HEALTH GUIDELINES FROM THE SCHOOL NURSE
I NEED TO STAY HOME IF...
I HAVE AN
I HAVE BEEN IN
Redness, itching, "crusty" eye drainage
Itchy head, active head lice.
I AM READY TO GO BACK TO SCHOOL WHEN I AM....
Fever free for 24 hours without the use of fever reducing medication i.e. tylonol, Motrin
Free from vomiting for at least 2 solid meals
Evaluated by my doctor and have note to return to school
Free from rash, itching, or fever. I have been evaluated by my doctor if needed
Treated with appropriate lice treatment at home
Free from diarrhea for at least 24 hours
Released by my medical provider to return to school
At the Elmira City School District, our District healthcare team understands that the health of our students directly impacts their ability to be successful in school. We work hard to ensure that all students are healthy and we are vigilant about attending to any health issues. If an injury or illness occurs, we have a well trained team of school health professionals available.
Health Office Phone Number
Emergency and Health History Forms: Please Make Sure They're Always Up-To-Date
It is vitally important that parents (or guardians) keep their student (s) home school up-to-date on contact information and important health information, including health history and current conditions.
Our District Has a Team of Healthcare Professionals
Every school has a health office staffed with a registered nurse (RN), and a licensed practical nurse (LPN) for additional support. In addition, the District employs a nurse practitioner, Kim Holden, FNP, who is available if any serious health concerns occur. A school district physician is available should any serious District health issues arise.
Use the links at the left to explore our Health Information.
Child Health Plus Insurance
Child Health Plus is New York State's medical insurance program serving uninsured children under age 19 in families whose household income exceeds Medicaid income eligibility. The insurance has no income limit and is provided free or at a low cost. Coverage includes well-child check-ups, immunizations, prescriptions, doctor's visits, dental care, x-rays and lab work, outpatient mental health, inpatient hospital care, emergency medical care and other services. The application is a simple one-page form requiring proof of the child's age, household income and residency.
Local assistance is available through Mothers and Babies Perinatal Network by calling 1-800-231-0744, or complete the online Kids Insurance Connection form and e-mail it to email@example.com.
Clothing: Important Parent Reminders
Note to Parents if Your Child is Not Potty Trained
If your child is not potty trained, or still having accidents, it is very important that parents send a change of clothes to school for your child.
The District does not supply clothes to children. It is very important that your child has extra underwear and a pair of clean sweatpants at school, just in case.
Parents: Please Dress Your Child Appropriately for the Weather
All students should dress appropriately for the day's weather conditions. Being comfortable will help them to be more successful in the classroom. Due to cut-backs in District funding, many schools set the thermostat at 68 degrees Fahrenheit in the cold winter weather, and in the hotter days of late spring and early fall, there is no air conditioning.
Dress your child appropriately, even if he or she takes a bus to school. There are still times when they may be exposed to cold weather for long periods of time.
Many students arrive at school in the cold, snowy winter weather wearing cloth sneakers and no socks, sometimes without a warm coat. It is the parent's responsibility to make sure their child is dressed warmly, including hats, boots and gloves. Elementary students will play outside for recess unless the weather is very cold, so dress your child appropriately. Even teenagers who insist on not wearing hats and gloves can be encouraged to wear a warm coat with a hood and socks on the coldest days.
New York State Education Department requires all students to have a dental exam (as well as a physical exam) as follows:
- All new entrants - all PreK students, all students who attend school in this District for the first time at Kindergarten or any other grade
- All students in grades 2, 4, 7, and 10
- As with the health exams, dental exams performed on or after Sept. 1 of the year before the child enters the District or the mandated grade, or later, may be used in any of the mandated grades. The school nurse must have documentation of the exam on the state-approved dental certificate form or other official documentation from the dental office. We cannot accept a parent's report of an exam or jotted note from the dentist saying only that student had one.
Click here to download the blank dental certificate form. Your school nurse can also provide this form. Your dentist also probably has the appropriate form.
