Many children with asthma have symptoms at school. That’s why it's important to get the school involved in managing your child’s asthma; your child needs a responsible adult at the school who knows when and how to administer asthma inhalers or other asthma treatment. Even if your child has mild asthma, working with the classroom teacher and other school officials is vital for managing your child’s condition and treating mild symptoms early on before they worsen.
With the prevalence of asthma increasing rapidly among children in the U.S., most schools have many students with asthma. Many classroom teachers -- and certainly the school nurses -- are very familiar with helping children with asthma. Still, it is important to take steps to ensure that your child gets adequate attention at school and that all the key people are familiar with what is needed in managing your child’s asthma and preventing asthma symptoms at school.
How Can I Prevent Asthma Problems for My Child at School?
The most important thing you can do to prevent asthma problems for your child at school is to talk to your child and, depending on how old he is, explain to him as much about asthma as he can understand. Ideally, your child should be able to keep track of when it's time to take his medicine, how to use the asthma inhaler properly, how to use a peak flow meter, what the number on the peak flow meter means, and what to do if that number is too low.
You should also make sure that the school officials know all about managing your child’s asthma. They must know how severe the asthma is, your child's asthma triggers, which asthma medications to use and how to properly give them, how to use the peak flow meter, and what to do in case of an asthma attack.
The specific steps for managing your child’s asthma at school should be written up in your child’s asthma action plan. The asthma action plan should be distributed to every school official who may care for your child. It’s important to have a conference with the child’s teachers and other school officials and explain the asthma action plan, including your child’s triggers, the severity of the asthma, and common symptoms and effective treatment of your child's asthma.
For in depth information, see WebMD’s article on Developing an Asthma Action Plan.
In addition, you should look around your child's classroom and other areas where he or she goes at the school to see if there are any known allergy or asthma triggers. If you identify possible asthma triggers (dust mites and dust are common triggers in a classroom), you should work with the teacher to reduce your child's exposure to these triggers.
Also, it is very important to give the school nurse all the medicines that your child might need during school hours along with the proper instructions, including your child's asthma action plan. Remember that for some asthma medicines, like asthma inhalers, there is often no way to tell whether the inhaler still has medicine or not. You will need to keep track of the date when you send the asthma inhaler and replace the medicines at school regularly.
Finally, it is important to talk with the teachers and other school staff frequently to make sure they’re properly managing your child’s asthma at school. It’s important to touch base and make sure everyone is informed and in agreement.
Who Should Manage My Child's Asthma at School?
The more teachers and other adults at school who know about your child's asthma, the better. Your child could have an asthma attack while in art or music class or in the hallway -- and the classroom teacher may not be present. That’s why the following people should be involved in managing your child’s asthma at school:
- Classroom teacher. This is the person who is most likely to be around if your child has an asthma attack at school. The more the classroom teacher knows and the more vigilant he or she is, the better the chance that your child will receive the care your child needs. Sometimes, kids who have difficulty breathing do not perform as well in school, even though they do not have asthma attacks. The classroom teacher should be aware that school performance might be affected by asthma symptoms.
- School nurse. You should talk to the school nurse and get an idea of what the school policies are. If your school shares a school nurse with other schools, make an appointment to see the nurse when she is in the school, and find out who will be in charge when the nurse is not around.
- Other teachers. Talk with the art teacher, music teacher, or any other teacher who regularly spends time with your child.
- Physical education teacher. The PE teacher has a special responsibility. In addition to spending time with your child like other teachers, the PE teacher should keep an extra eye on your child when he/she is exercising, because exercise can trigger exercise-induced asthma. Also, you should make sure that your child is not being left out because he or she has asthma. The PE teacher should encourage your child to participate as long as the asthma is under control.
- Office staff and school principal.
- Counselor. This is an important person to talk to, especially if your child has other problems, such as learning problems or problems dealing with other kids.
