Procedures

• Quick acting glucose source (e.g., BD glucose tablets, unsweetened juice, lifesavers);
• Appropriate follow-up snacks (e.g., digestive/Arrowroot cookies or crackers, cheese or peanut butter); and
• Glucagon emergency kit when appropriate.

Asthma 

WHAT TO DO IF A CHILD HAS AN ASTHMA ATTACK

Step 1 

• Remain calm.
• Remove the child to a quiet area.
• Stay with the child.
• Let the child sit – not lie down.
• Check if the child has his/her reliever inhaler.
• Let the child take their usual treatment.
• Phone the parents.

Step 2 

• Wait 5-10 minutes.
• Do a “symptom check.”

Symptoms Gone 

• Child can return to class.

Symptoms Improved but Not Gone 

• Give reliever inhaler again.

 Reliever Medication Not Working 

• Dial your local emergency number.
• Repeat reliever inhaler as instructed.
• Phone the parents.

Asthma

TREATMENT OF STUDENTS WITH ASTHMA

Information Regarding the Treatment of Students with Asthma 

General Information

Asthma is the most common chronic disease of childhood. As many as 10-15% of children have asthma, and it is the “number one” reason why children are admitted to hospitals.

Asthma is a condition where the lining of the lungs swell and fill with mucus. The airways then go into spasm. This causes breathing problems and distress. The symptoms are reversible but can be life threatening if not promptly and adequately treated. Children with asthma should be able to participate in school activities. However, they may need to take medication prior to exercise activities. Some field trips, cooking, perfume, chemicals or pets in the classroom may cause an asthma attack. Each asthmatic child will have individual needs.[1]

Some key points on asthma: 

• Asthma severity and management issues are individual and can change over time.
• Knowledge of asthma is essential in providing appropriate support to students with asthma.
• Avoidance of triggering factors can reduce asthma episodes and need for medication.
• Asthma clinic personnel and public health nurses can provide information and education of asthma.

Guiding Principles 

1. Asthma is a manageable condition that, if poorly controlled, can be serious and impact the student’s health and ability to learn.
2. All students with asthma will participate to the best of their ability in school activities.
3. A specific plan will be obtained from each parent that outlines the child’s asthma and what to do if symptoms occur.
4. Schools will be aware of and follow through with each student’s specific plan of care.
5. Schools will work to reduce environmental factors and school activities that exacerbate asthma.
6. Immediate and ready access to asthma medication will be arranged.

Responsibilities

Parent Responsibilities

1.  Parent(s) to complete the Emergency Medical Data Sheet for Students with Asthma on a yearly basis or if management changes during the school year.
2. Parent(s) to provide medication and administration devices for the child to use at school.
3. School personnel and parent(s) work together to reduce/avoid triggers of asthma in the school environment.
4. Appropriate medication use is vital to asthma management. Parent(s) needs to be made aware of how much reliever medication is used at school, as increasing can be an indicator of poor control of asthma.

School Responsibilities

1.  Schools to establish an accurate method of identifying students with asthma.
2. Schools offer asthma awareness sessions as necessary.
3. Schools obtain asthma resources and information.
4. Schools establish parent/school communications regarding the student’s asthma and medication use.
5. School personnel know the emergency plan for each child with asthma and follow it.
6. School personnel and parent(s) work together to reduce/avoid triggers of asthma in the school environment.
7. Schools support easy access and use of reliever medication.
8. School personnel follow appropriate medication as per individual emergency data sheet.
9. Schools liaise with health professionals as needed. 

References 

1. Emergency Medical Data Sheet for Students with Asthma (Forms Manual) - attach photo ID of student to this document
2. Asthma Policy for Schools, National Asthma Campaign, United Campaign
3. Suffolk Schools Asthma Policy, United Kingdom
4. Recommendations for an Asthma Friendly School Policy, Alberta Asthma Centre, 2000 Appendix 313B 

Epilepsy 

TREATMENT OF STUDENTS WITH EPILEPSY

Information Regarding the Treatment of Students with Epilepsy 

General Information

Epilepsy is a disorder of the brain. It is a condition in which the normally smooth functioning of the brain’s electrical system is briefly disrupted, causing a seizure. The seizure is like a brief electrical storm in the brain.

The frequency of seizures varies greatly from one individual to another. The brain controls motor movements, thoughts, sensations and emotions. It also regulates the involuntary movements of the heart, lungs, bowels and bladder. Some disruption of any or all of these functions may occur during an epileptic seizure.