The Chemung County Health Department also has a Dental Clinic available for people who are covered by Medicaid. For information call 737-2870.
District Wellness Policy
The Elmira City School District School Health Council, consisting of representatives from administration, teaching, student body, food service personnel, school board members, health professionals, child advocates and community members, assumes the responsibility of developing the School Wellness Policy. The implementation and monitoring of this policy will take place in conjunction with school board approval. The committee will meet quarterly to discuss concerns and alignment of District practice with the Elmira City School District School Wellness Policy.
Students with Food Allergies and Restrictions
School Meals -- Lunch
Students who participate in the school lunch program on a regular basis can be assured that the meals are planned to provide 1/3 of the recommended dietary allowance (RDA) for key nutrients and calories.
School Meals -- Breakfast
Students who participate in the school breakfast program on a regular basis can be assured that the meals are planned to provide 1/4 of the RDA for key nutrients and calories.
Free and Reduced-Price Meals
All schools in the District have a cash register system that is set up to ensure the security and confidentiality of every student in the program. The system requires students to input their ID numbers at the high school and middle school levels. Only the cashier would know, by reading the cash register screen, if the lunch is free or reduced. Elementary students report their name to the cashier, who in turn selects their name from a class list on a touch screen, allowing the cashier to process student accounts appropriately.
Foods Allergies and Food Restrictions
The food service staff in each school is aware of allergies and food restrictions for students in their building, based on information given to them by the nursing staff. Building nursing staff develops individualized healthcare plans and/or individualized emergency plans, as appropriate, for students with severe food allergies and/or restrictions. School nurses are responsible for notification and inservice of appropriate staff (teachers, dietary staff, bus staff, etc.), including teaching how to administer EpiPen, if appropriate.
The Elmira City School District discourages the use of food items as rewards at all levels and will strive to offer non-food incentives and those related to the desired behavior. If a teacher chooses to use food as a reward they MUST also offer a non-food alternative. Such examples include but are not limited to; additional recess or physical activity time, stickers, pencils, special time with a teacher, administrator or student, etc.
Statement about "Celebrations"
The Elmira City School District discourages more than two celebrations/parties each month (per classroom) involving foods of minimal nutritional value (MNV) while further limiting those foods of MNV to one per celebration. The District will actively involve staff, parents and community members in the notification of said restrictions while identifying and encouraging the offering of foods from a variety of nutritious foods. Celebrations not involving food are not subject to limitations.
For details about the District's Wellness Policy, click here. Go to the section called 7000 Students.
Emotional Health Screenings
Through a partnership with Family Services of Chemung County and the Chemung County school districts, a free, confidential and voluntary emotional health screening will be offered to all students in the county during the coming school year.
How a child feels influences the success of their relationships at home, in school and in the community. Checking on their emotional health on an annual basis is important, just as important as having their vision and hearing screened.
Screening information will be sent home, during the school year, from your child's school. This information may also be accessed online. For parents of children in:
- Pre-K - Grade 5: For a screening consent form, click here.
Grades 6 - 12: This screening may be completed by either the student or a parent. Click here for this screening consent form.
For additional information, contact Marilyn Cristofaro, Community Mental Health Program Coordinator, at Family Services of Chemung County, or call 737-2820 ext. 124.
- Family Services of Chemung County, Inc.
Attention: Marilyn Cristofaro
310 Pennsylvania Avenue
Elmira, NY 14904
Forms for Parents
Head Lice Policy
What are head lice?
Insects found only in human hair and are NOT a serious medical problem. They do NOT carry any diseases and can NOT be transmitted to or from pets. It is treatable and NOT life threatening. They can NOT jump or fly, they can only crawl.
Itching of the head, especially behind the ears or at the back of the neck.
Part hair and look at scalp for nits (eggs). They can be easier to see behind the ears or hairline at back of neck.
Comb through small sections of hair with a fine tooth comb. After each comb-through, wipe the comb on a wet paper towel and then examine the scalp, hair, comb and paper towel.