- Substitute teachers. You should try to talk to substitute teachers yourself and make sure the regular teacher knows to inform the substitute about your child's asthma. This is where your child's asthma action plan -- a written set of instructions -- from you is particularly valuable.
- Bus driver. Talk to your child's bus driver and let him or her know about your child’s asthma. Be sure the bus driver receives a copy of your child’s asthma action plan.
What Emergency Instructions Are Important When Managing My Child's Asthma at School?
You should give the school officials your child’s updated asthma action plan. You may also give the teacher a peak flow meter, if possible. The asthma action plan should have a clear set of instructions of what to do if there’s a low peak flow reading or the child is having asthma symptoms that cannot be stopped with an asthma inhaler. The school should have a clear idea of when to call your doctor and when to call 911. You should make sure that your child’s asthma action plan that you hand out to all school officials has your doctor's phone number, your preferred hospital (emergency room), as well as contact numbers for you, other guardians for the child, and a trusted friend.
When Should I Send Medications for My Child's Asthma at School?
Physicians and others authorized to prescribe medications, working together with parents and school nurses, should consider the list of factors below in determining when to entrust and encourage a student with diagnosed asthma and/or anaphylaxis to carry and self-administer prescribed emergency medications at school.
Most students can better manage their asthma symptoms if they carry and self-administer their asthma inhalers and other lifesaving medications at school. Each student should have a personal asthma action plan on file at school that addresses relevant issues such as carrying and self-administering emergency medications. If carrying medications is not usually done at your child’s school, then your child’s asthma action plan should include action steps for developing the necessary skills or behaviors that would lead to this goal. All schools need to abide by state laws and policies related to permitting students to carry and self-administer asthma inhalers and epinephrine auto-injectors. Epinephrine auto-injectors should be used without hesitation, even if the symptoms do not appear to be allergy related. The injection won't harm your child, but hesitating could lead to anaphylaxis and be fatal.
You and the physician who prescribes your child’s medications should assess and discuss if your child should possibly carry and self-administer lifesaving medications. Health care providers should communicate their recommendation to the parent or guardian and the school and maintain communication with the school -- especially the school nurse -- through notes, letters, forms or verbal communication.
Can My Child Self-Administer Asthma Inhalers at School?
You might wonder if your child is mature enough to carry and self-administer asthma inhalers and other lifesaving medication at school. Consider the following questions:
- Does your child wish to carry and self-administer asthma medications?
- Does your doctor believe the child to be an appropriate age, maturity, or developmental level?
- Does your child have the ability to identify signs and symptoms of asthma and/or anaphylaxis?
- Does he or she have knowledge of proper medication use in response to signs/symptoms?
- Does the child have the ability to use correct technique in administering medication?
- Does the child have knowledge about medication side effects and what to report?
- Is the child willing to comply with school's rules about use of medicine at school?
- Can the child be trusted to keep the asthma inhaler and/or auto-injectable epinephrine with him/her at all times?
- Will the child notify a responsible adult (e.g., teacher, nurse, coach, playground assistant) during the day when a bronchodilator inhaler is used and immediately when auto-injectable epinephrine is used?
- Will the child promise not to share medication with other students or leave the medicine unattended?
- Will the child not use bronchodilator asthma inhalers or auto-injectable epinephrine for any other use than what is intended?
- Has your child shown responsibility in the past by carrying and self-administering medicine while attending a previous school or during an after-school program?
- Does your child know to notify an adult immediately after administering a medication?
Although past asthma history is not a sure predictor of future asthma episodes, those children with a history of asthma symptoms and episodes might benefit the most from carrying and self-administering emergency or rescue medications at school. It may be useful to consider the following:
- Frequency and location of past sudden asthma attacks
- Presence of triggers at your child’s school
- Frequency of past hospitalizations or emergency department visits due to your child’s asthma
Check with your school officials and ask about the policy in your school district. The goal is for all students to eventually carry and self-administer their medications. Working with your child, his or her doctor, and the teacher and other school officials, you can come to a safe resolution for confidently managing your child’s asthma at school.