Which guidance would the nurse include in the teaching plan for a child who is allergic to dust

Parents' Guide to Managing Symptoms & Ensuring Academic Success

Childhood allergies and asthma are a growing concern. Allergic conditions are the most common health issue among U.S. children and asthma is the third-ranking cause of hospitalization among kids under 15. It's no wonder parents are worried about sending their little ones off to school. This guide helps parents not only find the right school for their child with allergies or asthma but also offers information on how to manage symptoms and prevent reactions while their kid is away from home. Find some peace of mind and help your child thrive in school.

Allergies and asthma are chronic conditions that children need to learn how to live with. Self-management can be difficult, but approaching these conditions with a positive attitude and embracing a life without limits can set positive expectations and improve quality of life for children.

Dr. David Stukus

Allergies/Asthma & School Performance

Managing allergies and asthma isn't just about safety – both can also have an impact on academic performance. Doing well in school requires working hard, concentrating on schoolwork and paying attention. These tasks can become difficult when a child is dealing with allergy/asthma symptoms or worrying about their next attack. Here's how childhood allergies or asthma can affect academic performance:

Missed school days

When allergies or asthma symptoms become severe enough, a child may have to stay home from school. The CDC notes asthma is one of the top reasons children miss school. And any time a student is absent, they risk falling behind, especially if they miss multiple days. A study in California showed only 17% of kindergarteners and first graders who were chronically absent were proficient readers by the end of the third grade, compared to 64% among those who missed less than 5% of school.

Anxiety and social withdrawal

Allergies and asthma don't just affect physical health – they can affect emotional and mental well-being as well. When a child is worried about whether they'll have an allergy or asthma attack during school, it can cause anxiety. This anxiety could also cause some children to withdraw from social or extracurricular activities in an attempt to avoid potentially unpleasant events and feelings. They might also feel embarrassed if they need to see the school nurse in the middle of class or recess. Children may focus on these negative feelings instead of their schoolwork.

Poor sleep quality

Severe or chronic allergy and asthma symptoms can make it difficult to sleep at night. This lack of sleep can mean children are tired throughout the school day, making it hard to concentrate on schoolwork and retain information.

Medication side effects

Even if a child's allergies or asthma can be controlled with medication, the side effects can hinder school performance. Children might suffer from brain fog, drowsiness and physical discomfort, such as headache, stomach pain, nausea or dizziness.

How to Keep Your Kid Safe at School

When it comes to safety at school, Dr. David Stukus of Nationwide Children's Hospital in Columbus, Ohio says communication is key. "Talk to teachers and administers before the start of the school year to allow time for school personnel to make any necessary preparations," he says.

Here are a few more important tips:

