Managing Chronic Health Conditions in Schools

About 25% of children in the United States aged 2 to 8 years have a chronic health condition such as asthma, obesity, other physical conditions, and behavior/learning problems. The healthcare needs of children with chronic illness can be complex and continuous and includes both daily management and addressing potential emergencies.

Health services in schools are a key component of the Whole School, Whole Community, Whole Child model. Ensuring that students have the health services they need in school to manage their chronic condition is important in helping them stay healthy and ready to learn—therefore, CDC works to improve the delivery of health services in the school environment for students of all ages.

Asthma

Asthma is a leading chronic illness among children and adolescents in the United States. It is also one of the leading causes of school absenteeism. On average, in a classroom of 30 children, about 3 are likely to have asthma. Low-income populations, minorities, and children living in inner cities experience more emergency department visits, hospitalizations, and deaths due to asthma than the general population.1

When children and adolescents are exposed to things in the environment—such as dust mites, and tobacco smoke—an asthma episode can occur. These are called asthma triggers. Asthma symptoms can be controlled by avoiding triggers and taking medications prescribed by a health care provider, if needed. Asthma is common but treatable: using treatment based on current scientific knowledge reduces illness and future episodes.2

Asthma-friendly schools are those that make the effort to create safe and supportive learning environments for students with asthma. They have policies and procedures that allow students to successfully manage their asthma. Research and case studies that looked at ways to best manage asthma in schools found that successful school-based asthma programs—

  • Establish strong links with asthma care clinicians to ensure appropriate and ongoing medical care
  • Target students who are the most affected by asthma at school to identify and intervene with those in greatest need
  • Get administrative buy-in and build a team of enthusiastic people, including a full-time school nurse, to support the program
  • Use a coordinated, multi-component and collaborative approach that includes school nursing services, asthma education for students and professional development for school staff
  • Provide appropriate school health services for students with asthma, ensuring that students take their medicines and learn to use them when appropriate
  • Provide asthma education for students with asthma and awareness programs for students, school staff, parents, and families
  • Provide a safe and healthy school environment to reduce asthma triggers
  • Offer safe and enjoyable physical education and activities for students with asthma
  • Support evaluation of school-based programs and use adequate and appropriate outcome measures

Diabetes

Ensuring that students with diabetes have the health services they need in school to manage their chronic condition is important in helping them stay healthy and ready to learn. Managing diabetes at school is most effective when there is a partnership among students, parents, school nurse, health care providers, teachers, counselors, coaches, transportation, food service employees, and administrators. Support may include helping a student take medications, check blood sugar levels, choose healthy foods in the cafeteria, and be physically active.

Diabetes doesn’t have to get in the way of a good experience at school. Remember, parents and schools have the same goal: to ensure that students with diabetes are safe and that they’re able to learn in a supportive environment. Schools should:

  • Develop a plan to help students care for diabetes and handle any diabetes-related emergencies.
  • Work with a child’s parents, doctor and school staff to create a Diabetes Medical Management Plan including information on services the school will provide and how to recognize high and low blood sugar levels.
  • Ensure all physician and emergency contacts are updated and provided to school staff.
  • Be sure school workers have a glucagon emergency kit and know how to use it if a student experiences a low blood sugar emergency. School staff should be given the National Diabetes Education Program School Guide hypoglycemia and hyperglycemia emergency care plans.

Help students to manage diabetes at a level right for his or her age

  • If a child is going to monitor his or her blood sugar, ensure that he or she feels comfortable doing so.
  • If a trained school employee will do the monitoring, be sure the student knows where and when to go for testing.
  • Encourage students to eat healthy foods, including a healthy breakfast, which will help students stay focused and active. Students and parents should look at the school menus together to help them make choices for a healthy meal plan.
  • Having diabetes doesn’t mean that a child can’t be physically active or participate in physical education classes. They should get at least 60 minutes of physical activity every day. In fact, being active can help a child improve his or her blood sugar control.
  • Check that students with diabetes have all recommended vaccinations (http://www.cdc.gov/vaccines/schedules/index.html), including the flu shot (http://www.cdc.gov/diabetes/living/flu/index.html). If a child with diabetes gets sick, he or she can take longer to recover than children without diabetes. Talk to the student’s parents to make sure their child has all the vaccinations they need before starting the school year.
  • Encourage students to wash their hands regularly, especially before eating and after using the bathroom.

Epilepsy

  • Epilepsy is a common disorder of the brain that causes recurring seizures.  Epilepsy affects people of all ages, but children and older adults are more likely to have epilepsy. Seizures are the main sign of epilepsy and most people can control this with treatment. Some seizures can look like staring spells while other seizures can cause a person to collapse, stiffen or shake, and become unaware of what’s going on around them. Many times the cause is unknown.
  • About 0.6% of children ages 0-17 years have epilepsy in the United States.  That is about 460,000 children in 2013. Picture a school with 1,000 students—that means about 6 students would have epilepsy. For many children, epilepsy is easily controlled with medication and they can do what all the other kids can do, and perform as well academically.  For others, it can be more challenging.
  • Compared with students with other health concerns, a CDC study shows that students aged 6–17 years with epilepsy were more likely to miss 11 or more days of school in the past year. Also, students with epilepsy were more likely to have difficulties in school, use special education services, and have activity limitations such as less participation in sports or clubs compared with students with other medical conditions. CDC also found that a larger percentage of children with epilepsy than those without the disorder lived in very low income households (below 200% of the federal poverty level). This suggests other unmet needs for families of children with epilepsy.

