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Why Is It So Hard To Be A New Nurse Among Experienced Nurses?

We’ve all heard that little expression “nurses eat their young” and give a little giggle because #newnurses, right? They are often young, inexperienced in nursing, inexperienced in life and in need of guidance by more experienced folks like ourselves.

I’ve seen and experienced this type of bullying among nurses throughout my career in healthcare and it really burns me up. It’s not even always “older” nurses or more experienced nurses but other nurses in general who feel like they have something to prove to whoever else they can try to bully into a false “respect”. In my experience it has also been my peers who were at exactly the same level of education and experience as myself attacking because they thought they could.

I’ve been on both sides of this. I have seen both how it feels to be irritated by some 20 year old hot shot who thinks they know everything right out of the gate, and how it feels to be the noob getting bossed around by everyone who thinks they know better.

I’ve seen fresh out of the boards noobs walk onto the unit and declare “I’m bored” or even better “I have my master’s degree and I’m better than you” before they even got a chance to see or do anything. Put. Your. Time. In.

I’ve been on the receiving end of older nurses saying to my face “You can’t tell me anything because I’ve been at this for longer than you and you don’t know anything!” I’ve been a fairly inexperienced team lead where the others just roll their eyes and do whatever they want because they can, not giving me the chance to prove myself.

What frustrates me the most about this whole topic is not so much “older” nurses bullying newer nurses, but the concept that some of the more experienced nurses just assume that someone new to them is also new to everything. Just because I’m new to your unit or to this particular job does not mean I am totally clueless. Just because I look younger than I am does not mean that I am young and stupid.

I’ve started on a new unit and had nurses with experience on that unit speak to me like I was a child and try to explain things to me like how to spike a bag, or how to manage a stretcher (FYI, once upon a time, I was a stretcher pushing PROFESSIONAL), or how to do an EKG (again, EKG pro here! I can’t read them that well admittedly, but I can perform one with the best of them!). I had them be shocked and amazed that I can pop in an IV like it wasn’t that hard – Bruh. I was an ER nurse. That’s what we do. Why all the shock that the newbie knows how to do her job?

Now I’m not saying that we shouldn’t all be open to listening and learning because that is one of the most important things about being a nurse – learning! Everyone from the nurse of 35 years to the nurse who is still studying for their boards should be open to learning new information, procedures, evidence based research, and best practice for patient care.

We should be listening to each other and giving a mutual earned respect for each other’s education and background. New or old, we all have a unique life experience that shapes what we know and what we do. A new nurse might be more up to date on current policies and procedures which an older nurse may not be aware of because “we always did it that way”. An older nurse should be listened to because she’s done the things, put the time in, and learned what works and what doesn’t.

Currently I’m working as a school nurse, as you all know. I’m fairly new to this particular area of nursing but certainly not new to being a nurse, dealing with kids, dealing with adults and parents, or understanding pediatrics in general. We weren’t given an extraordinary amount of training for this specific job compared to the many months of intense orientation on the critical care units in the hospital that I’m used to. We (the almost 300 nurses in the network) kind of rely on each other to understand our specific policies. It doesn’t mean I don’t know how to be a nurse, it just means I don’t always know the very specific details of some policies just yet.

My message for the new nurses, younger nurses, or new-to-this-unit nurses is this: listen to the ones with experience. Be open to learning always. No matter how many years of experience you get under your belt, there’s always something new to learn. Be teachable. Don’t walk into any unit and assume you know everything and can take charge. Go ahead and get your master’s degree but understand that it’s a piece of paper and classes you took, not real life experience. Get. The. Experience.

My message to the experienced and older nurses: Don’t assume the new people are young, dumb, and annoying. Don’t be offended when a newer nurse tells you something you didn’t know. Give constructive criticism without tearing the other person down. Be a teacher. Be a supporter. Be an encouragement. Don’t be a jerk.

Environmental Health and Your School: What You Need to Worry About (and What You Don’t). Part 1: Asbestos

We’ve all seen on the news lately about Philadelphia schools closing left and right over damaged asbestos and other possible toxins being found in the old buildings. There is a lot to be concerned about with this issue, but there are also some misconceptions. What are we to do if we are concerned about environmental toxin exposure in our buildings?

The biggest things we need to be worried about in the buildings we spend our time in is the DAMAGED asbestos, flaking lead paint, mold growth that isn’t easily visible, and mouse/rat/vermin infestations. I’ll get into why we do and why we don’t need to worry about this stuff!

I’ll get right into the big one that we are all worried about right now: ASBESTOS! Asbestos is a naturally occurring fibrous mineral found in some rocks that was discovered to have fabulous properties of being impervious to fire, damage or destruction. Asbestos is basically very tiny fibers that are not really able to be seen with the naked eye but when combined with other materials it was very useful. After its discovery it was used in lots of construction materials because it seemed like a really great find. They put it in literally everything from building insulation, roof tiles, floor tiles, wallboard, cement, even some types of heating unit parts (since it’s fireproof, it’s great on a heater because it won’t burn up). Asbestos is currently banned in over 60 countries but currently still a legal and used material in America. According to Dr. Frank from Drexel University’s Environmental and Occupational Health, after 1986 all schools are required by law to be inspected twice a year for loose or damaged asbestos and the reports for each school be made available to the public.

