So your kid has asthma, and they go to school. Here’s what the school nurse needs you to know about that:
1. I need you to understand what asthma is and isn’t. Asthma is not a cough or a cold. Asthma is not being out of breath from physical activity. Asthma is a big deal.
Asthma is an inflammation and swelling of the small tubes within the lungs that help a person exchange oxygen into their blood. Without good oxygen exchange, our brains and bodies can not function very well. It can be very serious, even deadly, if not managed.
Asthma is caused by a few things:
- Genetics: a lot of the time if a mom or dad or blood-related family member has asthma it can be passed on to kids. You can’t stop it from happening but you can manage it. Some kids grow out of it as they get older, some do not.
- Environment: Living in a city with lots of smog and bad air quality (such as our lovely City of Brotherly Love) can have a harmful effect on breathing and lead to asthma. Very cold weather or very hot weather can also cause asthma flares or attacks.
- Bad respiratory viruses in kids: Kids and babies who get RSV or other serious respiratory viruses can often develop asthma. It’s not a guarantee but it happens.
- Allergies: Asthma is very similar to an allergic reaction. Many allergens can cause an asthma flare. The same chemical that our body makes that makes you itchy or get hives with an allergy (called Histamine) also can cause a person with asthma to have their lungs tighten and cause an asthma attack. Some people have allergy-induced asthma meaning that when they are exposed to a “trigger” such as pollen or animal hair, they have an asthma attack.
- Smoking: I could include smoking under environment or allergy topics but I wanted to single it out. A child who is exposed to second or third-hand smoke (cigarettes, weed, or even fireplaces) will continue to have asthma symptoms and have a very hard time improving. If you are a smoker and your kids have asthma – please consider quitting as soon as possible.
2. I need you to understand how to deal with your kid and their asthma both at home and at school.
- Take them to the doctor. They need to be evaluated regularly to make sure they are doing ok and have all the right medications even if you think they seem fine.
- Get all the medications they are prescribed. The doctor prescribes the medications for a reason and that’s because they think it’s the best thing to help your child. I know that prescriptions can be expensive but there are ways to get them. If you need help, ask your doctor or school nurse about applying for assistance or finding low-cost options for paying for medical care.
- Tell your child’s school nurse! I have encountered quite a few students who apparently have asthma but I never received a health form, medication form, or any information indication that they have a health issue. If your kid has an asthma attack at school and I didn’t know they had asthma, it’s kind of a big deal. Send in the forms! And please please please do NOT stick an inhaler in your kids pocket or backpack and not tell the nurse or the teacher or both! More than once I’ve had a kid show up with an inhaler that wasn’t theirs or they didn’t know how to use correctly or they thought it would be a good idea to share with their friends and this is dangerous! Any medicine at school must be monitored by an adult and go through all the proper procedures for your child’s safety.
- Communicate: If your child is sick with a cold and needs extra support, tell the nurse (and the teacher). If they are having a flare and need their inhaler regularly until they are better, tell the nurse and teacher. If they just need their inhaler before gym class or recess, let the nurse and teacher know. Help us help you – we know nothing if we aren’t told.
- Provide a rescue inhaler (Albuterol, Ventolin) to the school nurse. In my district, we do not provide medication such as rescue inhalers, it is the parent’s responsibility to bring the medication to school along with the signed, filled out order forms.
- Listen to your kid. When they say that they feel like their chest is tight, that they feel like they can’t breathe, you hear them wheezing (a whistling sound when they breathe), they are coughing a lot, or even vomiting sometimes – take them seriously.
- Clean: This might seem obvious but having lots of dust or mold or pet hair around can trigger asthma or make a kid keep having flares. Try to keep dust and mold away. Try to keep things like carpets at a minimum (they gather a lot of dust).
- Eliminate things in the air: things like fragrances, scented candles, essential oil diffusers, or smoke are irritants and can make asthma worse.
3. I need you to know what asthma looks like and feels like. It can be very mild or become severe quickly. Take a drinking straw (oh wait, I’m not supposed to promote straws… find a paper straw!) and try breathing through it. See how hard it is? that’s how a person with asthma feels during an attack.
- Hard to breathe: When your kid looks like they are breathing fast, shallow, or tells you it’s hard to breathe.
- Wheezing: That whistling kind of noise that someone makes when they breathe in or out.
- Coughing: a dry constant cough, not so much congested.
- Eczema: not everyone with asthma has eczema and not everyone with eczema has asthma but they do often go hand in hand. Both are chronic inflammatory issues often caused by the same things. Some kids who get an eczema flare may also have more trouble with their asthma too.
