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 Ask the School Nurse
Q: I’m the mother of a kindergarten child who is allergic to peanuts, nuts, and fish. According to a new policy in her school, she must carry her EpiPen® with her all day. The school will no longer keep an autoinjector on the premises. Considering the age of the students, ages 5 to 8, is this safe?
Sandra S. Boyd, R.N.: To ensure this policy supports a safe and healthy situation, consider two essential questions: Who is going to administer the medication to your child if she needs it and how can you help your child learn to keep the EpiPen safe and ready-to-use? Here are some specific steps you can take to prepare both your child and the school.
1. If your school has a nurse, whether part-time or full-time, meet with her (or him) to work out a plan of action. The nurse will know the school officials, the teachers, the support staff, and the students, and will provide a unique perspective into school routines.
2. Coordinate with your physician and/or the school nurse to draw up a healthcare plan for your child. Include specific information about your child’s allergies and the symptoms that indicate she’s having an allergic reaction. Be sure to describe which symptoms are dangerous and require immediate attention. Clearly explain the emergency plan: when to notify a parent or physician; when to call for an emergency medical team; what medications should be given immediately, and how large a dose; what kind of care your child needs as the medication takes effect; and what changes to expect after the medication is given. Update this plan yearly, or whenever your child’s medical condition changes significantly. Give a copy of the plan to the school nurse, the administrative office, your child’s teacher, and any other teachers your child sees during the week (music? physical education? special education?). Also keep a copy with the EpiPen itself. A labeled photo attached to the plan will help everyone (teachers, substitutes) immediately recognize your child.
3. Since your child has specific food allergies, work closely with the cafeteria staff. Discuss menus, food content, and "hidden" ingredients that might be dangerous for your child. Post a labeled photo of your child to alert cafeteria workers to the emergency care plan. Post a copy of the plan with the photo.
4. Work with the nurse, teacher, or administrator to identify and train at least two adults (three would be better) to help your child in an emergency. Go over the medical plan with them so they know what symptoms to watch for and teach them how to use the EpiPen.
5. Arrange an informal, friendly meeting with your child and these trained adults so everyone can get to know each other.
6. Devise a safe, comfortable way for your child to carry the EpiPen around. A fanny pack might work, or a small backpack. Teach your child not to play with the medication or take it out to show others.
7. Give your child specific, age-appropriate education about her allergies. Teach her how to "read" her body and how to know when something is wrong. She needs to know who to contact for any symptoms of food allergy - or whenever she "just feels funny" or "different." Explain to her that she can’t wait for symptoms to go away - that they won’t "just get better" if she ignores them. She must tell the teacher, school nurse, or other adult immediately to get help.
8. Work with your child’s teacher to help the other students understand food allergies and why your child needs to be careful about what she eats. This could be combined with a unit on nutrition or health.
Student care is a partnership among parents, healthcare professionals, students, and school staff. Working together, with good communication, you can make school a healthy and safe part of your child’s daily life.
Q: Our grammar school has close to 700 students. We have a school nurse and I know she has her hands full. I don’t think she knows much about asthma and it isn’t one of her high priorities. How can I convince her to have in-service training for teachers and school administrators on asthma?
Sandra S. Boyd, R.N.: I suggest that you arrange a meeting with your school nurse at a time that will best fit both your schedules. Now is the time to have a discussion about asthma and its impact on the health of children and adults. Ask how many students and adults in the school have asthma or other respiratory issues, and if she would like some assistance in gathering resources. The discussion will likely lead to what information is currently available in the school district. The school nurse will appreciate your interest and offer to help.
Some suggestions on where to begin:
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