Why is asbestos such a big deal then if it’s so great? Well, it has two properties that make it awesome and also terrible: it’s indestructible and it’s made of almost invisible fibers. When you have loose fibers that are not contained in some other material and they make their way into your lungs those fibers are stuck there. Since the fibers are virtually indestructible and practically invisible they aren’t going to go away. As long as those fibers are stuck there they are blocking your air exchange from working like it should and they are causing your lungs to develop scars which further damages your ability to breathe effectively. Aside from permanent irreparable lung damage, the stuck fibers will can also cause lung cancer or a cancer called Mesothelioma, and other cancers like ovary or throat and mouth cancers. This. Is. A. Big. Deal.

If construction is being done or the suspicion of damaged asbestos is present then a professional will need to inspect and abate the asbestos correctly. The inspectors will visually assess the areas in question and determine what needs further testing and what material if any is visually identified as asbestos. The professional inspectors will take material samples and air samples collected in a filter system and examine it under a microscope to determine the presence of asbestos. They compare the findings to a scale of “safe” levels (because there are safe levels??) and then make a plan for abatement (removal) of said asbestos.

The removal of the asbestos should be performed by a trained licensed professional. They will follow the set standards by the EPA and OSHA (among others) for safe removal and cleaning. Generally this involves plastic shields to close off the areas, hepa vacuums which capture the fibers in their filters, and proper removal techniques. People who are not wearing respirator masks or are not trained in asbestos management should not be present in the home or building while this procedure is taking place. The air and material samples must be clear before anyone can inhabit the area safely.

If you are spending your time in a room with all intact asbestos walls, floor tiles, roof shingles, etc, then you likely have nothing to worry about. As long as everything is confirmed intact and not falling apart then you’re good. If you are in a place, however, with known asbestos insulation, broken floors, broken walls, or any kind of non-intact asbestos product then you are at risk. It takes a fairly long time of being exposed to the asbestos to actually become sick from it. Not everyone who is exposed will develop asbestos related disease. If you suspect that you or your child are being exposed and seeing any related health issues (chronic respiratory problems, worsening asthma) then you should definitely have an evaluation by a doctor.

If you think you or anyone is being exposed to loose asbestos some symptoms to look for are: constant dry cough even though they aren’t sick with an obvious cold, wheezing, worsening of existing asthma, shortness of breath (aside from a normal cold), and chest pain and/or chest tightness. Some people that have been exposed for a long time – many years – may experience bowel obstruction, weight loss, cancers of lungs and ovaries, or “clubbed” fingernails (the fingernails take a rounded shape and curve over, this is a symptom of chronic respiratory issues, among other things).

If you suspect that you are exposed to asbestos in the school building, the first thing to do is contact the administration in that school (principal, assistant principal). You can also contact the school district and voice your concerns an see what they know about it and what they are doing about it if anything. For my district, you can go on this page to see a lot of information about what is happening in our schools with the current asbestos and other issues:

Let your voice be heard. Be loud and don’t let anyone shut you down if you are worried. This is not an issue to be taken lightly or ignored. We want to keep our children safe and keep our staff safe so we can be the best us we can be!

Some resources to learn more about asbestos can be found here:

In the next post I will give a little info about some of the other environmental toxins we may encounter and how to deal with them.

Your Child is Starting Kindergarten, Here’s What the School Nurse Wants You to Know.

What a milestone you have reached in your child’s life! Starting kindergarten is exciting, scary, sometimes new to parents, always new to the kids. Often it’s a different school, different kids, and always a whole new schedule for them to learn.

As the school nurse I wanted to share a bit of information for parents of new kindergartners in a new school. Some things are specific to my district, some are universal and some are in between.

Medication and Medication Forms: Does your child take medication that would need to be given at school such as asthma inhaler, Epi-pen, ADHD medication that needs to be taken during the day, or insulin and blood sugar related issues? If they do, there is a form that the school district or doctor can provide that gives the school nurse specific orders for your child’s medications. This form must be filled out and signed by the doctor before any medications can be given, NO exceptions in my district. This form is needed every school year, you must have a new updated one for each school year. We also do NOT provide the medications so if you need your child to have it at school YOU must bring it. Be aware that any daily medications that can be given before or after school hours should be given at home by the parent.

Health Information Forms: My district has a one page form that outlines basic emergency health information about your child. It lists things like emergency contact info, their doctor and dentists name and phone numbers, insurance information, any health issues they may have, any assistive devices they may use (such as glasses, hearing aid, walking devices, etc), and very importantly, this form has a spot that gives or denies permission for the school nurse to administer Motrin or Tylenol to your child while at school. This form should be filled out by the parent and returned to the nurse yearly to catch any changes to the child’s health history. Please be sure to include things like medications that are taken at home, and all health issues even if they seem unimportant.

Physical exams: Your child should have a physical exam by the pediatrician within a year of starting school. They should have a physical every year but we need the form filled out prior to entering kindergarten. The physical exam form should be filled out and returned to the nurse any time they have a checkup at the doctor but the requirements are for kindergarten entry, first grade, sixth grade, eleventh grade, and any time they enter a new school. Ask your school nurse for the form you need or ask the pediatrician for their form. If you need assistance with finding a doctor please ask your school nurse.

