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Breathing Easy in School

By: Christine Haran

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 go when the child has asthma or severe allergies, which parents know all too well have the potential to be 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 5.2 million school-aged children, according to the American Lung Association. And an increasing number of children have life-threatening allergies. To ensure the safety of these children, experts recommend that parents first do some investigating to find out what school official is responsible for administering medication and handling medical emergencies. Not every school has a nurse, or it may share a nurse with several other schools in the district. Likewise, state and district policies about a child's right to carry life-saving medication in school vary widely. This includes asthma inhalers, which act quickly to stop symptoms that can lead to an asthma attack, and small auto-injecting devices that administer epinephrine to reverse severe allergic reactions called anaphylactic shock.

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?
We recommend that parents approach the school in the summer and ask for the forms they need so their child can be identified as having asthma or allergies. If the school allows children to carry inhalers and auto-injectable epinephrine and the children are trained to use them, they should fill out those permission forms as well.

We recommend parents 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 to the school. The plan should list each of their child's medications and note how much they're supposed to take and when they're supposed to take it.

The school also needs a set of all medication, labeled. Some schools don't allow children to carry an inhaler or auto-injectable epinephrine. 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, 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, all that swelling may have been going on for a while.

Parents can also list symptoms and early warning signs of an asthma attack because every child is different. 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, and sometimes a child has seasonal asthma and allergies, so a parent needs to share that information with the school.

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.

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 five 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 statues allowing children to carry anaphylaxis medication. In the states that still have not put any laws into effect, some districts allow children to carry inhalers and auto-injectable epinephrine and others don't.

Some school districts do not allow studies to carry and self-administer prescribed life-saving medications because that the schools are concerned with liability in case the medication is misused. Also, during the 80s, 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.

We have advocated for years for children to be allowed to carry their inhalers. Last May, several congressmen put together a bill called the Asthmatic Schoolchildren's Treatment and Health Management Act of 2003 (Asthma 2003). It gives funding to states that have statutes protecting a student's right to carry and self-administer prescribed lifesaving asthma and anaphylaxis medications while at school. These states would receive funding priority when applying for federal asthma-related grants for any state and local educational agencies.

We're hoping that this legislation encourages the other states to put statutes in place so that all school districts have one solid law that everybody can comply with.

When a physician writes a prescription for a child and knows that they're well trained, nobody should interfere with that. With a life-threatening allergic reaction or asthma attack, you could lose a child in minutes. We have heard terrible stories about children suffering and dying on school playgrounds, on buses, 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.

Should parents meet with their children's teacher(s)?
And even if there is a nurse, we recommend that parents meet with the teacher or, if your child has several teachers, 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?" That way you won't have everyone in the class blaming little Johnny in December because the duck is gone.

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 are other environmental triggers that parents may want to address in the school?
Dust mites and mold are common classroom triggers. Dust and mold on books, and water leaks that have caused mold on ceiling tiles, are common problems.

During the heating crisis of the 70s and 80s, schools blocked a lot of air ducts to try and save on heat, so it's important that schools check them.

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. AANMA has materials to help parents; our Web site is www.breatherville.org.

Published on: October 09, 2003

 

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