It can be difficult to distinguish between dandruff, dried hair gel and nits.
Treatment is a 3-part process.
Return to School:
The student may return to school the day after treatment however the parent or guardian must accompany the student to the nurse’s office to be checked again. If the nurse does find more, please be sure she shows them to you so you know exactly what to look for during treatment. If additional lice are found, the student will need to return home for additional treatment.
Your school nurse is an expert on the subject.
Please feel free to ask questions. She is there to help.
Informational Online Resource Regarding Head Lice: www.nasn.org/nasn/programs/educational-initiatives/lice-lessons
Minimum Immunization Requirements
Parents are required to provide proof that every child admitted to school has all the required immunizations in order to attend school. Minimum immunization requirements for school attendance (NOTE: THESE ARE NEW REQUIREMENTS FROM THE STATE, WHICH GO INTO EFFECT SEPT. 2016 - HIGHLIGHTED AREAS INDICATE NEW STATE REQUIREMENTS):
For Pre-Kindergarten students
- 4 DPT/DTaP (diphtheria, tetanus and pertussis)
- 3 IPV (polio)
- 1-4 Hib (haemophilus influenzae type B) if given before 15 months of age; 1 Hib if given after 15 months of age
- 1 MMR (measles, mumps and rubella), given on or after 4 days before 1st birthday
- 3 Hepatitis B
- 1 Varicella (chicken pox), given on or after 4 days before 1st birthday
- 1-4 Pneumococcal given at appropriate ages. For more information about dosing schedules, check with the school nurse.
For students in Kindergarten through Grade 5
- 4-5 DPT/DTaP (diphtheria, tetanus and pertussis)
- 3-4 IPV (polio)
- 2 doses MMR (measles, mumps and rubella)
- 3 Hepatitis B
- 2 Varicella (chicken pox)
For students in Grade 6
All immunizations in grades K-5, plus:
- 1 Tdap (tetanus, diphtheria and pertussis booster) for all students entering 6th grade – if 10 years old, may delay Tdap until 11th birthday (although there is a vaccine approved for 10-year-olds available)
For students in Grade 7-10:
All immunizations in grade 6, plus:
- 1 Meningitis (also called MCV4 or MenACWY – brand names are Menactra, Menveo or Menomune)
For students in Grade 11
All immunizations in grades 7-10, except Meningitis
For students in Grade 12:
All immunizations in grade 11, plus:
- 2 Meningitis (also called MCV4 or MenACWY vaccine – brand names are Menactra, Menveo or Menomune) – if first dose given more than 4 days before 16th birthday, must have 2nd dose given on or after 16th birthday and 8 weeks after first dose – exception: if first dose given on or after 4 days before 16th birthday, student does not need 2nd (booster) dose
The following guidelines are applicable regarding immunizations and exclusions:
- Parents will be notified by the school nurse of needed immunizations soon after school registration for new entrants; and well in advance, for students already enrolled in the District, to give parents plenty of time to arrange for the shots.
- No immunizations are given at school. Parents should contact their private healthcare provider or the local health department, for information about where their child can receive immunizations.
- Parents who believe their child should be exempt from required immunizations, for medical or religious reasons, must discuss this with the school nurse. State regulations will be followed for all exemption requests. Medical exemptions must be renewed annually.
- If a student is homeless, the school nurse will work with the child (and family) to get immunizations for the child’s protection.
Parents are responsible for:
- Getting their child properly immunized, including boosters.
- Getting written verification of these from the office or clinic that gave them.
- Giving this written verification to the child's health office as soon as possible, and keeping a copy for their own files at home.
Chemung County Health Department
The Chemung County Health Department provides some children with free immunizations. Parents may call the Chemung County Health Department (737-2028) to find out if their child is eligible to receive immunizations there, or if they will need to see their own healthcare provider for these.
Parents should bring previous vaccination records when having their child immunized, if available.
For more information about health services available through the Chemung County Health Department, call 737-2028.