Dental Exams: Your child should have a dental exam within a year of starting school. Dental exams are required for kindergarten, first grade, third grade, seventh grade, and any time they enter a new school. In my district we have a few mobile dental programs that come to the school and do dental exams and dental work on eligible students but they unfortunately do not see every student in school. If you need assistance with finding a dentist please ask your school nurse.

Immunizations: Your child must be fully up to date with immunizations OR have a written plan from the doctor for receiving the needed immunizations. Currently in my district students are being excluded from school if they do not have the required immunizations after multiple warnings. Please see my previous post about immunizations for more information on what exactly is needed and why. You may choose to be exempt from some or all immunizations for religious, medical or philosophical reasons but you must fill out and sign the exemption form yearly and turn it in to the nurse. If you do choose to exempt your child from immunizations be aware that if there is an outbreak of a vaccinatable disease in your child’s school that your child will not be allowed in school until the outbreak is cleared. No exceptions can be made on this issue.

Extra Clothes: Please provide extra clothes for your child at school. They should have a complete outfit including shirt, pants/shorts/skirt, underwear, socks, and shoes if possible (I know not everyone has extra shoes available to leave at school). The clothing should be replaced if used. Kids of all ages can have different types of accidents including potty accidents, vomiting, spilled food or dirty. Kindergartners especially are susceptible to the potty accidents even if they have been well trained for a while because they are in a new place with new rules and sometimes just don’t make it in time. Some young children are nervous of the school bathrooms or don’t know where to go right away so accidents happen. The nurse or counselor may have spare clothes but it is a very limited supply and they may or may not fit your child.

Emergency Contact Information: Please make sure the school has your correct contact information including correct current phone numbers, email addresses, and other emergency contacts and their phone numbers. If the school has an emergency with your child we need to be able to get a hold of someone. Often adults change phone numbers or employment or even move houses and forget to update the information with the school.

Custody and legal concerns: While the school nurse does not need to know any specific information regarding legal issues or custody arrangements, please let the school know if anything changes with custody or if there are any family members who we should avoid contacting about your child specifically – such as non custodial parents or if you are a foster parent and the child should not be in contact with their biological parents at any point. This information is often subject to changing at times and if a parent is previously listed as a contact person, we won’t know otherwise unless we are informed.

here is a link to all the forms you would need for Philadelphia in case you need them:

Here are Philadelphia city health centers in case you need to find a doctor or dentist:

Here is a great article from Nemours with other information about starting back to school:

If you ever have questions about your child’s health needs, school policies, or you need assistance with getting insurance, doctor recommendations, or any information, don’t be afraid to contact your school nurse or counselor. If we don’t know the answer we can always find out! We are here to help you as best we can.

What’s That Rash?

A question I’m asked frequently at school, “Nurse, what’s this rash from?” is honestly a tough one to answer. There are so many different kind of rashes, some are contagious, some are bug bites, and some are just random “nothing” rashes. I’ll tell you from the start, I have no idea what bug bit you. Unless you saw the bug or captured the bug in action then it’s only a guess. They don’t teach us that in nursing school.

Disclaimer: The school nurse can not diagnose a rash or an illness. They can only be aware of the signs and symptoms of various things and give an assessment. If they suspect a contagious or treatable condition, the child has to see a doctor for diagnosis and treatment.

It is important to have a basic understanding of some different rashes and conditions that are encountered at school so we know when they need to be treated or not.

Bedbug Bites : Bedbug bites look like small, itchy red bumps all over. Sometimes they look like little blisters with fluid inside them. Typically they are small like pimples, not as big as mosquito bites. It helps to know if there are bedbugs where the person has been sleeping/living. There is no treatment to get rid of them but you can treat the symptoms with anti-itch creams (Hydrocortisone) and antihistamine medicine (Benadryl). The most important thing for dealing with bed bug bites is to eliminate the bedbugs from the home which should be done by calling a professional exterminator who manages bedbug infestations. If you are living in a shelter or place you don’t have control over like a hotel then report the issue to management. If bedbugs are seen in a school building then the maintenance staff will see that the exterminator handles the situation.

Bedbug Bites

Ringworm : Ringworm is a fungal skin infection. It usually looks like a reddish circle on the skin with a clear center, or sometimes whitish in the center. It can be itchy. Often you will see just one spot but sometimes there are multiple areas of infection. frequently it is in the hair/scalp but can show up anywhere on the body. It is highly contagious by contact with the rash so it must be treated as soon as it is seen and covered with a bandage if possible. Your child can not come back to school until they have been treated for at least 24 hours. Ringworm is treated with a prescription antifungal cream and sometimes an oral antifungal medicine.

Tinea corporis (ringworm) SOURCE: Basil J. Zitelli, et al (2002). Atlas of Pediatric Physical Diagnosis, 4th Ed. “Ch. 8 Dermatology,” Page 272, Figure 8-33. 2) Thomas B. Fitzpatrick, et al (2001). Color Atlas & Synopsis of Clinical Dermatology, 4th Ed. “Tinea Corporis,” Pg. 696, Figure 21-9.

