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
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
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
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
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
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
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
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
Published on: October 09, 2003