Handling Health Concerns at School

When Adam Willits sauntered off for his first day of kindergarten, his parents, Mike and Debra Willits of Apex, had more concerns than the average parent of a kindergartner. Their son has a life-threatening allergy to nuts and peanuts and, for the first time, he was attending a school that allowed peanut products.

Willits’ private preschool had a nut-free policy, so his parents had very few worries about him having a reaction. But all of that changed when the Willits opted to send their son to public school.

Since the school was highly recommended by others, the Willits decided it was an opportunity to begin teaching their son to live with a food allergy in real-world circumstances. It was not an easy step to take. Most kindergartners cannot truly understand the ramifications of a serious food allergy.

The Willits did not, however, place their trust blindly in the school system. Before her son ever set foot in the school, Debra Willits met with school administrators and teachers to explain her child’s allergy and establish an emergency plan in case he had a reaction at school. Willits says it is critical for parents to advocate for their child when the child has medical needs that may require attention on a daily basis.

“At first, I thought I was taking up the staff’s valuable time, but the longer we dealt with this, the more I realized I was going to have to educate people because no one else was going to explain it to them,” Willits says. “I also made sure that my child understood what was happening.”

Medical needs of school-aged children can vary and include conditions like diabetes, food allergies, asthma and attention deficit disorder. Since these children are in the regular student population, staff members must be made aware of their needs and trained for emergency situations.

These conditions are no small matter for North Carolina’s school-aged children. According to the 2004 N.C. School Principal’s Survey, 50 percent of children with asthma reported missing school each month due to breathing difficulties. And an estimated $100 million is spent annually on asthma care for children in our state.

Do Your Homework

Parents of children with special medical needs can begin by garnering as much information as possible when considering potential schools.

Linda Winkler of Cary has a 9-year-old daughter with food allergies. Like Willits, Winkler’s daughter was fortunate to attend a preschool that was aware of her needs.

“It was a very experienced preschool director [in Colorado], and so it was very easy because they were so savvy,” Winkler says.

If a preschool is not accustomed to dealing with conditions like asthma and food allergies, it requires a great deal of parental attention.

For both Winkler and Willits, the more serious challenges occurred in public elementary school. Winkler says she was a “nervous wreck” when her daughter began kindergarten.

Both mothers provided alternative snacks for their children in case food was brought into the classroom, but Willits’ son still experienced two reactions at school, both within the first two weeks of kindergarten.

He suffered a red, swollen eye after touching playground equipment during recess. Fortunately, the exposure did not require use of an EpiPen, an injectable dose of epinephrine that prevents a severe, life-threatening allergic reaction called anaphylaxis. Since Adam did not ingest nut products, he did not have a more serious reaction.

But when a similar reaction occurred on the heels of the first one, the boy’s parents talked with administrators and teachers to revise their school plan.

“That’s when we knew that the lunch tables needed to be wiped and his class needed to wash their hands before going out to play or sitting at desks,” Willits says. Other children were eating things like peanut butter sandwiches, and the residue on their hands was enough to cause a reaction.

Both Winkler and Willits offer to be “Grade Mom” for their children’s classes to have firsthand knowledge of food coming into the classroom. But Winkler says even though she was in charge of class parties, food was often brought to class other times. When she tracked it last year, she found her child received additional food several days a week for at least half of the school year.

Communicate with Administrators and Staff

The Wake County Public School System does not have a school nurse assigned to each school. Instead, a nurse coordinates services and paperwork for students at a number of schools. Since a nurse is not on site daily, the administrative staff or teacher typically handles medications or medical needs during the course of child’s day, which is why it’s important for parents to talk with staff as well as the school nurse.

“I was sure every year to write a letter to the principal requesting a teacher who would be understanding of Adam’s allergies and capable and willing to handle any emergencies that might arise,” Willits says.

Lisa Feierstein is a registered nurse and founder of Active HealthCare, a medical equipment company in Raleigh that partners with physicians to provide respiratory devices to patients. Feierstein is an asthma sufferer herself and has a child with asthma. She says it is crucial to form a relationship with the school nurse and with those who will be interacting with your child on a daily basis.