Scabies : Scabies are little skin mites that burrow under your skin. The bites usually look like small blister-like pimples in clusters, often with grayish or red lines in between them. They burrow under the skin and travel leaving the lines on the skin (I know, I know, I’m itchy now too!) Scabies is very contagious and needs to be treated by a doctor as soon as possible. Usually the treatment is a prescription lotion that is spread over the entire body and left on for several hours before rinsing it off. It is recommended that anyone who has been in close physical contact with that person should also be treated.


Infection/Abscess : Usually something that is infected will be very red, painful, feel hot in the area where there is infection and likely have drainage (pus). The person sometimes will get a fever or red lines on the skin going away from the area. The infection could be anything from picking at a fingernail or a bug bite that got scratched open, to any cut or wound that gets a bacteria in it. Some infections are contagious such as MRSA (Methicillin Resistant Staph Aureus) but most of the time we just have bacteria everywhere and it gets in a wound. This is why we need to keep wounds clean and avoid infection. These must be seen by a doctor and treated – usually with antibiotics.

Eczema : A very common skin disorder, usually has red/pink itchy scaly patches on the skin. It can be genetic, or associated with some allergies (food, seasonal). It is not contagious. Eczema is usually treated with various creams – over the counter moisturizing creams and sometimes prescription steroid cream or allergy medicine. People who have frequent flare ups may learn what the triggers are for their flare ups and learn to avoid them.


Measles : Usually starts out with a high fever, cough, runny nose and red watery eyes. After a few days the rash appears looking like tons of red spots, some flat and some raised, so many that the spots join together. The rash usually starts in the hairline and face and spreads downward. Measles is extremely contagious and can be very dangerous for some people to be exposed to. In order to attend school all students should be vaccinated against it with two doses of the vaccine.


Chickenpox : Chickenpox usually starts out kind of like the flu – fever, cough, achy, swollen glands, etc. The rash looks like raised fluid filled blisters that are very itchy. They can show up anywhere but most often on the abdomen and back. It is very contagious – so much so that most doctors do NOT want you to come to the office and expose everyone there. Again, in order to attend school students should have two doses of the vaccine or have had chickenpox already so they are immune. There is no treatment but waiting for the virus to pass and treating the symptoms (cream for itchies, Motrin for fevers)


Bug bites: does your kid have random red bumps here and there? Probably itchy? Maybe hurts a little? Otherwise well appearing and feeling? It’s probably a bug bite but who knows what bug it was? Certainly not me! It could be mosquitoes, fleas, or maybe spiders. We can put on some Hydrocortisone and hope for the best.

Scarlet Fever : Scarlet fever gets a bad rap. It is literally strep throat that causes a rash in some people. Scarlet fever rash looks like tiny red dots on the chest, belly and back (but can spread all over) and the rash feels like sand on the skin if you feel it. It is usually accompanied by strep symptoms like sore throat, fever, stomachache, headache, or vomiting. Scarlet fever/strep is treated with antibiotics.

Measles vs Scarlet Fever

There are so many more rashes and conditions I could get into but these are some fairly common ones we encounter in a school population.

Look at your child’s overall condition to decide what to do. Are they feverish? Are they sick appearing? What other symptoms do they have, if any? If in doubt, don’t be afraid to call the doctor and see what they have to say.

This is an article all about rashes from that is really helpful too:

Your Kid Needs Immunizations For School: What You Need to Know.

So your child has started school, or started at a new school. You’ve provided all the information they asked for but the school nurse calls and sends a letter home saying that your kid needs immunizations. *Eye roll*, you thought you were all set but now you have to make a doctors appointment and drag everyone over there to get shots and no one is happy about it.

So whats the deal with this? What shots does your kid need? Why do they need more of them? Why can’t they just go to school with the ones they already have? Why do they even need to have any of them at all?

There is a lot of chatter in recent years about whether or not to vaccinate and what’s wrong (or right) about doing it but the fact is that whether or not you want to vaccinate, if you want your child to attend most schools aside from home-school or cyber school, you’re gonna have to get the important vaccines. There are currently options for exemptions from them which I will get into in a bit, but some of those exemptions are already in question and may not fly for much longer.

So why does your kid need vaccines? The short answer is that vaccines help protect people from getting certain diseases or illnesses. While nothing is 100% effective, they are pretty good at keeping those illnesses away or at least making it so that if you DO get one of them it will be far milder than if you had no vaccines. Another reason is that there are people who can not get immunizations for medical reasons (too young, allergic to the vaccine, has a health problem that the vaccine would make them really sick) so when other people are protected it helps protect those people who can’t be vaccinated.

What do vaccines even do? When you are given a vaccine, they are giving your body either a synthetic (created in a lab) or a weakened live version of the thing they are vaccinating against. Your body finds out that there is an “invader” and goes after that germ to fight it and get rid of it. The great thing about or bodies is that once we have fought off that germ, our blood cells remember it and fight it off very quickly if we ever get exposed again. This is one reason why we sometimes get a little bit sick after getting vaccines – your body is building an immunity so it can fight better later.

