As increasing numbers of children are taking medicine while at school, parents should be aware of school policies and be sure that they provide both permission and instructions. Good communication between parents, physicians and schools is key. With a new policy statement from the American Academy of Pediatrics, pediatrician and “Today” contributor Dr. Mark Widome offers some helpful advice.
Increasingly, medicines are making it possible for children with a variety of acute and chronic health conditions to participate more normally in daily activities including regular school attendance. Examples include oral antibiotics and antihistamines, medicines for infection and allergy, as well as inhaled medicines and insulin for asthma and diabetes. Often, these medicines can be prescribed outside of school hours to avoid having to arrange for medicine administration during the school day. But frequently that is not possible or practical. This week, the American Academy of Pediatrics has issued an updated policy statement providing guidance to schools on developing policies for administering both prescription and over-the-counter medicines to students at school. The statement outlines the benefits and risks of children taking medicine during the school day and some of the safeguards that can be put into place to assure that students receive maximal benefits and minimal risk.
Schools generally have written policies regarding administering medicines at school. These policies should cover both the use of prescription and non-prescription medicines as well as short-term use of medicine and medicines that children may need to take on a regular basis for chronic conditions. All parents should be aware of the specific policies at their children’s schools. If those policies are not spelled out for parents at the beginning of the school year, parents should ask.
Here are some important principles parents should keep in mind when considering the need for their children to take medicine at school:
WHEREVER POSSIBLE, ADMINISTER MEDICINE BEFORE OR AFTER SCHOOL, INSTEAD OF DURING SCHOOL
Too often, parents are under the mistaken impression that medicines prescribed for common conditions require a dose during school hours. Antibiotics for ear infections and strep throat can usually be given twice a day. When three-times-a-day dosing is recommended, these doses can be given before school, after school, and at bedtime.
Newer formulations of medicine for management of attention deficit disorder are long acting, usually requiring only a single dose in the morning. While these formulations may be more expensive, they avoid the need to take medicine to school, for the child to have his school day interrupted for a noon-time visit to the nurse, and for the child’s confidentiality to be breached.
Newer antihistamines for children with allergies are not only less sedating, but longer acting, allowing once- or twice-a-day dosing.
FOR SOME MEDICINES — AND SOME STUDENTS — IT MAKES SENSE TO ALLOW THE CHILD TO CARRY AND SELF-ADMINISTER THE MEDICINE
Asthma “rescue” inhalers are perhaps the best example of a medicine that many responsible children could and should carry and self-administer. Albuterol is the most common medicine for this purpose. With the permission of the child’s physician, the parent, and the school, children can usually self-administer this inhaled medicine as needed, before exercise or if they are developing asthma symptoms. Likewise, children with diabetes, requiring doses of insulin during the school day can self administer their injections according to a plan approved by the child’s physician or diabetes nurse, and by the school and the school nurse.
ALL PRESCRIPTION MEDICINES TO BE TAKEN IN SCHOOL SHOULD BE ACCOMPANIED BY A DOCTOR’S PRESCRIPTION AND INSTRUCTIONS
They should be properly packaged and labeled. This is a standard requirement of schools and is important for student safety. Most school districts have a standard form for the child’s physician to complete if a child is to take a prescription medicine at school. The form also documents the parent’s permission for the medicine to be administered by the school nurse. Parents should provide such medicines to the school in containers labeled by the pharmacist. When necessary, parents should request that the pharmacist fill the prescription in two separate bottles: one for home and one for school.
POLICIES ABOUT OVER-THE-COUNTER MEDICINES VARY
Parents need to know the policies for non-prescription medicines at their child’s school. For common medicines that may be needed only occasionally — but urgently — by students, there are often standing school policies approved by the school’s medical advisor. Many schools send forms home to parents at the beginning of the school year asking for parents’ permission to give their child medicines such as Tylenol or Benadryl for pain or allergic reactions, at the discretion of the school nurse, as needed. In some instances, these permissions require the physicians to specify a dose. In other instances, the school simply uses standard doses based on the child’s age and weight.
At some schools, children are allowed to bring a one-day supply of an over-the-counter medicine, along with a permission note, to self-treat minor symptoms and minor illnesses. At other schools, bringing a medicine to school is against the rules. In all schools, sharing of one’s medicine with classmates is against the rules, and parents and children should understand this so the child does not get in trouble — and so classmates are not harmed.
CERTAIN EMERGENCY MEDICINES REQUIRE SPECIAL PROVISIONS
Children with a history of severe food or insect sting allergy may need an emergency injection of epinephrine if they are having a reaction at school. If your child’s physician has recommended a self-injecting EpiPen for severe allergic reactions, make sure that the device is kept at school where it is immediately accessible to the child in the classroom, at recess, or during field trips. Teachers may need to be trained in how and when to administer emergency epinephrine. In some schools, teachers keep an EpiPen in the classroom. The school nurse is responsible for instructing teachers in the proper use of epinephrine should it be needed urgently when the school nurse might be unavailable.
SAFE ADMINISTRATION OF MEDICINE AT SCHOOL DEPENDS ON GOOD COMMUNICATION
Surveys have shown that medication errors are common at school. Most commonly, doses of medicine are forgotten or given late. Less commonly, the wrong dose is given, the wrong medicine is given, or medicine can even be given to the wrong student. Parents should talk to the school nurse about any medicine that must be taken regularly at school, reviewing the dosage, the reason for the medicine, the time of administration, possible side effects, whether refrigeration is necessary, and the duration that the medicine will be needed. This is in addition to a note or prescription from the child’s physician.
Children should also be familiar with medicine that they are supposed to get at school. They should know the name of the medicine, what the medicine looks like, and when they are supposed to get it. They should be encouraged to speak up if they have questions.
OTHER RECOMMENDATIONS FROM THE AMERICAN ACADEMY OF PEDIATRICS:
Medicines should be given at school in a way that protects children’s privacy and confidentiality.
Schools need to have policies (and parents need to know) about how medicines will be given on field trips and other out-of-school activities. In the absence of the school nurse, the person giving a child any medicine must be educated about how to give the medicine and contraindication to giving the medicine.
Medicines shared with classmates should be immediately confiscated, and the school should remove the child’s privilege to carry and self-administer medicine.
Any medicine taken on a regular basis, even non-prescription medicines and herbal medicines should require a doctor’s note or prescription to the school. Some herbal medicines can have serious side-effects.
Schools should keep good records of medicines and other therapies that children receive at school. Any errors should be documented and reviewed so that preventive measures can be taken.
Mark Widome is professor of pediatrics at the Penn State Children’s Hospital and a regular contributor to the TODAY show. His latest book, “Ask Dr. Mark: Answers for Parents,” is published by the National Safety Council.