My work as a school registered nurse and my personal experience with my own children has taught me several things about the way minds of little ones work. In order to retrieve pertinent health information from a very young child without the guidance and comfort of a parent or familiar face, one must bring everything down to their level.
Sounds simple, right?
Yes. When discussing simple math and reading concepts over a 10-month school year, teachers and teacher assistants have a plethora of strategies, tools, and resources to teach pre-kindergarten students the basics. However, when trying to assess a student with the chief complaint of a “belly ache” as quickly and as efficiently as possible, one has to be creative.
The main causes of a “belly ache” for seemingly healthy pre-kindergarten students are (1) nausea and/or vomiting, (2) a stomach virus, (3) the need to have a bowel movement, or (4) diarrhea or constipation. Obviously, gastrointestinal assessment through questioning can be pretty straightforward with young children:
What did you eat?
Do you need to throw up?
Did you throw up today or last night?
Do you feel like you need to use the bathroom?
Have you pooped today? Oh, you have?
Well honey, tell me about your poop.
You’ll be surprised at the giggles and snickering filling my little, subzero clinic when questioning a pre-kindergartener about his or her poop. Students, faculty, and staff alike get a good chuckle in with my poop questions.
Well, what did it look like?
Was it hard or soft, or just normal?
Was it loose? Like water?
By this time, the student is red from embarrassment and the teacher is red from trying to contain her laughter. Students are usually pouring in my tiny closet-of-a-clinic because, well, it’s lunch time and everyone has to poop after eating broccoli, pineapples, square pizza, and fat-free milk. So I need to bring my questioning down further, to the level of a 4 year old.
Baby. Did it look like a golf ball, a banana, or like soup?
By this time the teacher has spit her coffee out and is doubling over in laughter, “I may never eat a banana or soup again”! The child is laughing in confusion while describing every detail about his or her poop. I can now help this child, and send this child back to class or home. Job done. But what would my 4 and 5 year olds say when asked by their school nurse about their poop? Will they waste 5 or 10 precious minutes of the school nurse’s time in embarrassment?
Let’s have a learning moment!
I sat my youngest child down, who’s pretty smart and witty and totally into the human body and Doc McStuffins…
Me: Jai’la, do you remember being sick and having to poop a lot?
Jai’la: Yes. I pooped a lot mommy.
Me: Was it normal like a banana or loose like soup?
Jai’la: Loose like soup.
Me: Do you know what that’s called? (Ready to discuss the differences between hard, normal, and loose stools. I was ready to talk about diarrhea.)
Jai’la: Yeah mommy, I know.
Me: Well, what’s it called?
Jai’la: Poop soup.
I’m both proud and amused at this revelation. POOP SOUP.