So what vaccines does your kid need to go to school? There are CDC and Academy of Pediatrics recommendations that are nationwide, and recommendations that may differ from one district to another for what immunizations your child needs to attend school. The requirements for my district are:

  • DTaP (Diphtheria, Tetanus, Pertussis) : Diphtheria is a potentially fatal disease that affects your throat and swallowing. It can cause damage to your heart and death. It is mostly gone now because of the vaccine. Tetanus is the disease we all know about that you can get from a rusty nail or other dirty cuts. It causes severe and painful contractions of muscles and can cause death. It is also rare because of the vaccine. Pertussis is better known as Whooping Cough which is a very serious respiratory illness. It has made a comeback in recent years and it is recommended that we all get booster shots for this. It is required that kids have 5 DTaP shots – the last one being after their 4th birthday.
  • Polio : Polio is a virus that affects your spinal cord and can cause permanent paralysis or disablement. It can be deadly. It is also pretty rare now because of the vaccine. The requirement is 4 Polio vaccines, the last one after the 4th birthday.
  • Hepatitis B : Hepatitis B is an infection of the liver. It is usually acquired by an infected needle stick, sharing of infected needles, sexual contact, or passed from mother to baby during pregnancy. It can cause permanent damage to your liver and lead to liver failure. It is wise to have the vaccines as infants or children well before potential exposure. It is required to have 3 doses at a specific interval.
  • MMR (Measles, Mumps, Rubella) : Measles is a respiratory virus that causes a rash, fever and potentially can lead to encephalitis (infection in the brain) and pneumonia. It is rare because of the vaccine but still around with recent outbreaks across America. Mumps is a viral infection of the salivary glands in the mouth and neck. It can lead to hearing loss. Rubella, also known as German Measles is similar to Measles. Students are required to have two MMR vaccines – one after the 1st birthday and one after the 4th birthday.
  • Varicella (Chickenpox) : Chickenpox is a respiratory virus that has a very itchy blistery rash all over, fever and cough. While usually thought of as a relatively mild childhood disease that we all had, it can lead to pneumonia, infection and death. Students are required to have 2 vaccines – one after the 1st birthday and one after the 4th birthday.
  • Tdap (Tetanus, Diphtheria, Pertussis) : a booster of the DTaP that is given after the 11th birthday.
  • Meningococcal (MCV4, MenB) : Meningitis is an infection in the brain and spinal cord. It can be deadly. It is highly contagious and spreads easily in places like school, college, camp, home, or prisons where people are in close proximity to each other for extended periods of time. The MCV4 is required at ages 11 and 16. MenB is not required by every district but it is wise to get.
  • Additional immunizations that are not required by most schools but are part of the routine immunization schedule and wise to receive are: Pneumococcal (4 doses), Hib (Haemophilus Influenza, 4 doses), Rotavirus (3 doses before 9 months old), HPV (Human Papillomavirus, 3 doses), and Flu shot (1 dose every year).
  • This is the recommended schedule by the CDC:
  • This explains all the diseases that we should be vaccinated against:

In order to attend school in my district, your child is required to have at least one of all the required vaccines for their age and also a written plan for getting the rest of them. If you do not get the required immunizations or have a schedule planned with the doctor then the district has the right to exclude your child from school until plans have been made or vaccines have been given.

This will link you to the Philadelphia School District web page about immunizations including forms you may need and what is required:

You may choose to defer immunizations for religious or medical reasons. Medical reasons usually consist of an allergy to a vaccine, a person who has a poor immune system and the doctor says it would not be safe to get those vaccines, or the doctor feels that they have had enough to be immune to that disease. Be aware if you do choose this and there is an outbreak of anything your child is not immunized against that they will not be allowed to come to school during that outbreak, even if they are well. There is a specific legal form that must be filled out and presented to the school nurse for exemptions to be allowed.

There is also an option for “philosophical exemption” currently but that may not be permitted soon, and is already not permitted in some states.

There are multiple options for getting the vaccines needed. You can go to your pediatrician for a routine checkup and get them then, or schedule a visit for just the vaccines. Your school nurse can help you find a public health center if you don’t have a pediatrician or if you don’t have insurance. Your school nurse or public health center can also help you with insurance if that is a problem. There are resources available to help those in need.

PCCY will help you with insurance and medical resources and referrals in Philadelphia:

You can find Philadelphia city health clinics here: Greater Philadelphia Health Action is a great resource in Philly for health care needs. They have medical, mental health and pharmacy.

TL/DR: Vaccines are helpful. Your kid needs vaccines for school. Talk to your school nurse for specific information.

Is Your Kid Too Sick to Go to School?

“I’m siiiiick!” says your kid, first thing in the morning when it’s time to get ready for school. Now what? Do you call out of work and keep them home? Do you just send them in and hope for the best? When is your kid too sick to go to school? and why can’t they go to school when they are sick?

Sick kids do not learn well. Sick kids get everyone else sick. In addition to teaching the kids important things like frequent proper handwashing and how to cover their cough, it’s important to know when you should keep them away from everyone else. This list explains some reasons why sick kids should stay home.