Medications in School
Elmira School Board policy states that prescribed medication for students should, under normal circumstances, be administered under the parent or guardian supervision before or after school hours. However, the Board understands that this is not always possible or in the best interest of the student. When a parent or guardian cannot be present to supervise the administration of a medication, the District will, under certain circumstances.
The following is required for any medication to be taken in school. This applies to all prescription and non-prescription (over-the-counter) medications, including pain relievers and cold/cough medicine.
The school nurse needs:
- A written order by a licensed prescriber. Click here to download this form.
- A written request from the parent or guardian to give the medication in school as ordered by the prescriber.
- An adult must deliver the medication in a properly labeled original container to the school. Medication in baggies, foil packets, etc. cannot be accepted. The label on the bottle must match the prescriber's order. If you need a second prescription bottle, so that you have one for home and one for school, your pharmacist will provide one for you upon request.
- All medications are kept in a locked cabinet in the health office. In some cases, older students (usually 7th grade or older) may be permitted to carry and self-administer their medication - ask your school nurse about this, if you feel this is necessary.
- It is the parent's responsibility to take care of these matters during school hours. Other staff members are not able to deal with these in the absence of the health service staff.
- Any child who has medication of ANY kind in school without fulfilling all of these requirements, is in violation of school policy and may be subject to discipline.
Contact your child's health office with any concerns/questions.
If your child is receiving special education services, or has a serious special health need, see also Students with Special Health Needs.
Inhalers in School
The District permits students who have been diagnosed by a physician or other duly qualified healthcare provider as having a severe asthmatic condition to carry and use a prescribed inhaler during the school day, with prior approval of the prescriber and the school's health office. The health office must receive written permission of the prescribing physician, or other qualified healthcare professional, and parental consent, based on the healthcare provider's determination that the student is subject to sudden asthmatic attacks. Once this documentation is received, the student may be allowed to carry an inhaler (contingent on the school nurse's assessment of the student's ability to do so safely) and the school health office may also take custody of a spare inhaler. In general, students younger than seventh grade are not eligible for this privilege.
Emergency Medication (EpiPen and Glucagon)
The administration of emergency medication to a student may be performed by a (non-nurse) school staff member responding to an emergency situation, when such use has been prescribed by a licensed prescriber. The only medications that can be given by non-nurse staff in schools are EpiPen for serious allergic reactions, and Glucagon for severe low blood sugar in students with diabetes. The registered professional school nurse, nurse practitioner, physician or physician's assistant must have trained the staff member to administer the emergency medication for that particular emergency situation and given him/her approval to assist the student in the event of an emergency. Such a response would fall under the Good Samaritan exemption for rendering emergency care during a life-threatening situation. Non-nurse staff cannot administer any other medications in the school setting, including extra-curricular and off-campus activities (e.g., sports and field trips).
Blood Glucose Monitoring
Children with diabetes have the right to care for their diabetes at school in accordance with the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act of 1973, which provide protection against discrimination for children with disabilities, including diabetes. Accordingly, blood glucose monitoring is allowed in the school setting at any time, within any place, and by anyone necessitating such testing. Children will receive assistance, if needed, with the procedure. The school nurse oversees any arrangements that need to be made for testing, and a system to report the results to the nurse as needed. Proper arrangements will be made for the disposal of sharps.
Alcohol-Based Hand Sanitizers
Alcohol-based hand sanitizers are considered over-the-counter drugs by the United States Food and Drug Administration. However, because careful hand-washing and sanitation is the most effective way to control the spread of illnesses (including influenza and methicillin-resistant Staph aureus or MRSA), the New York State Education Department allows a medical exemption in the school setting to permit the use of alcohol-based hand sanitizers.
The District does not routinely provide these products. Parents are allowed to send hand sanitizer to school with their child. However, keep in mind that this is toxic when ingested and highly flammable, and not recommended for young children.
Parents may provide written notification to the school in the event that they do not wish to have their child use this product.
