School has started, and many students begin bringing their inhalers and nebulizer treatments into the nurse’s office. A child has brought me an inhaler with no prescription label on it and no note attached from the parent. Handing me the inhaler, she says, “My mommy said I need to take this if I can’t breathe!” I look at the inhaler more closely and see that it has expired. I kid you not, this has happened more than I would like to say. It will not be long before my medication cabinet is full of inhalers and medications for the nebulizer. I am always amazed at the amount of inhalers I receive every year. I would like to think that, maybe, many parents do not know the policies for their local schools. I would like to share some information that may be helpful from the standpoint of a retired school nurse.
After the bell rings, I look into my medication cabinet and begin to go through all the medications. I begin calling each parent to find out the extent of a child’s asthma. This is my first priority. I write down all the information and alert the teachers right away if one of their students has asthma. I then begin the task of putting the information in the computer.
I check for expiration dates and labels. It is always helpful if a parent comes to speak with the nurse before school begins so proper documentation and information about the child’s asthma is already on file. For a parent, it would be wise to make sure you check for expired dates and proper labels on the inhalers a couple of months before school starts. A school nurse cannot give an expired medication or a medication without a label. Many schools have a health website in which consents can be printed out, or you may contact the school and they can mail you a consent form during the summer months.
If a medication is brought to the nurse office on day one, consents are sent home for the parents to sign and instructions given, telling them they must have their physician sign the order within 30 days. What most parents do not realize is that there are many children with asthma and the directions vary. It is important that the child is receiving their inhaler at the right time and in proper amounts.
Many factors cause a child to have asthma. Some asthma is exercise induced. Some children will only need their inhaler before doing any physical activity. They will come in before P.E. and recess. Children have seasonal allergies, causing asthma symptoms to act up and may need treatments for two or three months during the allergy season. It is up to the parent to contact the nurse when treatment or inhalers are no longer needed. Chronic asthma in children is more troubling. Any changes such as stress, sickness, change of foods or weather may trigger their asthma.
There are many types of emergencies when it comes to asthma. If your child was needing breathing treatments the night before at home, it is always helpful to give the school nurse a call or send a note to the teacher so the school is alerted of possible problems that may occur at school. Always send alternate numbers in case of emergency. There is nothing more frightening than a child having an asthma attack with no inhaler at school, no alternate numbers and no documentation that the child has asthma. All the nurse can do at the time is call 911. A trip to the emergency room can be very costly for the parent if there is no health insurance. Sometimes, these types of situations can be avoided by being proactive.
Sometimes parents do not realize there are different types of inhalers. There are rescue inhalers and long acting inhalers. A child seen in the emergency room for an upper respiratory infection is common. The emergency doctor prescribes an inhaler to be used for a couple of weeks. It is important that the emergency room doctor send a written order stating that the inhaler is only for short-term use. It is up to the parent to contact the nurse and pick up the inhaler once the prescribed time is over. Most doctors are glad to write something for the school.
There are times when a child may be using their rescue inhaler as a daily medication. The nurse calls a parent, alerting them that he is using his inhaler too much and may need a long acting inhaler. A rescue inhaler is used only if needed, for an emergency, but not for long-term use and many times a day.
If your child has seen a doctor for asthma, it is wise to ask for an “Asthma Action Plan” for school. This information is invaluable to the school nurse. Sometimes a student has to have his peak flow assessed. This is when a child blows into a peak flow meter and it will let the nurse know the amount of air he is moving and if he needs his inhaler at the time. The peak flow chart will have a color chart, with green, yellow and red. If a child is in the yellow zone, then the plan may call for two puffs of his inhaler. Red may mean he needs a nebulizer treatment right away and to call the parent. Green is telling the nurse he is moving air just fine and does not need his inhaler. Each child’s number may vary, and that number should be noted on the plan. Some children may blow a higher or lower number. An action plan lets a nurse know what is normal for that child. A parent is responsible to bring a meter to the school for their child. Nurse notes are written on the peak flow chart whether there was any wheezing noted, and if the inhaler was given. This is also valuable information for the doctor. A parent should ask the school nurse for a copy of this flow chart to take to their next doctor visit. Always remember, please ask the doctor for an inhaler for school and at home. Most insurance will cover the cost of an inhaler for school.
I hope this has given you some valuable information concerning your child maintaining a safe and healthy environment while they are in school.