  • Fever: If your child feels warm, check their temperature. The current guidelines say that if a child has a temperature of 100.4 or above they should not come to school and must stay out of school until their temperature is normal (below 100) for 24 hours without any fever-reducing medicine (Tylenol, Motrin). If they have a fever and you give medicine to bring it down, they still need to stay home! You can not give them Motrin/Tylenol and send them to school – you’re gonna get a phone call as soon as the fever comes back and have to pick them up anyway.
  • Diarrhea: Diarrhea is technically 3 or more loose bowel movements in a day. Often it is accompanied by stomach cramps, a fever, vomiting, and fatigue. There isn’t much you can do to stop it from happening since you shouldn’t really give kids antidiarrheal medicine, so you just have to wait for it to run its course and treat the side effects. They need rest, fluids to stay hydrated, bland foods (like the BRAT diet – bananas, rice, applesauce, and toast), and the comfort of their own toilet at home. They should stay out of school until they are at least 24 hours without diarrhea.
  • Vomiting: This pretty much speaks for itself. If your child is throwing up they need to stay home. Not only can they not learn very well while they are nauseous and throwing up but they will likely get everyone else sick too. The same information applies for vomiting as diarrhea – they need rest, fluids (sips of Pedialyte or Gatorade), bland foods (like the BRAT diet), and their own bed or couch to lay on until they feel better.
  • Cough: If your child has a cough you have a few things to consider about keeping them home or sending them to school. Why are they coughing? If they have simple seasonal allergies that you are managing then they can come to school (assuming they aren’t having a severe allergy attack with uncontrollable coughing). If they have asthma that is under control but having a bit of a flare then they can come to school and the school nurse can help manage asthma medications at school. If they are having a bad asthma flare that you are having a difficult time controlling then they need to see a doctor (pediatrician, urgent care, or emergency room) and not come to school until they are under control. If they are having cold symptoms including excessive coughing, excessive stuffy/runny nose, fevers, or vomiting from coughing so hard then they should stay home. Not only can they not concentrate on school and learning but they are going to get everyone else sick too.
  • Sore Throat: Sore throats can come from a lot of things. Sometimes it’s a simple scratchy throat from allergies or post-nasal drip (mucus that runs down the back of the throat from the nose) or even lots of yelling but sometimes the sore throat is bad and an indicator of a bigger issue such as Strep Throat. Strep is super contagious. It usually includes a sore throat, swollen red tonsils with difficulty swallowing, spots and white stuff on the tonsils (in the back of the throat) and fever. Sometimes strep also comes with stomachache and vomiting, headache, or a red spotty rash all over that feels rough like sandpaper. Strep rarely has a cough or congestion associated with it but sometimes you can have two things at once and also have a cold with your strep. The child needs to see the doctor and be tested and treated with antibiotics for strep. Your child needs to be treated for at least 24 hours for strep before they can return to school.
  • Rashes: Most rashes are no big deal and your child can probably come to school with no issue. Occasionally they get something that is contagious though. Rashes such as ringworm (a red circle with a clear center, itchy) MUST be treated before returning to school. A rash that looks like chickenpox (clear fluid-filled blisters, super itchy, accompanied by a fever and respiratory symptoms) MUST stay home until the blisters have crusted over and the other symptoms are gone. Scabies looks like small red pimples that often travel in a line on the skin and are itchy. The student must be treated by a doctor before returning to school. MRSA (Methicillin Resistant Staph Aureus) looks like inflamed pimples or abscesses on the skin. It is also very contagious and needs to be addressed by a doctor. I could go on forever about different rashes but that is for a different post.
  • Lice: Again, this one speaks for itself. The current protocol for my district (and I think many others) is that if your child is noted to have lice at school they may stay till the end of the day and then may not return to school until they have been treated and the parents bring proof that the child is treated. If they only have nits (eggs) they may come to school but it is super important to carefully comb through the hair and remove the eggs. See my other post about dealing with lice for more information.
  • Pinkeye: If your child has tons of discharge from their eye (more than normal eye sleepies), the eye is red and super itchy then definitely keep them home and have that looked at by a doctor.
  • An outbreak of vaccinatable disease that your child isn’t vaccinated for: It’s important that all students have a complete schedule of immunizations when attending school but sometimes they don’t for various reasons. If your child does not have full immunizations for something like Measles and there are cases of Measles known at your child’s school then your child will need to stay home until the outbreak is over. This is for their own safety and the safety of others to prevent more spread of the disease.
  • General Illness: You know your kid better than most other people so when your kid acts sick or says they are sick then listen to them and use your judgment if they seem like they would benefit from being home. Sometimes it’s a stomachache or a headache or they didn’t sleep well and you can see that they are in no condition to concentrate in school. While we want everyone to stay on track and have good attendance, we also don’t want them to be sick or unable to learn.

All of this being said, as the parent or guardian of the child/children in question you have to make yourself available to be contacted in the case that the school needs to call you. If your child has a fever at school, begins vomiting or having diarrhea, or anything else is noted, we absolutely must be able to contact you. Make sure the school has correct and current phone numbers, email addresses, and home addresses in case of an emergency. I know not everyone has a great support system, unfortunately, but try to have a backup babysitter just in case your child is sick and you can’t call out of work.

We also need to know about your kid. Get the health forms filled out and turn them in so we know what to expect with your child’s health and how to best care for them. Bring the medication forms and medications needed at school so we can help them in an emergency. Fill out the form that gives us permission to give your child Motrin or Tylenol – or state that you do not want us to, that’s up to you!

When in doubt, don’t be afraid to call your school nurse and ask!

I have included a link to an awesome website from Dupont Hospital that can give you a lot of information.

TL/DR: Keep kids home from school if they are sick. Wash hands and cover coughs. Provide the school with emergency info like contact information and health forms.

