Back to School with Asthma and Allergic Rhinitis

On an average school day, more than 10,000 kids are absent because of asthma. If your child has asthma or allergic rhinitis (hay fever), there are some important steps you can take in these final weeks of summer to get your child started at school on a safe and healthy footing.

Rosemary Stinson, MSN,CRNP, a nurse practitioner with the Division of Allergy and Immunology at Children’s Hospital of Philadelphia (CHOP), suggests that you work closely with your child’s school to identify potential asthma and allergy triggers — making sure your child’s exposure is limited — and to make sure a clear plan is in place to respond in an emergency.

Meet with your child’s allergist and with key staff at school

In last week’s article, “Back to School with Food Allergies,” Rushani Saltzman, MD, advised parents to take three important steps as the school year approaches:

1. Review your child’s medical action plan with your allergist. Make sure it’s updated based on your child’s current age and weight.
2. Provide the school nurse or other school staff with up-to-date medications and the forms required for their use.
3. Build a partnership of care with key people at your child’s school. Meet with the school nurse, the principal and other administrators, and your child’s teachers to review your child’s health needs and discuss how the school will meet those needs.

Those steps also apply to children with asthma and hay fever. You want to share your child’s up-to-date asthma care plan with the school, make sure everyone involved has what they need in order to follow it, and have confidence everyone understands their role.

It’s particularly important to be clear about who will handle a breathing emergency — the yellow and red zones on the care plan. Make sure that role is clear no matter where and when it happens, whether in the classroom, at recess or on the playground.

If your child uses an inhaler, you may need to plan ahead in order to have two — one at school and one at home. Some insurance plans will only allow for one to be purchased in a 30-day period.

Visit the school and your child’s classrooms to look for potential triggers

Arrange to visit the school before classes start, and use your knowledge of your child’s asthma and allergy triggers to scout for potential problems. Act as a detective as you look around.

• Are windows open when the weather is warm? That could be a problem for a child with asthma or allergies triggered by pollen.
• Has new carpeting been installed? If so, it could be emitting volatile organic compounds (VOCs) that could trigger breathing problems.
• Is there mold in the bathrooms?
• Are there pets in the classroom?
• What is the arrangement for storing outdoor clothes and backpacks? Allergens from pets and other sources can come into the classroom on clothing and gear. If that’s a potential problem for your child, you might make arrangements for a separate cubby or locker.

Changes and accommodations made ahead of time — before school starts — are less likely to make your child feel different or be noticed by the other kids.

Plan ahead for recess and gym

The goal is to encourage your child to participate in school as fully as possible. The key to making that happen is preparation.

• If your child’s asthma action plan includes rescue medication before recess, outdoor play or gym, make sure teachers and gym staff know about it and plan for it in the daily schedule.
• If your child is strongly allergic to pollen, pay attention to pollen levels in the air. When they are high, be sure to follow your child’s medical action plan, at home and at school, with allergy medication or with accommodations to stay indoors for recess and gym.
• Pay attention to other aspects of the weather, too. Cold weather, dry air, windy conditions, and high air-pollution levels can all affect kids with asthma and allergies.

Building a three-way partnership

As with food allergies, the key to a healthy school experience for your child is the three-way relationship between you, the school and your child’s allergist. Your role is to help the school’s staff understand the medical advice from your child’s allergy provider and to help the school implement a plan that protects your child’s health without unnecessary isolation.