Willits, for example, asked elementary school teachers to inform her in advance if any food would be distributed in class or used during class projects. She has found that most teachers are willing to work with her and willing to listen, but she also does a lot of legwork.

“Often I would have to go to the cafeteria to check the cookies or the cake they were serving during special events like the ACC basketball tournament,” she notes.

Eleanor McGeary of Cary also spent time talking with administrators and school nurses about her 9-year-old daughter, Madeline, who has nerve deafness in both ears that is corrected with hearing devices. Although Madeline does not require medications, she may on occasion need an extra battery for her hearing device.

“We have been very fortunate because the school has really worked with us to get things set up for Madeline,” her mother says.

Willits also had a good experience. “In elementary school everyone was very good about protecting Adam,” she says. “Everyone always washed their hands after eating, and I had to ask the teacher to make sure that happened.”

Create a School Emergency Plan

Experienced parents and staff say the first step when children require medical attention or medicines during a school day is to create an emergency action plan for the child by completing the paperwork that outlines symptoms a child may experience and actions staff should take.

Triangle-area school districts require specific forms to be filled out by parents and school staff and signed by a physician before prescription medication may be dispensed. Nonprescription medicines must be labeled with the child’s name, the name of the medication, the correct dosage and the directions.

In addition to paperwork from physicians and the school nurse, Willits also provided two sets of necessary medications, one for the classroom and one for the front office. She gave staff written examples of items that are safe for her child to eat and ones that could typically cause a problem.

“I met with [the] administration before school started and met with the teacher before school started,” Willits says. “I gave them a sheet with an emergency plan describing symptoms and what to do.”

Willits also includes a one-page description of Adam’s medical issue for a substitute teacher folder. The page has a photo of Adam on a red background to make it harder to miss and a brief description of his food allergies and emergency plan.

Feierstein, the nurse and asthma sufferer, developed an Asthma Action Plan for her child as well, so staff would be able to recognize her child’s symptoms and use medicines when necessary.

“It’s so important that the physician, the family and the school work together to develop a plan,” Feierstein says.

Educate and Empower your Child

Share the emergency action plan with your child so he or she can understand what will occur when medical needs arise at school. Encourage children to act on their own behalf as much as possible. Tell them, for example, to inform adults if they are having asthma symptoms.

If a child has food allergies, show the child the alternative snacks you will leave in the classroom for occasions when the class has food. Instruct a child about medications that will be at school for conditions like asthma, diabetes and food allergies. Adam Willits also wears a medic alert bracelet.

Now that 11-year-old Adam is in middle school, he is expected to be responsible for his own safety. “I no longer talk to his teachers or train his teachers,” Willits says. “I send a note at the beginning of the year and try to speak to each of them at open house.”

In elementary school, Adam was accustomed to teachers wiping tables for him and making sure he did not sit next to anyone eating peanut butter. Now he is sure to eat lunch on his lunchbox so his food will not touch the table, and he asks people to move down a few seats at lunch if he sees they are eating peanut butter.

He no longer relies on adults to check food items for him. “Now I have to read the ingredients everywhere I go, and if they have no ingredients [listed], I shouldn’t eat it,” he says. He also is certain to carry his medicines with him at all times. At school, his medicines are in his locker and in the school’s main office.

Many parents send their children off to school with the typical anxieties about how a child will do in a classroom setting or how difficult the transition will be, but parents who have children with medical needs have the added responsibility of ultimately teaching the child how to cope with whatever challenges the condition creates. By helping children gradually learn how to take responsibility for themselves at school, parents prepare their children to handle medical issues once they are adults.

Tips for Parents

*Have your child’s teacher explain your child’s needs to the class when appropriate.

*Provide an informational sheet for substitute teachers with your child’s photo and medical needs.

*Develop an emergency action plan with the school staff and nurse.

*Educate those who will be interacting with your child.

*Remember that a medical identification alert bracelet is an option.

*Outline how medicines will be handled on class field trip days.

*Provide medicines to be kept with your child and/or in the main office.

*Fill out appropriate paperwork with your physician and school nurse.