For most students, missing a few days of the school year is no big deal. However, for children with a chronic health condition, frequent absenteeism becomes a major problem that compounds itself with each passing school year.
Students with asthma and allergies may miss school due to medical appointments, preventive evaluations, or treatments, as well as illness. Therefore, teachers and parents should establish plans for keeping up with daily classroom assignments at the beginning of the school year. Students should not be penalized for missing deadlines or failing to attend a sufficient number of school days if illness is the cause.
One aspect of school absenteeism is entirely preventable and almost never considered: children with asthma who are forced to go to the clinic every time a medication is needed. Some children must use medication three or four times a day. A child who leaves the classroom for one dose of medication per day loses an additional 11 days over the course of the school year!
Teaching children how to use medicines properly and permitting them to carry inhaled medications throughout the day will eliminate this problem. Discuss this with school officials and your physician. Also talk with your doctor about medication options. Some medicines require fewer doses per day than others.
When should asthma go to school?
It is often difficult to decide whether your child should go to school or not. The following guidelines are suggested by the Center for Interdisciplinary Research on Immunologic Diseases at Georgetown University, Washington, DC:
Your child can go to school with:
- a stuffy nose, but no wheezing
- mild wheezing that clears after medication
- the ability to do usual daily activities
- no difficulty breathing
Keep your child home with:
- evidence of infection, sore throat, or swollen, painful neck glands
- a fever over 100 degrees F, orally; face hot and flushed
- wheezing that continues to be labored one hour after medicine is given
- weakness or tiredness that makes it hard to take part in usual daily activities
- difficulty breathing
Your child’s peak flow meter reading can also help you decide. A lower-than-normal reading, coupled with other early warning signals (such as a chronic cough or pale skin color), may be a sign that an asthma attack is imminent. Parents should medicate their children as instructed by the physician and base their decision to send the child to school on the child’s response to the medications.
Good communication among the teacher, parent, and child will enable the child to attend school on marginal days. Notify the teacher that your child is in pre-asthma stages but controlled with medications. If possible or indicated, go to the school to check on your child just before the next medication is due. A quick assessment with the peak flow meter and listening to the child’s chest will tell you what you need to know.
Some children’s asthma is worse in the morning than at midday. This can be a problem with morning kindergarten or preschool programs. Try to arrange for afternoon school for the younger child, and remember that this tendency may improve as the child gets older. Older children with this same problem don’t need to miss an entire day of school. A half day at school is better than none at all.
When a child needs help
The key to keeping kids in school is keeping them healthy. Children with high absentee rates need medical help. Children who can never participate in physical activities need medical help. Children who are frequently in crisis need medical help. These are signs that the asthma or allergy management plan is not working, and parents and teachers should take the time to identify why the child is missing school and unable to participate fully:
- Is the child under the care of an asthma or allergy specialist?
- Is the asthma or allergy management plan written down?
- Are the home and school environments free of allergens and irritants?
- Is the school environment a healthy place for the child to breathe?
If any of the questions above are answered with "no", the child can be expected to miss more school than necessary. If all the questions above are answered with "yes" and the child is still having problems, further investigation by the physician or perhaps a second medical opinion would be helpful. In a small percentage of cases, children struggle with severe illnesses complicated by insufficient immune responses. These children need support, not condemnation, when they miss many school days.
A child who misses too much school can benefit from a tutor. Many school systems provide this service; however, in most cases the child must miss an extraordinary number of school days before being eligible for help. Parents should not hesitate to request special help for their children.
Home Schooling
Choosing not to enroll your child with asthma in school simply because you believe you can control the child’s symptoms better at home can create a false sense of security and inhibit the child’s ability to manage his own health. Home instruction may be the only alternative for a small minority of children whose physical condition is severe, but it should never be chosen because of poor home or school coping skills or outdated medical management.
