~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ This message is from PedTalk! To reply to the group, use "" ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ I am a school nurse in Pa. and have been on the list for a few weeks. Now your talking my language. I am in an elementary building and have 43 children on ritalin to date. This number always increases after the 1st marking period. While I have seen magical results with this treatment modality, I have just as many concerns. We as school nurses have valuable observations, but must also obtain parental permission to share our assessments with the prescribing physicians. I have often wished that more meetings would occur between teachers, parents, physicians, and school nurses when evaluating the dosages and effectiveness of various medications. Just last week I had a parent mention her child's physician was planning to increase the dosages at school because the effect was not lasting a full four hours. This child already receives 30 mg. of ritalin + 2 mg tenex in the AM, 25 mg. ritalin +2 mg. tenex at lunch, and 25 mg. ritalin + 2 mg. tenex after school (at 3:30), Since she attends day care, mom picks her up between 5:30 and 6:00 each weekday. I didn't even think mom say her for 4 hours, except of course on the weekends!!! Although the teacher in small special ed classroom are not seeing any attention problems, I did obtain verbal Ok from mom to discuss possible increase with physician. I explained my discomfort giving a dosage which exceeds the max recommended in PDR without at least verification Despite my reporting to the physician about attention being satisfactory at school, he stated that often children exhibit different behaviors in comfortable home environment. It would be so valuable if schools and physicians worked together for the best interest of the child. With children being in school for the better part of their waking hours, valuable observations are made and should be shared. I wish more physicians would weigh school input with home input, they would establish a more realistic view of the child's total behavioral profile. For the record, nurses in my district do count and record # pills when they are received. Parents must bring the medicine in and are not permitted to send in school bag or on bus with the child. I have personally invited physicians to school in the past to attend parent meetings for the purpose of composing an accurate description. I also medicate several children at school daily in the morning because of inconsistent dosing at home. I encourage all physicians to request parentinput from the teacher and school nurse prior to subsequent appointments and medication refills. This could even be a signed contract when it is decided to treat with medication. We have had several parents who we suspected of Munchausens by proxy. The meds kept increasing and increasing and the child developed continuing difficulty in school. Several to the point of hospitalization. We, as school nurses, would love to share crucial assessments from a medical point of view. Please remember, the door swings both ways. You can also ask parent permission to call us! ____