St Thomas’ Moorside C.E. (VA) Primary School
ASTHMA AND EPILEPSY
POLICY
Date: October 2007
Approved by Governors:………………………………..
Reviewed:………………………………………………..
ASTHMA POLICY
1.
Background
A child’s educational years are the greatest opportunities for investment in the next generation.
For years, schools and teachers have worked to ensure all children have an equal opportunity in
their educational environment. Many issues remain within the sole remit of education.
However, key areas which impact on a child’s ability to get the most from school, such as health
lie outside the remit of education.
The impact of many medical conditions on a child in the classroom can be significant. Some
conditions can be severe and are rare, such as epilepsy and diabetes. Others, particularly asthma,
are common. Asthma UK (2004) states asthma is the most common long-term childhood
medical condition, affecting 1.1 million people in the UK. One in 10 children have asthma. The
decision to administer medicines by teachers remains voluntary. The document is designed to
support, educate and train school staff to enable them to take on this role if they wish with
appropriate input from the local NHS and Health Authority. This policy is designed to run
alongside the risk assessments and care plans schools develop in accordance with DFES
documentation.
2.
Asthma in the Classroom
Asthma is a common condition, but its severity varies considerably. People can be affected to
greater and lesser degrees. For any one individual the occurrence of the condition can be
episodic. This means that children can be well for long periods of time and then have sudden,
acute and at times severe relapses.
The major principle underlying the policy is immediate access for all children to reliever
medication.
Therefore every asthmatic child should carry their own inhaler wherever possible, both in school
at PE and on school trips. For younger children (usually those in Early Years of Key Stage One)
this is not practical. There should therefore be a system in school that both teachers, parents
and children know about which allows safe ready access at all times.
3.
Asthma Symptoms and Medication
Asthma is caused by a reversible narrowing of the airways to the lungs. It restricts the passage
of air both in and out as you breath. As the air whistles out of the narrow passage it produces
the characteristic wheeze. Because the child is failing to get enough oxygen into the body, this is
often accompanied by extra effort of respiration and an increased rate of respiration. The
symptoms however are rapidly reversible with appropriate medication. Only when symptoms
fail to be reversed need medical attention be sought.
3.1
Types of Treatment
There are two types of treatment for asthma:
a) Relievers: the main reliever used in the management of asthma in childhood is Salbutamol,
although Bricanyl may also be used. These treatments give immediate relief and are called
bronchodilators because they cause the narrowed air passages to open up. It is these
relievers that children will have in school with them.
b) Preventers: Preventers are a group of treatments that are designed to prevent the air
passages narrowing. The ultimate objective is to reduce the attacks. These medicines should
be taken regularly, usually morning and evening. There is therefore no indication for them to
come into school with the child. These medications will not have an immediate effect if
taken during an attack.
THIS POLICY REFERS ONLY TO RELIEVERS.
3.2
The best way for people to take their asthma medication is to inhale it. There are a
variety of devices available. Most inhaled medicines are given through small pressurised
aerosols. These ‘puffers’ deliver a small puff of medication into the mouth, which is then
inhaled.
3.3
For young children and those with co-ordination problems, other devices are
sometimes used. These devices are breath activated so that the device fires automatically when
the child is breathing in.
3.4
Some children use a spacer device. The aerosol is passed into the spacer and then the
child breathes in and out of the spacer device. This is very useful for those who have difficult
co-ordinating their breathing and inhaler. The spacer device is also very useful in the case of an
acute asthmatic attack (see section on Managing an Acute Asthma Attack).
3.5
All children who need their relievers should have them in school and readily available
at all times. Key Stage 2 children should have their inhaler with them at all times. The
administration of the reliever to these children will be on their own perception of whether or not
they need it.
3.6
Key Stage One and Early Years children may need more help and encouragement
with taking their reliever. Inhalers should be kept in a marked box in the stock room of the
classroom, where staff can reach it with the minimum of difficulty.
3.7
It remains the responsibility of the parent to seek medical attention and to liaise with
the school on the frequency with which inhalers are taken.
4.