Disposal of Unused Medication
Any unused medication (including unused routine medications, or expired prescription and nonprescription drugs) must be picked up by the parent/guardian by the end of each school year. Students may not transport medications home. If the parent/guardian does not pick up the unused medication by the end of the school year, the school nurse or designated health office personnel must document that the medication was abandoned and destroy it.
Non-Public and Charter Schools
Elmira City School District provides nursing services for non-public and charter schools within our boundaries:
Holy Family Elementary
Notre Dame Junior High/High School
Physical Examinations for School
New York State Education Department requires all students to have a physical examination as follows:
All new entrants - all PreK students; all students who enroll in the District for the first time at Kindergarten or any other grade
All students in grades 1, 3, 5, 7, 9, and 11
Within the past year for work permit
Within the past year for students trying out for a school sports team (modified, junior varsity, or varsity) - physical exam dated as far back as the first day of the month, one year prior to the start of the sports season
At least every 3 years for students receiving special education services (students with an Individualized Education Plan)
The school nurse must have documentation from the healthcare provider of the physical examination findings. We cannot accept parent's report of a physical or a jotted note on prescription pad saying only that student had a physical, without the findings. Your child's pediatrician or other healthcare provider will probably have the proper form to fill out for school. Or, click here to download the Physical Examination form to take to your private physician's office.
It is preferable that your child be examined by his or her own healthcare provider (doctor, physician assistant or nurse practitioner, practicing in New York State or within 50 miles of a NYS border). The goal of the physical exam is to identify health factors that contribute to or interfere with your child's ability to function satisfactorily in school. The physical exam done in school is not intended to replace the more thorough physical with your child's personal physician.
Examinations performed on or after Sept. 1st of the year before the child enters the District or the mandated grade, or later, may be used in any of the mandated grades. If documentation of a new entrant or grade-mandated physical is not received by November 1st of the mandated year, the school nurse practitioner can perform your child's physical at school. You will be notified with a letter beforehand. The school nurse practitioner can perform physicals at school for students for special education purposes, if needed, but only if the parent/guardian signs a written consent form. The school nurse can provide this form.
During physical exams performed at school, just as in a private medical office, boys will be checked for the presence of both testicles and for inguinal hernia. Girls will be visually checked for breast and genital development for the purpose of maturity screening. New York State law allows parents to request to be present for this exam. Exemption from a school physical is permitted by the state, but only on grounds of sincere and genuine religious beliefs - ask your school nurse, if you believe this applies to your family.
If the parent wants a private physical but can't get it by the end of September, he or she must notify the school health office of the date of the appointment. Screenings such as vision, hearing, scoliosis, blood pressure, height and weight are done in different grades and should not be confused with the required physical.
Physical Exams for Athletes
The student must bring in documentation of a physical done by the private healthcare provider for participation in sports. If this is not possible or if the student is a new entrant to the District, the school nurse practitioner may perform this physical exam. This form is good for one year, plus to the end of the month in which they are done (e.g., a physical done on Aug. 1 2012 is good through Aug. 31, 2013). For more information about health requirements for sports participation, click here.
Physical Exams for Work Permits
The district does not provide physical exams for this purpose - the student must bring in documentation of a private physical, or signature of the private healthcare provider on the Physical Fitness Certification portion of the work permit application. Any physical exam done within the past 12 months of the date the work permit is issued, may be submitted.
Required health screenings
At the Elmira City School District, our school nurses often conduct health screenings in addition to the minimum screenings required by the state. Our staff members are always alert to student health issues that might affect their academic success.
Growth (Height and Weight):
- All new entrants, plus 1, 3, 5, 7, 9 and 11 - plus yearly for all athletes.
Distant Vision and Near Vision:
- All new entrants, plus 1, 3, 5, 7, and 11 - plus yearly for all athletes. Also, if student or teacher request, due to vision difficulties in class.
- All new entrants.
- All new entrants, plus 1, 3, 5, 7, and 11 - plus yearly for all athletes. Also, if student or teacher request, due to hearing difficulties in class.