To Ice or Not To Ice

To ice or not to ice? This is an issue I face daily as the school nurse. The little ones get bumped and boo-boo’ed and the first thing everyone thinks is “oh dear, you need ice for that pain!”. But when is it appropriate to give ice for an injury and when is it not appropriate?

First of all, why is ice even used? When you get an acute (new) injury, your body is programmed to start an inflammatory response – your blood vessels dilate (get wider) drawing more blood to the site of the injury to try and heal it. This creates redness, heat, swelling, and often pain. Your body may also create a bruise – some of the tiny blood vessels break from the injury and a little blood leaks out under the surface of the skin and creates that bluish/greenish/purplish bruise (ouch!). The purpose of the ice is to help reduce this inflammatory response. Ice will help reduce swelling, reduce the appearance and pain of bruising. Ice can also slow bleeding a bit by helping the blood vessels shrink down again.

Ice is best used when there is an injury such as a twisted ankle (or other areas) that is swelling, a head injury that includes swelling, or any injury that produces swelling, bruising and pain. Pain alone does not mean ice is needed. Ice is also used for overuse injuries (think baseball pitcher, athletes), also for injuries like back and neck strain or tendonitis type issues (issues that most kids don’t have to deal with).

Ice should be used within the first 48 hours of the injury occurring. It should be applied for 15 to 30 minutes, three times a day. Always wrap ice packs in a towel or cloth of some sort to prevent skin injury from the ice.

All of this being said, brings me back to my original question: should we ice or not? In an elementary school setting the short answer is “probably not”. In general, the minor injuries that happen in elementary do not require ice. Bumped elbows on desks, slaps, thrown pencils, thrown food,  trips, and bumps (why does everyone hit their heads on the bathroom door?) do not require an ice pack and a 15-minute time-out. Yes, sometimes an ice pack makes the “big boo-boo” feel better along with the caring and attention from a grown-up and that’s ok and expected with these little ones who are away from their caregivers during the day.

Big injuries that occur less often such as fights involving closed fist punches, fell while running or playing, heads with visible bumps, twisted ankles or knees, or any kind of injury that produces swelling and/or a bruise all warrant an ice pack and a time-out. Injuries that happened at home or last week that “still hurt” do not require ice. The ice will not serve a purpose in that situation.

 More often though, what I encounter is students who are erroneously instructed that “ice will heal the injury no matter what it is”. The students have a pain for whatever reason and they think that ice will solve it. Sometimes the school nurse (or teacher) can see that the student is upset by the pain and perhaps will be able to get on with their day a little better with the application of some ice, but for a lot of these “injuries” children (and adults too, honestly) need to understand that sometimes we have a pain or a discomfort but it does not need to be addressed because it will go away. Many times I have said to the kids after hearing a complaint that they have a bumped body part “yes it hurts, but it will stop hurting” because that’s what our bodies do. They hurt for a short time but then it goes away.

It’s a difficult balance to decide which is more important for the kids: do they need the attention of seeing the nurse and receiving an ice pack or do they need to learn to tolerate discomforts and move on? The majority of the time, the students need to remain in their class and participate in learning. There is nothing wrong with the expectation that they will move on from minor bumps and boo-boos without intervention.

When all else fails, a little “boo-boo cream” (aloe or body lotion or plain water in the fridge labeled “boo-boo away”) might just do the trick!

Your Kid Has Asthma: What the School Nurse Needs You to Know

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.

Your Kid Has Lice

So you’ve received the dreaded phone call from school: your kid has head lice. After you have gotten yourself together and stopped scratching your own head (phantom lice, I totally get it), I can give you some tips and info.

  • Lice are icky, itchy, no fun all around and sometimes expensive to deal with. They do NOT, however, transmit any diseases. 
  • Lice are also NOT an indicator of how clean or dirty a person or their environment is. Lice actually prefer to hang out in clean hair over dirty hair. 
  • Lice are transmitted by direct contact with someone who already has LIVE lice in their hair – this includes touching heads, sharing hats, hairbrushes, hair accessories, and sometimes scarves or pillows. 
  • They are NOT transmitted by flying, hopping, or being in the same room as a person who has them. 
  • Lice can only survive for about 24 hours when not on a human host. That means that once the bugs jump off the person’s head and go on a carpet or a sofa, they won’t live more than a day or so. 
  • A louse can lay 3-5 eggs a day and the eggs take about 7-10 days to hatch. Then they take another 7-10 days to be mature enough to lay their own eggs. It’s a whole cycle. 

So what do we do now that we got the news? There are quite a few things you can do for lice, some are just things to help but are not proven. 