- Retractions or nasal flaring: This is a sign that the child is having trouble sucking in air. You will see them flaring their nostrils, possibly the area at the base of their neck sucking in as they breathe, sometimes they have the area around the bottom of their ribs sucking in as well. This is a big deal – call the doctor right away!
- Vomiting: sometimes kids with asthma start vomiting as a sign of an attack. Look for other symptoms if your asthma kid is throwing up.
- Leaning over or “tri podding”, pursed-lip breathing: sometimes we instinctively put ourselves in positions to help us breathe when it seems hard. When you see your asthma kid leaning over or blowing through their lips like they are whistling, they are likely having a hard time breathing and should be addressed.
- Panicking: A person who has asthma and is having an asthma attack may start to panic when they can’t breathe. The lack of oxygen plus the fear of not being able to breathe causes this. Help that person stay calm while you get their medicine. Have them sit upright, focus on you and concentrate on breathing slowly and deeply (they may be limited on “deep” breathing but the focus and the slow breaths help).
- Blue lips, blue skin: Call 911 and get albuterol right away. If someone is blue that means they aren’t getting oxygen. This is a major emergency.
- Not waking up or very drowsy/passing out: Call 911 and get albuterol right away! This also means this person is not getting enough or any oxygen and needs emergency help right away.
4. I need you to know what the medications are and what they are used for. Rescue inhalers are not the same as daily maintenance inhalers. There are also various pills and nebulizers that can be prescribed. It’s really important to know what they are and how to use them. I’m not listing every medication but these are some of the ones you will see more often for kids.
- Albuterol inhaler (also known as Ventolin or Proventil, ProAir, Xopenex): this is a fast-acting rescue inhaler. When your child is having an asthma attack this should be the first thing you go for. The purpose of Albuterol is to quickly open up the tubes in the lungs so more air can pass through. Generally, they are used every 4 hours but during an asthma flare, your doctor may give you other instructions for using it. Your school nurse needs to have this inhaler at school for your child in case of an emergency.
- Flovent, Advair, Pulmicort, Qvar: These are inhaled steroids and combination medicines. These are used as daily maintenance medications or maintenance during a flare. These do not relieve coughs or sudden onset symptoms like a rescue inhaler. These are usually kept at home and used once or twice a day as prescribed by a doctor.
- Singulair: It’s an allergy medicine but it helps with those inflamed, swollen lungs. remember when I was talking about the Histamine causing allergies which can make asthma worse? Singulair helps stop that Histamine from making asthma bad. It’s a tiny pill you take once a day. Not all doctors prescribe this but some do, it depends on what is causing your child’s asthma.
- Prednisone: A steroid medicine that helps when someone is in an asthma flare. Steroids help take away the swelling and inflammation in the lungs. Prednisone is usually given as a pill or liquid medicine, prescribed by a doctor for a short period of time during a bad flare-up. Be aware – Prednisone can make kids super crazy! Understand that they may have bad behavior and lots of energy when they are on this.
- Nebulizer Machine: This is just a different way to give some of the medicines like Albuterol or Inhaled steroids. The nebulizer uses little capsules of the same medicines but you use a mask or mouthpiece to breathe in the cool medicated steam for 10-15 minutes or so. Personally, I like nebulizer machines better because I feel like they work better but the inhalers are quicker and easier to carry around for emergencies. You can bring this to school if you wanted to but you would have to follow the same rules as inhalers – provide the machine and all its parts, and the medicine, and the doctor’s form ordering it.
5. I need you to know what happens at school when your kid has asthma. It’s not universal, different schools and districts have different policies on medications and health care management.
- Your job as the parent: you will provide the health forms and medication orders along with the medication that is needed at school. You will let the nurse know about any changes or needs for your child.
- My job as the school nurse: If your child is scheduled to use their inhaler before gym or recess I will give it at the correct time.
- If your child comes to me and says they feel like they are having chest tightness or cough, or other asthma symptoms I will evaluate them. If they are wheezing or exhibiting signs of distress I will give them their inhaler and probably call you. If they are not wheezing and don’t appear to be in distress I will take non-medicine measures first like having them sit down and rest, drink water, and deep breathe. If they don’t feel better then we will try the inhaler.
- If I do not have an inhaler for them and they need it then I will call home and request that a parent bring their inhaler or pick them up and take them to the doctor or hospital (depending on how much distress the child is in). If I am unable to contact a parent or family member and the child is having an asthmatic emergency I will call 911 and your child will be transported to the nearest emergency room for treatment.
Know what asthma looks like in your kid. Know what the meds are for and when to use them. Understand that asthma is a very serious issue that can lead to death if not managed well. Communicate with your child’s school nurse and teacher about their asthma and provide the appropriate medicine and paperwork required by your child’s school in order to best care for your child.