• Create an action plan Allergy and asthma treatment can vary greatly so it's important to work with your child's doctor to create an action plan. An effective plan will clearly outline triggers, symptoms and the necessary steps to take when a child doesn't exhibit symptoms, when they exhibit mild symptoms and when they exhibit severe symptoms. An example of a food allergy action plan may look something like this, while an asthma action plan may look like this.
• Ask for accommodations via a 504 Plan Under the Rehabilitation Act of 1973, life-threatening allergic reactions (e.g. anaphylaxis) are considered a disability, which means children with such severe allergies can't be excluded or discriminated against, and schools must provide accommodations to keep the child safe. These accommodations are filed as a 504 Plan and are typically used for severe food allergies. The plan should be established with guidance counselors, school nurses, your child's teacher and any other school staff who might be contact with your child. It should also be reviewed every year to make sure it's up-to-date, but you can call a meeting with the principal to make changes anytime throughout the year. Kids with Food Allergies has a few different examples of common 504 accommodations.
• Inform teachers and administrators of symptoms and medication When meeting with teachers and administrators to create a 504 Plan, it's a good idea to also go over everything else they need to know about your child's allergies or asthma. "Make sure your child has an up-to-date action plan on file with their school each year, which outlines exactly what treatment to administer according to symptoms," Dr. Stukus recommends. He also recommends informing the school of any prescribed medication, such as epinephrine auto-injectors and inhalers. "Any medications prescribed by a physician for use on an as needed basis should be filed with the school, along with current prescriptions," he says.
• Find an appropriate balance You and your child's pediatrician are the experts when it comes to your child's allergies or asthma but you'll have to work with teachers, administrators and staff to ensure your child's safety during school hours. You need to be your child's advocate and make sure proper accommodations are in place, but you also don't want to ask for so much that the school becomes overwhelmed and gives up. "Allowing and encouraging questions and active participation from school personnel can be very collaborative and helpful," says Dr. Stukus.
• Prepare your child for potential allergic reactions and asthma attacks It's crucial for the school to be prepared for allergic reactions and asthma attacks but it's equally important kids know what to do when they're away from home. Start educating your child about their allergies or asthma and teach them how to ask for help. Make sure your child can tell when they're experiencing an allergic reaction or asthma attack and that they know exactly what to do during one. They should also know emergency contact and medication information.
• Give your child an information card Teacher and administrators have a lot of things they need to remember, so they might have trouble keeping track of the allergies, medications, dosing guidelines and medication side effects for all students. To help, your child should carry an information card at all times. It should list allergies, medications, triggers, side effects, medication administration rules, emergency contact information and the doctor's phone number.
• Prepare for potential social issues Exclusion from social activities is a big concern among parents of children with allergies or asthma. You may want to ask the principal or teacher to notify other parents that there's a child in the classroom with certain allergies and make them aware of specific accommodations such as food restrictions when bringing snacks for the entire class so your child doesn't feel left out. If problems arise, work with the school to resolve them, not the parents or children.
• Consider online or home schooling If your child has severe asthma or a life-threatening allergy, online learning or home school might be an ideal option and can also offer peace of mind to worried parents. Attending regular school may be an option once your child is older and their peers have a better understanding of your child's health concerns.

How to Find the Right School

Choosing the right school for your child is a difficult task, even if they don't have asthma or an allergy. Selection will come down to the school's ability to keep them safe. The following tips can help parents determine if a school is right for their child:

Parents should keep an open line of communication with their child's teacher and allow for questions and feedback regarding their strategy to avoid reactions and treat symptoms when they occur.

Dr. Stukus

Do your homework

Think about what your child needs to avoid to be safe and see if the school can meet those needs. For instance, if your child is allergic to dust, will chalkboards in the classroom be an issue? According to PBS, thirteen states have guidelines for managing food allergies in schools. Find out if you live in one of those states and look up the guidelines, as well as the policies at the schools you're considering so you have an idea of what to expect when it comes to your child's accommodations.

Talk to your pediatrician or allergist

What does your pediatrician or allergist say about local schools and districts? Do they have any school recommendations or suggestions on how to vet school options?

Interview the school principal

Meet with the school principal and ask how the school has handled allergies and asthma emergencies in the past as well as what it currently does to prevent such emergencies. Although allergies and asthma are common among kids, there are still some schools that have never had students with allergies/asthma so may not have the proper experience and knowledge to deal with your child's specific needs. Examples of important questions to ask are:

• Is the school nurse full- or part-time?
• How does the school deal with bullying about allergies and asthma?
• What do teachers do to maintain an inclusive environment for students with allergies/asthma?
• Where will my child's medication be stored during the school day?
• Have all staff been trained to administer epinephrine auto-injectors?

Meet with the school nurse

Explain your child's situation to the school nurse and ask questions to see if they're able to meet your child's needs and whether you feel confident leaving your child in their care. Also ask about the person who takes over when the school nurse isn't there.

Meet with the food services director

If your child has a food allergy, ask about the food services and, if possible, arrange to meet with the person who oversees the school's catering. What kind of allergy policies are in place? Is it possible to make meal requests/substitutions and if so, what's the process?

Talk to other parents

Parents who have already gone through this process – or are currently going through it too – are great sources of information, advice and support. Reach out to parents at the schools you're considering and check out online forums. What schools do fellow parents of children with allergies/asthma recommend and why? What advice do they have based on past experiences? What would they have done differently if they could?

Once a good school is found, keeping your child safe at that school might require constant adjustments. "Parents should keep an open line of communication with their child's teacher and allow for questions and feedback regarding their strategy to avoid reactions and treat symptoms when they occur," says Dr. Stukus says.