- All new entrants, plus 1, 3, 5, 7, 9, and 11
- Girls: Grades 5 and 7 only
- Boys: Grade 9 only
Sick Day Guidelines
When to Keep a Child Home Because of Illness
Sometimes it's hard for a parent to decide whether to send children to school when they wake up with early symptoms of an illness or complaints that they do not feel well.
In most cases, the illness is not serious, and children will do just fine with a supply of tissues, reassurance, and a little encouragement to get up and going. However, there are times in which it is best to plan on keeping your child home for the day to rest and recuperate or to arrange for an appointment with your healthcare provider. Here are a few such situations:
- Fever greater than 100° orally, including a fever that requires active control with medication to keep down to normal.
- Child is too sleepy or ill to profit from sitting in class all day.
- Significant cough that makes a child feel uncomfortable or disrupts the class.
- Sore throat that is severe, accompanied by fever and/or simply feeling ill, that persists longer than 48 hours, or after known exposure to a confirmed case of streptococcal throat infection.
- Honey-crusted sores around the nose or mouth that might be impetigo, or a rash in various stages including boils, sores and bumps that may be chicken pox, OR a significant rash accompanied by other symptoms of illness.
- Red, runny eyes until cleared as non-contagious by a physician.
- Large amount of discolored nasal discharge, especially if accompanied by facial pain or headache.
- Severe ear pain or drainage from the ear - this needs to be evaluated by your healthcare provider.
- Severe headache, especially if accompanied by fever, which should be evaluated by your healthcare provider.
- Vomiting or diarrhea within the past 24 hours.
- Any condition that you think may be serious or contagious to others.
In cases of an outbreak of a specific infection or contagious disease (you would hear about this on the local news, or by a letter sent home from school), be alert for any symptoms that might suggest your child is coming down with the same infection. In these cases, it's best to take your child to the doctor's office. Be sure to ask your physician when it is safe for your child to return to school, both for your child's health and for the health of the rest of the school.
If you send your child to school even though you are uncertain whether it's significant illness, it is a good idea to call the school nurse and alert her to your concerns. Make sure she has your daytime phone number should your child become more ill and require early dismissal. If you find a pattern of your child's asking to stay home from school, especially if they are falling behind or appear anxious by the thought of attending school, or if there does not appear to be any obvious physical symptoms, it may be a good idea to contact your child's teacher, the school nurse and your healthcare provider to discuss your concerns.
In general, during cold and flu season, unless your child is significantly ill, the best place for him or her is in school where they have all already been exposed to the same germs and where they are less likely to expose other more vulnerable people, like the very young or very old, to their routine bouts of cold and flu. Remind and show your children to discard used tissues promptly, not to share personal items, to cough or sneeze into the crook of their elbow, to keep their hands away from their face, and to wash hands thoroughly and often with soap and warm water. Teach them to wash their hands long enough to silently sing the Happy Birthday song twice.
Finally, if you know your child is still running a fever, it's not a good idea to simply give him Tylenol and send him to school. As soon as the medicine wears off, you could get a call from the school nurse to come to pick up your feverish child. Better to let him stay home in bed with a fever and take his medications at home until he feels well enough to return to school.
Students who Become Ill or Injured in School
We work hard to ensure that all students are healthy, and we are vigilant about attending to any health issues. If an injury or illness occurs, we have a well trained team of school health professionals available. The school nurse can't call every parent who comes into the health office. However, if the student is experiencing a serious or repeated health issue, the parents will be contacted.
Emergency and Health History Forms: Please Make Sure They're Always Up-To-Date
Sometimes when students become ill or injured at school (sometimes seriously), we find that the phone numbers we have on file are outdated or disconnected. We notify the emergency contact listed in your student (s) record. Please keep your student (s) school informed and up-to-date with phone numbers and emergency contacts!
Our District Has a Team of Healthcare Professionals
Every school has a health office staffed with a registered nurse (RN), with support from a licensed practical nurse (LPN). In addition, the District employs a nurse practitioner, Kim Holden, FNP firstname.lastname@example.org , who is available if any serious health concerns occur, and for supervision of the nursing staff. A school district physician is available for consultation for serious District health issues.
