It can be hard for some parents to send their son or daughter off to school in the fall. It's especially hard to let them go when they have asthma or severe allergies, which can be potentially life threatening. While asthma and allergies can be effectively managed in a school environment, parents have a key role to play.
Asthma affects more than 5 million school-aged children, according to the American Lung Association. And an increasing number of children have life-threatening allergies. Since most schools differ on policies for student medication and more are forced to cut fulltime nurses, experts recommend that parents do some investigating before the school year begins.
Below, Sandra Fusco-Walker, the outreach education coordinator of Allergy and Asthma Network: Mothers of Asthmatics (AANMA) and the mother of three children with asthma, explains how parents can make sure their child with asthma or allergies is safe in school.
How can parents make sure the needs of their children are being met at school?
Parents should approach the school in the summer and ask for any forms they need so their child can be identified as having asthma or allergies. If the school allows children to carry inhalers and EpiPens, auto-injectable epinephrine, and the children are trained to use them, they should fill out those permission forms as well.
Parents should also have an asthma action plan from their physician. That gives the parent instructions about how to take care of their child on a day-to-day basis, so they can relay that information to the school. The plan should list each medication and note how much and when their child is supposed to take it. Parents should also provide exact instructions on what to do in case of an emergency such as what steps to take and who to call.
The school also needs a set of all medication, labeled. Some schools don't allow children to carry an inhaler or EpiPens, but even if they do, the school should have one on the premises in case the child has forgotten or lost their medication.
If a child with asthma is able to use a device called a peak-flow meter, then parents should provide one to the school and write down the child's normal range and what medication should be taken when results are out of range. The peak-flow meter measures the volume of air that you can blow out. When you're having asthma problems, your airways become inflamed and clogged with mucous. By the time you get to a full-blown asthma attack and you're coughing and wheezing and choking, and all that swelling may have been going on for a while.
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Since every child is different parents can also list symptoms and early warning signs of an asthma attack for their teacher or school nurse. Asthma is not always wheezing. Some children just cough. Some younger children make no sounds.
Likewise, asthma attacks can be triggered by allergens such as pet dander, dust or mold. Sometimes a child has seasonal asthma and allergies, so a parent needs to share that information with the school.
Should parents meet with their children's teacher(s)?
Yes and even the school nurse. If your child has several teachers, then meet with the homeroom teacher, to address potential asthma and allergy triggers in the classroom such as pets.
It's much easier right in the beginning of the school year to say, "So-and-so is allergic and it's not a good idea to have pets in the classroom. Can you make sure they don't come in?" This way your child won't be blamed by classmates when the classroom pet has to be removed during the school year. As an alternative to pets in the classroom, some schools can have a section of the school or a closed-off room where they show pets.
What if the school doesn't have a nurse?
Unfortunately, that's an issue that a lot of people in this country face. You have school nurses who may be assigned to an entire school district, so they may be floating between students in four or five schools.
Each school handles this situation differently. Sometimes medications are administered by the principal, or the receptionist administers them. You would have to approach a school district to find out exactly how they handle it. If there is no school nurse, it would fall to the parents to meet with the teacher and the coaches to educate them about their child's asthma and allergies.
When can children self-administer their medication?
Every individual is different. You may have a child who is 5 years old who is very competent and well trained, and then you may have a 10 year old who is not responsible and loses things. Each case has to be judged by the physician and the parent. Once the child is trained, parents should have a medical note from the physician basically saying that this child is trained and is allowed to carry and self-administer when there is a problem.
Do most children have the legal right to carry an inhaler?
There are a total of 23 states that have laws requiring that schools allow children to carry and self-administer their inhalers, and 11 of those states have statutes allowing children to carry emergency allergy medication like EpiPens. In the states that still have not put any laws into effect, some districts allow children to carry inhalers and EpiPens and others don't.
Some school districts do not allow students to carry and self-administer prescribed life-saving medications because the schools are concerned with liability in case the medication is misused. Also, during the 1980s, zero drug tolerance policies were introduced in response to illegal drugs in schools. Under these policies, students aren't allowed to carry aspirin; emergency medications were caught up in those policies.
"When a physician writes a prescription for a child and knows that they're well trained, nobody should interfere with that," says Fusco-Walker. "With a life-threatening allergic reaction or asthma attack, you could lose a child in minutes." There are terrible stories about children suffering and dying on school playgrounds, on buses or at after-school athletic activities because the inhalers were locked up in the building and nobody could get to the inhaler in time. These things should not be happening.
What are other environmental triggers that parents may want to address in the school?
Dust mites and mold are common classroom triggers. During the heating crisis of the 1970s and 1980s, schools blocked a lot of air ducts to try and save on heat, so it's important that they be checked.
When buses idle outside the classrooms while waiting for the kids to come out, the exhaust from the buses gets sucked up into the filters into the school, or if the windows are open, it goes right into the classroom, so it's not a good idea to have buses idle.
If you're keeping the air clean inside the school for the children who have asthma and allergies, you're also helping people who don't have asthma and allergies. Most parents find that the school nurse is usually an advocate for them.
What overall advice to parents?
When it comes to children in school, parents are their child's best advocates. They really do need to take on the role of making sure that their child is safe at school and teaching their child to advocate for themselves and to speak up if they're having a problem.