The Physical Environment
a)
Passive Cigarette smoke: School has a total no-smoking policy applied to all areas of the
school – including the grounds – at all times.
b)
Animal fur and hair – Some children can have marked acute and chronic symptoms if
they are exposed to animals including mice, rabbits, rats, guinea pigs, hamsters, gerbils,
chinchillas and birds. Consideration should be given to the placement of school pets in the
classroom, and special vigilance may be needed on trips to farms and zoos where children
handle animals.
c)
Grass pollen – Grass pollens provoke attacks in asthmatic children. This is one of the
most commonly recognised provoking agents of acute asthmatic attacks. Grass is usually cut
during school time (although not whilst children are playing on the grass). Children may require
extra vigilance following grass cutting.
5.
Access to Reliever Medication
Asthmatic children must have immediate access to reliever inhalers at all times.
It is the parents’ responsibility to ensure their child is equipped with their asthma
medication if it is required in school.
If a child displaying symptoms of asthma is found not to have their inhaler in school, school will
contact parents by telephone and ask them to bring their inhaler in straight away or to collect
their child from school, as it may not be possible to manage the condition without the correct
medication. Another person’s inhaler may only be used in extreme emergency to sustain life.
Junior age children are responsible for their own inhalers and keep them in their desks. They
must be reminded by staff to bring them on trips, to PE sessions etc.
The inhalers of children in early years and infants are kept in the class stock room in a clearly
marked box. It is the class teacher’s responsibility to ensure that all staff know where the
devices are kept.
6.
WHAT TO DO IF A CHILD HAS AN ASTHMA ATTACK
If an asthmatic pupil in your class becomes breathless or wheezy or starts to cough:
Keep calm, it’s treatable. If the treatment is given at an early stage, the symptoms can be
completely and immediately reversible.
Let the child sit in a position they find most comfortable. Many children find it most
comfortable to sit forwards with their arms crossed on the table. Do not let them lie down. Do
not ask them to re-breathe from a paper bag.
Ensure the child has two puffs of their usual reliever and wait five minutes. Stay with the child.
If the symptoms disappear, the pupil can return to the lesson as normal.
If symptoms have improved but not disappeared, then give two more puffs, stay with the child
and wait five minutes.
If the child does not have their inhaler, contact parents and ask for it to be brought to school.
Encourage the child to sit quietly until the inhaler is brought or the symptoms subside.
7.
MANAGEMENT OF A SEVERE ASTHMA ATTACK
How to recognise a severe attack
• The reliever has no effect after 10 minutes or a reliever has not been provided and symptoms
are not subsiding.
• The child is either distressed or unable to talk
• The child is becoming exhausted
• You have doubts about the child’s condition
Stay with the child
• Send someone else to call an ambulance immediately. Inform them that the child is having a
severe asthma attack and requires immediate attention.
• Using the child’s reliever and a spacer device (located in the first aid cabinet) give one puff
into the spacer. Allow the child to breathe the medicine from the spacer. If the device
whistles, ask the child to breathe more slowly and gently. After one minute, give another
puff and allow the child to breathe the medicine. Repeat at not more than one minute
intervals until the ambulance arrives.
• In the event that you cannot gain access to a spacer, a paper or plastic cup can be used
instead of the spacer device. Cut an ‘X’ shape in the bottom of the cup and use as described
for the spacer device.
• Contact the parents and inform them what has happened.
• If you are concerned and need emergency advice, ring the Accident and Emergency
department at The Royal Oldham Hospital on 0161 627 8228.
8.
Training
It is anticipated that policy implementation will include staff training. This will include teachers
and support staff as necessary. Training to support the policy will be provided and will require
commitment from the Health Authority, Local Hospital Trust and Education Authority.
Dissemination to all levels within the schools is needed.
SAMPLE PARENT LETTER
Dear Parents
The school has a policy for the management of asthma, based on a joint policy between the
Health Authority, Education Authority, PCT and the local hospital. If you child has asthma, we
would be grateful if you could fill in the form included with this letter and return them to school
as soon as possible. This will be kept in school as a record of your child’s asthma treatment.
You may need to ask your child’s GP or Practice Nurse to help you.
If your child is diagnosed as having asthma, please let the school know as soon as possible so we
can ensure that they have appropriate access to their medication.
Please let us know if you child’s regular treatment is changed at any time. It is important that
you tell us in order that the records can be updated.