Managing epilepsy while at school may involve:

  • Educating the school nurse, teachers, staff, and students about epilepsy and its treatment, seizure first aid, and possible stigma associated with epilepsy.
  • Following the seizure action plan and administering first aid (including the use of rescue medications).
  • Understanding the importance of medication adherence and supporting students who take daily medications.
  • Helping students avoid seizure triggers, such as flashing lights, or other triggers identified in the seizure action plan.
  • Monitoring and addressing any related medical conditions, including mental health concerns such as depression.
  • Providing case management services for students whose medical condition disrupts their school attendance or academic performance.
  • Referring students with uncontrolled seizures to medical services within the community or to the Epilepsy Foundation for more information.
  • Understanding the laws related to disability, medical conditions, and special education to ensure that children with epilepsy are able to access the free and appropriate education afforded to them under the law.
  • Monitoring student behavior to prevent bullying of students with epilepsy.

A Seizure Action Plan contains the essential information school staff may need to know in order to help a student who has seizures. It includes information on first aid, parent and health care provider contacts, and medications specifically for that child. Seizure Action Plans are an important tool that help parents and schools partner to keep children safe and healthy during the school day.

Food Allergies in Schools

Food Allergy Facts

Food allergies are a growing food safety and public health concern that affect an estimated 4%–6% of children in the United States. There is no cure for food allergies and reactions can be life threatening. Strict avoidance of the food allergen is the only way to prevent a reaction. However, since it is not always easy or possible to avoid certain foods, staff in schools, out-of-school time and early care and education programs (ECE) should develop plans for preventing an allergic reaction and responding to a food allergy emergency, including anaphylaxis. Early and quick recognition and treatment can prevent serious health problems or death.

What is a Food Allergy?

A food allergy occurs when the body has a specific and reproducible immune response to certain foods. The body’s immune response can be severe and life threatening, such as anaphylaxis. Although the immune system normally protects people from germs, in people with food allergies, the immune system mistakenly responds to food as if it were harmful.

Eight foods or food groups account for 90% of serious allergic reactions in the United States: milk, eggs, fish, crustacean shellfish, wheat, soy, peanuts, and tree nuts.

The symptoms and severity of allergic reactions to food can be different between individuals, and can also be different for one person over time. Anaphylaxis is a sudden and severe allergic reaction that may cause death. Not all allergic reactions will develop into anaphylaxis.

  • Children with food allergies are two to four times more likely to have asthma or other allergic conditions than those without food allergies.
  • The prevalence of food allergies among children increased 18% during 1997-2007, and allergic reactions to foods have become the most common cause of anaphylaxis in community health settings.
  • Although difficult to measure, research suggests that approximately 4% of children and adolescents are affected by food allergies.

Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs

CDC in consultation with the U.S. Department of Education, several federal agencies, and many stakeholders, developed Voluntary Guidelines for Managing Food Allergies to provide practical information and recommendations for each of the five priority areas that should be addressed in each school’s or ECE program’s Food Allergy Management Prevention Plan:

  1. Ensure the daily management of food allergies in individual children.
  2. Prepare for food allergy emergencies.
  3. Provide professional development on food allergies for staff members.
  4. Educate children and family members about food allergies.
  5. Create and maintain a healthy and safe educational environment.

Oral Health in Schools

Oral Health Facts

Tooth decay (cavities) is one of the most common chronic conditions of childhood in the United States. About 1 of 5 (20%) children aged 5–11 years have at least one untreated decayed tooth, and about 1 of 7 (13%) adolescents aged 12–19 years have at least one untreated decayed tooth.The percentage of children and adolescents aged 5–19 years with untreated tooth decay is twice as high for those from low-income families (25%) compared with children from higher-income households (11%).

Poor oral health can have a detrimental effect on children’s quality of life, their performance at school, and their success later in life. Tooth decay is preventable and ensuring that students have the preventive oral health services they need in school is important in helping them stay healthy and ready to learn. Dental sealants prevent tooth decay and also stop cavities from growing—they result in a large reduction in tooth decay among school-aged children 5–16 years of age.

Addressing Oral Health in Schools

School-based sealant programs provide sealants to children in a school setting, and school-linked programs screen the children in school and refer them to private dental practices or public dental clinics that place the sealants. These programs have been shown to increase the number of children who receive sealants at school, and are especially important for reaching children from low-income families who are less likely to receive private dental care. Programs that offer oral health care to students should:

CDC, Food Allergies February 14, 2018 Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion https://www.cdc.gov/healthyschools/foodallergies/index.htm