Common Types of Allergies & Asthma

About 40% of children in the U.S. suffer from allergies, according to the Asthma and Allergy Foundation of America (AAFA), Anyone can be allergic to almost anything, from dust to insect stings to shellfish, but some allergies and asthma conditions are more common than others.

EpiPens & Inhalers

For children with potentially life-threatening allergies, epinephrine auto-injectors are strongly recommended. These medical devices deliver a premeasured amount of epinephrine into the bloodstream to treat an anaphylactic reaction.

Despite the necessity of these devices, financial constraints can mean not all kids have them. For example, the most common epinephrine auto-injector on the market in the U.S. is the EpiPen (and EpiPen Jr., which delivers a smaller dose of epinephrine). According to the New York Times, filling the prescription once can cost up to $600 for those without health insurance or who aren't eligible for special manufacturer savings plans.

The generic version of EpiPen can cost around $300, as reported by CNN. Cheaper alternatives exist, such as Adrenaclick and Auvi-Q. They are usually sold at much lower cost compared to the EpiPen. According to Consumer Reports, some CVS pharmacies sell the generic version of Adrenaclick for as little as $110. Factor in a $100 discount coupon from the manufacturer and that brings the cost down to just $10.

Keep in mind that epinephrine auto-injectors do expire and need to be replaced every year or two, depending on the specific type. The medication doesn't go bad once the expiration date hits, but it does become less effective and may be unable to produce the desired effects when used.

For children with asthma, a metered-dose inhaler is a must for controlling symptoms. These inhalers deliver a specific amount of medication to the lungs in aerosol or powdered form.

There are two primary types of asthma inhalers. One is fast-acting, which is intended to provide quick relief during an active asthma attack. The most common medication used in fast-acting inhalers is albuterol. Prices for albuterol vary, but user comments on CostHelper suggests parents can expect to pay anywhere from $50 to $150.

The second type of inhaler is a corticosteroid, which is used for long-term asthma management. Common brand names are Flovent HFA, Pulmicort Respules and Qvar. The cost for corticosteroids can vary – non-insurance prices range from about $150 per month for Qvar to almost $800 per month for the highest dose of Pulmicort Respules, according to Consumer Reports.

Useful Products to Consider

Several products are now available to help make allergy/asthma management easier and even fun and stylish. When choosing products to keep a child safe in school, it pays to do serious homework. "I strongly encourage parents to use vetted evidence-based resources from professional and advocacy organizations for their information," Dr. Stukus says. "The American College of Allergy, Asthma & Immunology has great information available online. Patient organizations such as the Asthma and Allergy Foundation of American and Food Allergy Research & Education (FARE) also have great resources."

Here are examples of useful products you might want to consider:

• AeroChamber Many children have trouble coordinating inhalation with the activation of their metered dose inhaler, which means they don't always receive the necessary dose of asthma medication. The AeroChamber helps ensure they receive the intended dosage.
• Aid Puppy Aid Puppy is a pouch shaped like a stuffed animal that can be used to hold basic medications and tools in case of an emergency. It's also a great cuddle buddy.
• AllerMates Allergy Medicine Case This kid-friendly pouch carries a variety of asthma and allergy medications including epinephrine auto-injectors and inhalers.
• Baby Buddy Bear This easy-to-clean and chemical-free Baby Buddy Bear is certified allergy and asthma friendly. It can withstand deep cleaning to remove any allergens or asthma triggers.
• Beware Bandits These special allergy bracelets for children provide a clear way for unfamiliar individuals to become aware of a child's allergies and what to do in case of an emergency.
• Food Journal for Kids Designed for kids, this food journal encourages them to write down and draw what they eat. Keeping a food journal can be helpful for those suffering from food allergies.
• LegBuddy Some kids may prefer to carry their epinephrine auto-injectors discreetly. This neoprene leg holster for children, teens and adults that can hold up to two epinephrine auto-injectors and can be concealed under long pants.
• Child Safety Cards These safety cards inform first responders of a child's medical condition in situations where the child cannot communicate this information themselves. The cards fit in wallets and phone pouches or can be attached to backpacks, jackets, pants and other clothing.
• Veta Smart Case for EpiPen This case holds only EpiPens. It links to the user's smartphone to notify them if the EpiPen is left behind or is at a temperature that is harmful for the epinephrine. It also provides light and sound alerts to help locate a lost EpiPen.

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