If your child might possibly need asthma treatment while at school, you must ensure that your
child has an inhaler at school at all times, including for school trips. The inhaler should clearly
be marked with thee child’s name. Please ask your GP to prescribe a new inhaler and spacer
each September at the start of each new school year to be kept in school. At the end of each
school year, inhalers can be taken home and used normally.
IMPORTANT
Poorly controlled asthma can interfere with a child’s school performance. Please let your child’s
class teacher know if your child’s asthma is being more troublesome than usual, especially if their
sleep is being disturbed.
Please sign the enclosed form regarding the giving of relievers in the event that your child has a
severe attack in school
Name of Child……………………..………………. Date of Birth…………………
PLEASE STATE WHICH INHALERS/MEDICINES ARE LIKELY TO BE NEEDED IN
SCHOOL AND THE LIKELY INDICATIONS FOR USE.
(e.g. Relievers: before games/going out into cold air/during a bad cold etc. Preventers: if your
child’s preventer must be administered the school day, how often and when must this take place)
INHALER 1………………………………………………………….
LIKELY REASONS FOR USE………………………………………………………………..
INHALER 2………………………………………………………….
LIKELY REASONS FOR USE………………………………………………………………..
Has your child got a self-management plan? Y/N (contact your Practice Nurse if you are not
sure)
I understand that I am responsible for ensuring that my child is equipped with their asthma
medication as required.
I understand that, should my child display symptoms of asthma and is found not to have
medication in school, I will be required to attend school with their inhaler or to take my child
home.
I understand that school has an emergency spacer, which may be used with my child’s inhaler if
necessary.
Signed…………………………………….. Parent/Guardian
EPILEPSY POLICY
What is epilepsy?
Epilepsy is the most common serious neurological condition, affecting one in 250 school-age
children. It is the tendency to have repeated seizures and blackouts unless these are controlled
by medication.
Those with epilepsy may experience blackouts for periods of confused memory, episodes of
staring, unexplained periods of unresponsiveness, involuntary movement of arms and legs, or
fainting spells with incontinence. Excessive fatigue may follow a seizure. Epilepsy is covered by
the Disability Discrimination Act because it is a physical impairment which, for many students,
has a substantial and long-term adverse effect on their ability to carry out normal day to day
activities.
Implications for Learning
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Students with epilepsy may experience difficulty in sustaining attention.
Short-term memory can be impaired.
Concentration and attention levels may be poor.
Background noise will cause distractions.
Hand-eye co-ordination may be poor and reaction times slow.
Extra time may be required when processing an answer to a question.
Auditory memory may be poor.
Sometimes medication can affect mood, making the student depressed or hyperactive.
Some students may demonstrate bizarre or repetitive behaviours as symptoms of a
seizure.
Strategies for Teachers/Staff In The Classroom
Be aware of the students seizure type, individual health-care plan and where their medication is
stored.
• Be positive, provide a student-friendly environment
• Repeat key points and summaries at the start and end of lessons
• Avoid letting the student use their epilepsy as an excuse
• Avoid treating the student’s condition as an illness.
• Use a multi-sensory approach V.A.K.
• Ensure key words are displayed.
• Provide multiple-choice answers to questions to reduce reliance on memory.
• Give simple, concise instructions with visual clues.
• Be consistent in expectations of behaviour.
• Use sticky-notes to develop organisational skills.
• Highlight important points.
Health & Safety
Allow students with epilepsy to participate in the same activities as their peers unless medical
advice is to the contrary.
The following uses should, however be considered:
• A risk assessment may need to be carried out in certain situations to ensure the safety of
both the student and the staff within the school.
o Practical lessons: science, food technology, PE.
o Out of schools activities.
Examinations
Students with epilepsy may be granted access arrangements. These may include extra time in
exams, provision for rest breaks, use of prompt, and provision for sitting the exam in a small
room.
Tonic – Clonic Seizures (Grandmal) Response
Stay calm
Ensure safety by clearing the area around the student
Do not restrain them
Cushion the head with something soft
Send for the first aider
When the seizure has finished, aid breathing by gently placing them on their left side,
preferably in the recovery position
• Re-assure and re-orientate
• Do not give them anything to eat or drink
• After the student has recovered, complete the Record form attached.
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If a child not known to have epilepsy has a seizure, phone for an ambulance and contact
parents immediately.