For some kids, having the right school supplies doesn’t just give them an advantage in the classroom. It can mean the difference between life and death.
Thousands of children in private and public schools across the country have such severe asthma that they often require puffs from an inhaler, a small canister of medicine, to quickly open their airways. Otherwise, they simply don’t get enough air and can suffocate to death.
Many of those same children also have severe allergies to food, latex or certain insect stings that can cause serious or even fatal reactions. Some children can develop a reaction simply by smelling or touching a substance to which they are allergic. Children with these allergies need an immediate injection of a drug called epinephrine or they risk anaphylaxis, a condition in which the body’s systems begin to shut down and can often result in death.
But schools are not always well prepared for dealing with allergy or asthma emergencies. Concerned about illegal substances, many schools have “zero tolerance” drug control policies, requiring all medications to be kept in the nurse’s office or, if there is no nurse, with a senior official of the school. And though some children can safely wait minutes to hours before getting epinephrine or a puff from an asthma inhaler, others can die within minutes if they don’t get their medication.
The situation has experts and parents concerned that the nearly 5 million U.S. students with asthma could find it hard to get their medication inhalers at school.
“We’re seeing situations in which an asthmatic child’s inhaler is locked up in a drawer in the school office — and the key to that drawer is with the vice principal who isn’t even in the building that day,” says Dr. Michael Welch, a member of the American Academy of Pediatrics’ section on Allergy and Immunology.
Asthma on the rise
The problem appears to be growing. Several studies indicate that since 1984, asthma has increased among school children by 80 percent and among preschool children by 160 percent, according to the AAP. Deaths among children with asthma have almost tripled in the last 15 years.
And having asthma increases the likelihood that a child with a food allergy will have a severe reaction, says Dr. John W. Yunginger, a consultant in pediatric allergy at the Mayo Clinic in Rochester, Minn. Statistics show that 6 percent of school-aged children have food allergies. One in 5 food-allergic children will have a reaction while in school, according to the American Academy of Allergies, Asthma and Immunology (AAAAI).
There is no single policy on the use of medication at school because each state sets its own medication rules, and local school districts adapt these rules as they best see fit. The school district in Prince Georges County, Md., for example, has intricate plans that allow children with authorization from a doctor to use an inhaler on their own once they demonstrate to a school nurse that they are able to do so. The district also teaches teachers and bus drivers how to administer epinephrine.
But other schools are more stringent. “One school, claiming they were educators not doctors, even said that they would not administer the medication, but instead call 911 or call the parent to come to school,” says Anne Munoz-Furlong, founder of the Food Allergy Network, an advocacy and information group for people with serious allergies. ”[That] could have disastrous consequences.”
Call for reform
Many are calling for reform. “Under civil rights law, children with allergies cannot be discriminated against and must be accommodated during the school day,” says Ellie Goldberg, an education rights specialist in Newton, Mass. Goldberg says the law means that each child must be dealt with on a case-by-case basis. “If a child’s classroom is next door to the nurse’s office and she’s there at all times to administer the drug, then it’s fine to keep the drug there,” says Goldberg. “But if your child doesn’t have immediate access to the nurse, you need a plan that will specifically accommodate your child.”
Meanwhile, fewer schools than ever have full-time nurses. Janet Williams, a spokeswoman for the Chicago chapter of the American Lung Association, says budget cuts have forced many school districts to share nurses among several schools, which means that the nurse may only be in your child’s school building a few days a month.
The AAAAI policy on school administration of epinephrine calls for older, responsible children to carry the epinephrine on them and to train teachers and others to administer the drug if students becomes so ill that they aren’t able to do so. Teachers and other supervisors of younger children would keep the drug and pass it along to a trained adult each time a child changes locations during the day.
But that policy can’t work if school districts require the drug to be kept in a locked office.
Use of asthma inhalers is a little more complicated. Dr. David Tinkelman of the AAP says that in the majority of cases, school administrators will make an exception to their no-drug policy if the child has a letter from a doctor. But not all doctors agree that children, especially kids younger than 10 years old, should have complete control over use of their inhalers. And children who are using their inhalers frequently, may actually need other, daily drugs to better control their asthma.
Administering the epinephrine is actually quite simple. While pharmacies still sell kits that have the drug in syringes, about 97 percent of the epinephrine sold these days is in a spring-loaded device called an EpiPen.
The EpiPen looks like a big magic marker. It’s used by pulling off the top and pressing it against a thigh. The device will inject the drug, even through thick jeans. Dr. Matthew Simon, co-chair of the AAAAI’s committee on anaphylaxis, says the EpiPen is the preferred device because it is not as scary to children, parents or school officials as a syringe.
EpiPens, which are only available by prescription, cost about $30 to $50 each and will often be covered by insurance. Children who must carry an EpiPen must also have an action plan, signed by their doctor, that instructs personnel what to do in case of a reaction.
Erring on the side of caution
Epinephrine may cause the heart to race a bit faster but there are no known serious side effects, even if it turns out that the drug wasn’t necessary. When in doubt, opt for the medication, says Dr. Scott Sicherer, an assistant professor of pediatrics at Mount Sinai School of Medicine and the Jaffe Food Allergy Institute in New York City: Erring on the side of giving the epinephrine is better than not giving it.
In many cases, the epinephrine fully prevents or reverses an anaphylactic reaction, though a child must still be observed by a physician to make sure a second reaction doesn’t occur. And speed is of the essence — which is why having epinephrine at school is so crucial.
Despite care by parents and teachers to keep allergic children away from foods that can cause a reaction, accidents happen. FAN notes a case of a child with a peanut allergy who died at home after using a knife that had previously been used for peanut butter. The knife had been wiped clean, but not washed. And a child at school who didn’t even have a prescription for epinephrine because she knew to stay away from anything with nuts, died of an allergic reaction to candy, that, unknown to the child, did contain nuts.
Both FAN and the Allergy and Asthma Network/Mothers of Asthmatics recommend that even if a child with severe food allergies does know what items to stay away from, parents still sit down each year with their doctor to devise an emergency plan.
Munoz-Furlong urges parents to ask school officials to take all reactions seriously. One child went to the school nurse three times in a single day after eating candy that may have contained nuts. On the third visit, an ambulance was finally called, but the child died waiting for it to arrive. Allergic reactions can include stomachaches, vomiting, itchy eyes and mouth, difficulty breathing, nausea and other symptoms.
Some, though not all parents have found schools quite willing to work with them to make the school environment as safe for their child as possible. Rachel Butler, editor of Asthma Magazine whose son, Alistair, has severe peanut allergy, worked with her son’s public school in Hingham, Mass., to make sure that there are EpiPens in the nurse’s office, in the classroom and in a lunchbox that goes with her son’s teacher on field trips and to the playground. Alistair also carries an EpiPen in his backpack, and school bus drivers have agreed in their contracts to administer the drug in an emergency, “though initially they considered going on strike over the issue,” Butler says.
While parents, of course, don’t like to resort to legal means to get the care they need for their child, education rights expert Ellie Goldberg says that “schools are zero-reject institutions” and you have the right to demand that your child get the assistance he or she needs.
Fran Kritz is a freelance health-care writer. She has been a staff reporter for Forbes and U.S. News & World Report, and has contributed articles to many national publications including The Washington Post, Newsweek, Self and Good Housekeeping.