What Happens When a Student Becomes Ill or Injured at School
Board policy states that all school District staff are responsible for obtaining first aid care for students who are injured or become ill under school supervision.
In most instances, first aid should be given, and, if necessary, the parent may be contacted to come to school and transport the student to a family physician. Beyond first aid, the medical care is the responsibility of the parent.
The school District provides first aid care only. We are not able to make a medical diagnosis of what is wrong with a child, nor are we able to provide treatment needed, beyond basic first aid. We cannot and do not provide the same types of care provided in your child's doctor's office or in a hospital's emergency department.
If a student has a problem, the school nursing staff will:
Provide first aid care.
For a serious problem, use the phone numbers provided by the parent to reach someone. This is why it is important for you to notify us of any changes.
For a mild or a minor problem, routine first aid care will be given.
We cannot call every parent whose child reports to the nurses' office for minor injury or illness. Some students will be given a written note, which they are instructed to place in their pocket, book bag or backpack and take home to the parent. It is then their responsibility to give this to the parent. We will attempt to reach the parent/guardian in cases of more serious illness or injury, or if there are particular signs or symptoms the parent/guardian needs to watch for at home.
If there is a serious or potentially life-threatening situation, the 911 system will be activated, and/or an ambulance may be called.
Health Insurance When the Injury Happens at School
Many parents have questions about insurance coverage when there is an injury at school or during a school function. If the child has private health insurance coverage, that becomes the primary coverage. If there are additional claim balances after being submitted to the primary coverage, you may call the Elmira City School District's Insurance Office at 735-3005 to apply for possible coverage for an incident occurring at school.
Students with Special Health Needs
Some students come to school with diverse medical conditions that may impact their learning as well as their health. Some of these conditions are serious and may be life-threatening, some are simply conditions that affect the child's everyday life activities. It is very important that parents inform the school nurse of any health concerns a child has that might require special attention. These might include diabetes, asthma, severe allergies (such as peanuts or bee stings), hearing/vision loss, mobility issues, etc.
If your child is a student receiving special education services, and has an Individualized Education Plan (IEP), this student should receive a physical at least every three years, depending on progress and Committee for Special Education (CSE) requirements. Special health needs will be documented in the IEP. The school nurse may be a valuable resource for the family, school staff, and CSE committee in cases where children have special health needs. Alternately, some students may benefit from having a plan for accommodations under Section 504 of the Rehabilitation Act ("a 504 plan"). Please ask your school principal or school nurse if you believe this would benefit your child.
The school nurse will plan with the parent for daily care and/or emergencies. Please call the school nurse to bring this to the her attention. A phone or face-to-face conversation with the school nurse is the most effective way to notify her, and gives the opportunity for discussion of your child's needs.
All students within the District with known life-threatening conditions should have a comprehensive plan of care in place: an Emergency Care Plan (ECP) and/or Individualized Healthcare Plan (IHP), and if appropriate an Individualized Education Plan (IEP) or Section 504 Plan. Please remember - in order for us to plan appropriate care, we must know about your child's special health condition - so please come in and talk to us!
