needs feel supported at school.

Does your role cover children in the independent sector? Are there school nurses across the UK? (I don’t think we have one for our area)

Yes we do cover referrals from Children and Young People at independent schools, although a lot employ their own nurse.
All areas should have a school nurse team, as we deliver the healthy child programme across the country, the services can vary widely in different areas, an sometimes, sadly, it also depends on how helpful and approachable the individual school nurse is.

How much training do you have on anaphylaxis?

Legoninjago
A lot, it is mandatory training we have to do every year as we support the schools wkrh training sessions and dummy epi pen sessions for staff working with children who carry an epipen.

I want to see what would be done in th situation.

4 year old suspected ASD awaiting diagnosis from panel. Is incontinent and doesn't seem to have any awareness. His diat is shocking extremely limited. It's not bahviual it's sensory and texture related. I have had to fight thought out nurseries over drinks as he point blank will not drink water. He is in the over weight catorgrie. He has seen a dietician that now works on making sure he's getting the correct nutrients, vitamins and minerals. A healthy diet is actually the least of our worries. It's not all about him wanting junk food either as he doesn't like chocolate, only likes 1 type of sweets and will only eat skips as crisps. He doesn't eat any potatoes products apart from chips. He will only eat meat wise popcorn chicken and hot dogs. He won't eat pasta rice noodles ECT. He will only eat Philadelphia cheese sandwiches. He will eat pizza and black pudding and yoghurts. That's literally it. School want him on dinners when he starts school as all over class children will be on dinners I want him on sandwiches so I can provide what he will eat. School think because others are eating he will which he won't we have had the same argument all way though nursery and it was the HV in the end who sorted it with nursery. What would be your suggestion?

re the epipen. Do you have the same training with glucagon?

t1mum3
that training would be provided by the specialist paediatric diabetes nurse, there are also specialist paediatric epilepsy nurses, GP practice nurses do the care plans for problematic asthmatics, otherwise they go onto the school asthma reigster.
However, there is no specialist anaphylaxis nurses, which is why we fill in the gap for training school staff.

This may be different in other areas.

Aspieparent
In our area we would see your 4 year old and you in our school nurse clinic and work with you on continence and diet, referring to specialist services if necessary. Tn our Trust, once he has a diagnosis, we would fund continence products but also work hard to help him achieve continence if there is no medical reason why he couldn't.

With the eating, he is eating more of a range of foods than some children we work with, although his diet does not seem to be that nutritious, you don't mention if you are worried about his weight or energy levels. As he has seen a dietician, and presumably had bloods done, if they were unhappy they would have prescribed a supplement, but this could also stop his appetite for real food and become a meal replacement, so they are often very reluctant to do this.

With school dinners, we have had this with school in our area and children with additional needs - you could let school try him on the school dinners at first, but also send a packed lunch in so that if he won't have the meal provided by school he will have some lunch. This will also demonstrate to the school that he won't tolerate the school dinners and it's not just you being an over anxious mum. As the school say, sometimes children will eat school dinners if others are, but if he is suspected ASD its not quite that simple. Its worth giving it a try with a packed lunch as back up. He should still be allowed to sit with his peers who are having school dinners, to do otherwise would not be inclusive. Schools have to make reasonable adjustments for children with disabilities, and this would be a very small adjustment for them to make.