There are two types of generalized seizures:

 1.   Convulsive Seizures 

      This type may last from 2-5 minutes. Symptoms include: 

• Muscle stiffening and jerking;
• Some difficulty breathing; and
• Saliva foaming around the mouth.

 2.   Non-convulsive Seizures 

      This type may last from 5-15 seconds. Symptoms include: 

• Brief interruptions in consciousness;
• Staring spells;
• Small muscular facial movements; and
• Confusion.

Medication is sometimes able to reduce the number of seizures or eliminate them entirely. While the child is growing, it may be difficult to find the right level of medication, and it may take time for the child to adjust to medication, particularly during growth spurts.

The School/Teacher Role 

All students with epileptic disorders should have their condition noted on the Student Registration form. 

When a generalized seizure occurs: 

• Protect the child from injury by moving any hard or sharp objects.
• Guide the child’s movements, but do not try to stop or restrict movements.
• Loosen tight clothing.
• When the seizure is over, gently turn the child to his/her side with face turned slightly downward. This will keep the child from choking on vomit or saliva and will keep the airway open. DO NOT try to force the child’s mouth open or put anything in his/her mouth.
• Protect the child’s privacy by asking onlookers to leave.
• Call 9-1-1or emergency medical number for medical need IF the child has a second seizure shortly after the first or:
• If unconscious for more than 5 minutes; or
• If it is the child’s first seizure and you do not know the cause.
• When convulsions stop, wipe away fluid from the mouth and nose. Lay child on his/her side (recovery position), with the top knee and bottom arm extended to keep him from rolling on his/her stomach. Stay with the child and allow him/her to rest.
• Contact the child’s parents.[2] 

Diabetes 

TREATMENT OF STUDENTS WITH DIABETES 

Information Regarding the Treatment of Students with Diabetes 

General Information 

Diabetes is one of the most common chronic diseases of childhood. Diabetes is a serious chronic disease that impairs the body’s ability to use food. Insulin, a hormone produced by the pancreas, helps the body convert food into energy. In people with diabetes, either the pancreas does not make insulin or the body cannot use the insulin properly. Without insulin, the body’s main energy source – glucose – cannot be used as fuel. Rather, glucose builds up in the blood. Over many years, high blood glucose levels can cause damage to the eyes, kidneys, nerves, heart and blood vessels.

The most common type of diabetes in school-aged children/youth is Type 1 diabetes. People with Type 1 diabetes do not produce insulin and must receive insulin through either injections or an insulin pump. Insulin taken in this manner does not cure diabetes and may cause the student’s blood glucose level to become dangerously low. Type 2 diabetes, the most common form of the disease typically affecting obese adults, has shown to be increasing in youth. This may be due to the increase in obesity and decrease in physical activity in young people. Students with Type 2 diabetes may be able to control their disease through healthy eating and exercise along or may require oral medication and/or insulin injections. All people with Type 1 and Type 2 diabetes must carefully balance food, medications and activity level to keep blood glucose levels as close to normal as possible.

Definitions

Hypoglycemia 

A blood sugar level that is too low (generally less than 4.0 mmol/l). This may be called an insulin reaction. Hypoglycemia is a medical emergency and can lead to seizures and death if not treated properly. 

Symptoms occur when the body gets too much insulin, too little food, a delayed meal or snack, or more than the usual amount of exercise. Symptoms include: 

• Tremors;
• Sweating;
• Lightheadedness;
• Irritability/mood changes;
• Confusion;
• Drowsiness;
• Hunger;
• Paleness;
• Blurred vision; and
• Decreased ability to concentrate. 

The student will need to ingest carbohydrates promptly and may require assistance. Severe low blood sugar may lead to unconsciousness and convulsions and can be life threatening if not treated properly. 

Hyperglycemia 

A blood sugar level that is too high (generally over 8.0 mmol/l). High blood sugars can affect student learning. 

Hyperglycemia occurs when the body gets too little insulin, too much food or too little exercise. Stress or an illness, such as a cold, may also cause it. Symptoms include: 

• Thirst;
• Frequent urination;
• Blurry vision;
• Tiredness;
• Decreased ability to concentrate; and
• Irritability/mood changes.

If untreated over a number of days, hyperglycemia can cause a serious condition called diabetic ketoacidosis, which is characterized by nausea and vomiting. This condition can be life threatening and requires medical attention.

Glucagon 

A chemical hormone produced in the pancreas. It mobilizes stored sugar and causes the blood sugar level to rise. It is used to treat severe hypoglycemia and must be given by injection. 