Potentially Life-Threatening Health Conditions
Some students in our District have been diagnosed with potentially life-threatening conditions, such as severe allergies. And some chronic health conditions (e.g., diabetes, seizure disorders, asthma, sickle cell anemia, etc.) are associated with occasional serious symptoms, such as very low/high blood sugar, difficulty breathing, etc. For these students, it is essential that the District work cooperatively with the parent(s) and the student's private healthcare provider to:
- Develop an Emergency Care Plan (ECP) for each at risk student to ensure that all appropriate personnel are aware of the student's potential for a life-threatening situation;
- If appropriate, develop an Individualized Healthcare Plan (IHP) that includes all necessary treatments, medications, training and educational requirements for the student. If the student is eligible for accommodations based upon the Individuals with Disabilities Act (IDEA), Section 504 of the Rehabilitation Act of 1973 or the Americans with Disabilities Act, the appropriate procedures will be followed regarding evaluation and identification;
- Provide training by licensed medical personnel (e.g., registered professional nurse) for all adults in a supervisory role in the recognition and emergency management of a specific medical condition for the student;
- Obtain specific legal documents duly executed in accordance with New York State law; appropriate written orders from the student's healthcare provider that includes the frequency and conditions for any testing and/or treatment, symptoms, and treatment of any conditions associated with the health problem; and directions for emergencies;
- Secure written parental permission and discuss parental responsibility that includes providing the healthcare provider's orders, providing any necessary equipment, and participating in the education and co-management of the child as he/she works toward self-management;
- Allow self-directed students, as assessed by the school nurse, to carry life saving medication with prior approval by the medical provider and according to health practice and procedures, as long as duplicate life saving medication is also maintained in the health office in the event the self-carrying student misplaces the medication;
- Assure appropriate and reasonable building accommodations are in place within a reasonable degree of medical certainty.
In addition, the District will:
- Provide training in the recognition of an anaphylactic reaction for all staff who directly supervise a student having a known life-threatening health condition;
- Have standing emergency medical protocols for nursing staff;
- Request that the School Medical Director write a non-patient specific order for anaphylaxis treatment agents for the school's registered professional nurse to administer in the event of an unanticipated anaphylactic episode;
- As permitted by New York State law, maintain stock supplies of life saving emergency medications such as epinephrine in all health offices for use in first time emergencies;
- Ensure that Building-level and District-wide school safety plans include appropriate accommodations for students with life-threatening health conditions;
- Encourage families to obtain medic-alert bracelets for at risk students;
- Educate students regarding the importance of immediately reporting symptoms of an allergic reaction.
Creating an Allergen-Safe School Environment
For students with known severe allergies to foods or other allergens (e.g., latex), avoidance of exposure to allergens is the key to preventing a life-threatening anaphylactic reaction. The risk of accidental exposure or cross-contamination is always present, particularly for students with food allergies. The school setting can be a high-risk environment for accidental ingestion of a food allergen due to the presence of a large number of students, increased exposure to food allergens, and cross-contamination of tables, desks and other surfaces.
To guard against accidental exposure to allergens, monitoring of the following high-risk areas and activities may be needed, depending on the severity of risk for affected students:
- Food sharing;
- Hidden ingredients in art, science and other projects;
- Fund raisers and bake sales;
- Parties and holiday celebrations;
- Field trips;
- Before and after school programs.
These will all be considered when developing individualizes healthcare and emergency plans for students with severe allergies.
Use of Epinephrine Auto-Injector Devices (EpiPens) in the School Setting
The administration of EpiPen to a student with a known severe allergy needing an anaphylactic treatment agent may be performed by a school staff member responding to an emergency situation when such use has been prescribed by a licensed prescriber. However, a registered professional nurse, nurse practitioner, physician or physician's assistant must have trained the staff member to administer the EpiPen for that emergency situation and given him/her approval to assist the student in the event of an anaphylactic reaction.
Documentation of training will be maintained by the school nurse for each affected student. The emergency response by non-licensed school staff members is permitted under the Medical Practice Act (Education Law Section 6527(4)(a)) and the Nurse Practice Act (Education Law Section 6908 (1)(a)(iv)) and is covered by the "Good Samaritan Law" (Public Health Law Section 3000-a).
The District will work toward assisting students in the self-management of their chronic health condition based upon the student's knowledge level and skill by:
- Adequately training all staff involved in the care of the child, on a "need to know" basis, while maintaining appropriate confidentiality;
- Assuring the availability of the necessary equipment and/or medications;
- Providing appropriately trained nurses as required by law;
- Providing additional appropriately trained adults to complete delegated tasks as allowed by law;
- Developing an emergency plan for the student; and
- Providing ongoing staff and student education.