  • The number one thing you’re going to do is get a proven (proven meaning safe, studied, and approved as a “medication” on the market) store-bought lice treatment shampoo. You can go to whatever store is convenient (Walmart, Target, Rite-Aid, wherever) and find Rid, Nix, store brand lice shampoo, or there are a bunch of products on the shelves. The effective shampoos usually contain Permetherin or Pyrethrin (I know, it’s a chemical but it’s kind of necessary). There are a lot of products at the store that have non-chemical ingredients or claim to be “preventative” but they are not proven to work effectively. 
  • Alternatively, if one needed to, you can go to a local health clinic, Emergency Room, or your pediatrician and they can prescribe a prescription shampoo that can be paid for with medical assistance or health insurance (if you have that). 
  • After you’ve treated with the shampoo, the next most important thing to do is to go through and comb out those nits (eggs)! This is a very important step because if you leave the eggs in their hair they will hatch and re-infest the hair so all the treatment will be for nothing. A lot of the lice shampoos come with little metal or plastic lice combs to use. There is a cool product called the Liceguard RobiComb that uses a little bit of electricity to zap the nits and live lice – it’s NOT a proven treatment but it’s kind of cool and doesn’t hurt (you can get that here: You will start at the hairline at the back of the neck, take small sections of hair and carefully comb through removing the eggs with the comb and/or your fingers. Go all the way through the entire head in very small sections. It might take a while but it is the only way!
  • You should re-treat in about a week because the eggs that didn’t get removed will hatch. 
  • It is recommended to examine everyone in the home for the presence of live lice and/or nits and treat if lice are present since people living in close quarters are likely to all have lice together. There is no need to treat someone who does not have any notable lice or nits but it is wise to recheck everyone after about 10 days or so to make sure.

After the people are treated you still have to contend with the house as everyone will just be re-infested if you don’t address the house. 

  • Wash and machine dry all bed sheets and linens from the person with lice that were used within 3 days before treatment. Use the HOT water cycle (130 degrees) for the wash and dry with the high heat setting. 
  • Anything that can’t be washed (stuffed animals, certain clothes, etc) SEAL into a plastic bag for at least 2 weeks so the lice are killed. or have dry cleaned. 
  • Soak combs and brushes in very hot water (130 degrees) for 5-10 minutes OR throw them out and get new. 
  • Vacuum, vacuum, vacuum. Vacuum furniture and carpets daily. The lice will get sucked up into the vacuum and die because they don’t have a person to feed on. 
  • It is not necessary to call in companies that will get rid of the lice for you but you are welcome to if you have the means to do it. 
  • It is not necessary to do fumigation sprays or bug bombs in the house since they are not only toxic to humans and pets but also costly and unnecessary. 
  • you can refer to this page about lice from the CDC for further info as well. 

Many people are interested in alternative solutions to using chemicals on lice, which I totally get! There are a few treatments and ideas that you can try out. I will note that these aren’t scientifically or medically proven to be effective as they have not been studied adequately, but plenty of people have success if done correctly. It is also important to note that using alternative treatments should be done with the knowledge that there are potential side effects such as allergic reaction to products, or introduction of infection due to non-medicinal products being used. It is NOT recommended to use these methods as the only means for treating lice.

  • Mayonaise:  Literally get a jar of mayo – any kind will do. Slather it all over the person’s hair and put on a shower cap. Leave it all night and wash it out in the morning. The mayo is thick and will suffocate the lice. You will still have to comb through with the lice comb to remove all the eggs because the mayo will not get rid of them. 
  • Coconut oil, olive oil, Anise oil, Vaseline (ew!): It’s the same as the mayo. Maybe a bit more expensive though. 
  • Tea Tree Oil: Put drops of tea tree oil on the scalp with a shower cap on and leave it overnight. Wash it out in the morning and comb out all the eggs. There are a lot of products containing tea tree oil that you can use for preventative measures (although not proven medically, many people swear by it!). Be wary though, if you haven’t used Tea Tree oil (or essential oils in general) on the person in question the possibility exists of an allergic reaction or and contact reaction which could be uncomfortable and dangerous. Most essential oils do require a dilution via carrier oil or even water as they can be irritating if used undiluted. Use with caution.
  • Call in the professionals: There are a few companies that will come to your house and do it all for you!  Hair Heroes, Lice Lifters, and Lice Doctors are a few with really good ratings. This can be costly and is not necessary but if you have the means and don’t want to do all of the treatment yourself you can definitely give them a call. 

There are rules in my district regarding the handling of lice at school that come from the Department of Health. You can check with your school nurse on your school’s policy on handling lice. 

  • Because lice do not pose a health hazard, students may remain in school until the end of the day after lice have been noted. The parents will be notified by letter and phonecall (if possible). 
  • The students can not return to school until they have been treated for the lice and the parent brings proof of treatment AND the student checks out as clear by the nurse. Proof of treatment can be the box and the receipt from the purchase. 
  • We no longer check all the students in a class when one student is noted to have lice, nor do we send home letters to every student in the class about it. This not only brings shame and potential bullying to the student who has lice but it also isn’t necessary. 
  • The students are permitted to be in school with eggs in their hair as eggs are not transmittable but the parent should still carefully remove them as soon as possible before they hatch and cause a new infestation. The parent of the student will be notified if eggs are seen. 
  • If you notice lice on your child at home, you should treat them as soon as possible. Please make sure to inform your school nurse and your child’s teacher. 


Lice are not that bad! They may be yucky but they don’t cause any major issues. Treat them with lice shampoo. Alternative treatments may or may not work and have the potential for unwanted effects. Clean in your house for lice in addition to treating the people. Check the whole fam at the same time and treat anyone with lice so it doesn’t keep coming back. COMB OUT THE EGGS!!! Godspeed. 

For school nurse resource please visit for all the best info on all things buggy.

Here is the newest guidance regarding management of head lice, an excellent read!–Cf90dcsd8KYrAAfQWFfse_stOxnGDM

And another great article regarding head lice management:

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