Responsibilities 

Parent Responsibilities 

Parents are to provide all materials and equipment necessary for diabetes care tasks, including: 

• Blood glucose testing;
• Emergency hypoglycemia testing kit, including glucagons when indicated;
• Insulin administration;
• Urine ketone testing; and
• Sharps disposal for insulin needles and lancets. 

Parents are to collaborate with the diabetes team, school public health nurse and school personnel to complete a Diabetes Care Plan, which will be reviewed on a yearly basis and revised during the school year as needed. (See format of Diabetes Care Plan in Forms Manual.)

Parents are to arrange an annual meeting with school personnel to update medical information and arrange for yearly education sessions for school personnel.

School Responsibilities 

1. Schools will establish a method of identifying students with diabetes to staff using a photograph displayed in a visible location.
2. Schools will facilitate and provide opportunity for all school personnel in contact with the student with diabetes (including teachers, substitute teachers, office staff, lunchroom and recess supervisors, and bus drivers) to attend staff education sessions on diabetes. Sessions will include the treatment of hypoglycemia, hyperglycemia and glucagons administration when indicated. Trained personnel will be identified in the Diabetes Care Plan.
3. Personnel responding to student needs will be instructed to remain with the student until appropriate treatment has been administered and blood glucose level stabilizes.
4. Schools will allow flexibility in the student’s class routine/school rules to ensure that the student with diabetes can appropriately manage his/her diabetes. Situations may include allowing the student to eat on the bus or at his/her desk, not participate temporarily in certain activities, ask for assistance from school personnel, etc.
5. If indicated in the Diabetes Care Plan, designated school personnel will administer glucagons for the treatment of severe hypoglycemia. The glucagons emergency kit should be labeled and kept in an accessible and secure location with the student’s hypoglycemia treatment kit.
6. Schools will provide a hygienic, safe and private environment for the student to perform diabetes-related tasks if the student wishes privacy.
7. Schools will provide for safe and accessible storage of the student’s food supplies.
8. Designated school personnel will notify the parent if: 
    
   • The student does not eat all scheduled meals and snacks (age appropriate) or vomits.
   • There are any expected changes in the school schedule that will affect the student’s meal/snack times and activity level.
   • The student is unwell or exhibits signs of hyperglycemia, such as frequent thirst or urination.
9. Schools will provide adequate supervision at special events, such as field trips, intramural sports, recess, etc., to ensure the safety of students with diabetes.
10. Schools will communicate and liaise with the public health nurse and diabetes care team as required. 

Student Responsibilities 

1. Children and adolescents will implement their diabetes care at school with parental consent to the extent that is appropriate for the student’s development and his/her experience with diabetes.
2. The extent of the student’s ability to participate in diabetes care should be agreed upon by the student, parent(s), the diabetes care team, school public health nurse and school personnel. This should be documented in the Diabetes Care Plan.
3. The child/adolescent with diabetes will communicate with school personnel any concerns with diabetes care tasks, including circumstances of hypoglycemia or hyperglycemia, when feeling unwell, or when requiring assistance from school personnel.

 Equipment/Resources 

1. Diabetes Care Plan (Forms Manual) – attach photo ID of student to this document
2. Education training sessions on diabetes for school personnel provided by parents, diabetes care team and school public health nurse
3. Preventing and Treating Low Blood Sugars pamphlet, Chinook Health Region – photo ID of student can be attached to this document and displayed in visible location for staff
4. Glucagon emergency kit administration handout
5. Emergency hypoglycemia treatment kit (provided by parents and labeled with the student’s name) containing: 
   
   • Quick acting glucose source (e.g., BD glucose tablets, unsweetened juice, lifesavers);
   • Appropriate follow-up snacks (e.g., digestive/Arrowroot cookies or crackers, cheese or peanut butter); and
   • Glucagon emergency kit when appropriate.
    
6. Kids with Diabetes in School resource package, Canadian Diabetes Association
7. Guidelines for Student Capabilities in Diabetes Care

References 

1. Clinical Practice Recommendations,ADA, 2001
2. Kids with Diabetes in School, Canadian Diabetes Association, 1999
3. Clinical Practice Guidelines for the Management of Diabetes in Canada, 1998
4. Keeping Well with Diabetes: Preventing and Treating Low Blood Sugars (Diabetes and Lipids Education Program), Chinook Health Region, 2002
5. School Health Resource Manual, Chinook Health Region, 2002

[1] Source: School Health Resource Manual, 2002, Chinook Health Region.

[2] Source: School Health Resource Manual, 2002, Chinook Health Region.