Q1. What is asthma?
Asthma is a condition that affects the lungs. Over time, triggers in the air such as pollens, moulds, animal dander, and dust can cause the airway to become red, sore, and swollen. The airways are also quite sensitive to other triggers such as exercise, weather, cigarette smoke, pollution, and heightened emotions. These triggers can make the airway tighten, making it difficult to breathe.
For more information watch the 'Boostershot comic – ‘What is asthma? – Pathophysiology of asthma video. This gives an overview of what happens to the airway and how symptoms can be treated.
Find link here: https://www.youtube.com/watch?v=2ur1XreTiNg
Q2. How does asthma affect children and families?
There can be problems accepting diagnosis as well as stress and jealousy felt by other family members.
Q3. What types of medicines are used in asthma?
The majority of children and young people with asthma will have a number of medicines to manage their asthma. These are broadly spilt into two different categories:
These are medicines which are taken to relieve symptoms or to treat an asthma attack. The most common is salbutamol which helps to open up the airways. This is a life saving medication. It is important for teachers and school staff to know who in the class has asthma and uses this medicine. It is important to have plans in place to support staff and CYP under your care in who can help, how, and when to give salbutamol.
These medicines come in a number of forms but the most common are tablets or inhalers (puffers) and are used regularly to help improve the health of the lungs and prevent asthma symptoms. These are usually given at home prior to and / or after school. It is important when planning school trips to speak to parents and carers to ensure children and young people still receive these whilst away from home.
All children and young people should have an asthma action plan; this will tell you what may trigger their asthma symptoms, the medications they use to prevent their asthma, and, most importantly, what and how much medicine to give when they are breathless or having an asthma attack.
Q4. Where can I find more information about how to manage asthma within my school?
All local authorities will have guidance on how to manage health conditions within schools; some may have additional guidance on how to manage children with asthma.
For additional information and to ensure your school meets the highest standards we would recommend reviewing The Healthy London Partnership asthma toolkit which is full of lots of useful information and guidance about how to manage asthma in your school. Downloading and reading the ‘Schools Guide’ would be a good starting point.
Q5. Where does the school obtain salbutamol from?
The school should have a policy in place detailing medicine administration in school; these can be obtained often from the local authority or school nursing team. Schools are responsible for the medical welfare of children whilst they are under their care. It is often advantageous to have access to salbutamol in the school for children with asthma as it allows for the early treatment of asthma attacks; this can prevent the need to call an ambulance, attend hospital, and reduce disruption to the child and their education. We would recommend keeping a register of all children with asthma who attend the school and how you intend on managing the child during an asthma attack (i.e. using the child's inhaler, school held inhaler, or no treatment within school). It is important to obtain the legal guardian's consent for all schemes:
1. Children and young person’s holding their own salbutamol in school
Some children may be able to manage their own condition, carrying their own inhalers on them, and administering them when required. It is important that these are kept on the child at all times and school staff are aware of their medical condition. The following advice provided by the Healthy London Partnership describes the legal responsibilities of the school, school staff, parents, and children.
2. Using the child or young person’s own salbutamol which is kept safe by school
We would recommend that the school keeps the child or young person's legal guardian consent, reliever inhaler, spacer device, and asthma action plan together in one place. These should be kept safely and securely outside of the sight and reach of children, but close by if needed.
Additional information and advice regarding how best to manage this system, i.e. requirements for documentation, and informing parents of doses, can be obtained from your school nurse or found within the Healthy London Partnership Schools Guide found here: https://www.myhealth.london.nhs.uk/system/files/HLP-schools%20asthma%20guide%20May%202016.pdf
Q.6 Emergency salbutamol inhalers in schools
Due to a high number of children and young people failing to take salbutamol to school, in 2014, schools were able to hold salbutamol in case of asthma attacks if needed. These can be administered to children who are known to be asthmatic, if the school is aware that their usual treatment for asthma attacks would be salbutamol, and if they have consent from the child's legal guardian to give salbutamol if needed.
It is important that the school has policies in place to support this and supplies can be obtained from their local pharmacy. The Health London Partnership Schools Guide provides information on Emergency Salbutamol for schools found here: https://www.myhealth.london.nhs.uk/system/files/HLP-schools%20asthma%20guide%20May%202016.pdf additional information about how to obtain salbutamol from pharmacies can be found on the Healthy London Partnership website under the following link:
Q7. How do we tell if it is an asthma attack?
The signs of an asthma attack are:
- Persistent cough (when at rest).
- A wheezing sound coming from the chest (when at rest).
- Difficulty breathing (the child could be breathing fast and with effort, using all accessory muscles in the upper body).
- Nasal flaring.
- Unable to talk or complete sentences. Some children will go very quiet.
- May try to tell you that their chest ‘feels tight’ (younger children may express this as tummy ache).
When to call an ambulance:
CALL AN AMBULANCE IMMEDIATELY AND COMMENCE THE ASTHMA ATTACK PROCEDURE WITHOUT DELAY IF THE CHILD:
- Appears exhausted.
- Has a blue/white tinge around lips.
- Is going blue.
- Has collapsed.
- You are following the child or young person's personalised asthma action plan and it directs you to call for an ambulance.
Q8. I'm worried about a child in my class who has asthma. They seem to be having lots of asthma symptoms, what do I do?
Speak to your school nurse and also let the child’s parent or carer know you have concerns. It is important that the child has an asthma review with their GP or Practice Nurse to assess their asthma control and to ensure they are on the correct medication.
Q9. Can children with asthma still participate in PE?
Children and Young People with asthma should be able to undertake physical exercise in line with their peers. Teachers should speak to the family or carers to identify any additional needs the child or young person may have with regards to physical activity; some children may be required to take additional precaution, limit their activities, or take medications prior to exercise based on medical recommendations.
Q10. How do we ensure children with asthma are safe on school trips?
We would recommend, when planning a school trip, to contact families / carers to update your records of any relevant medical conditions the child has. Children should continue to receive their medicines whilst under the care of the school on trips. Please review your school / local authority police on managing medical conditions.
We would recommend ensuring that you have an up-to-date copy of the child or young person's asthma action plan, including their preventer (regular medications), and also the plan for if the child has an asthma attack. Some children and young people may be able to manage their own medicines and these can be kept on them. If not, the school should ensure these are safe but kept close to the child at all times. Medications should be labelled for the child with the correct instructions.
Please see below this very useful guide for children with epilepsy in school – it will answer many of the common questions school staff may have: https://www.epilepsy.org.uk/sites/epilepsy/files/Education%20Epilepsy%20in%20schools%2014%208%2014.pdf
Q1. Should my student attend school trips?
Yes – We advice that a child with epilepsy should attend school trips and that a risk assessment is completed prior to the trip to make it as safe as possible. We are on hand to help with any further training needs and questions. When a risk assessment is completed we advice the student (If old enough) and parents/carers are included.
Depending on how long the school trip is, it is worth checking to ensure you have a care plan in place for the child or young person and this is correct. If you are going away longer than the school day, the child may require additional medicines to control their epilepsy. Your school should have a policy on administering and managing medicines for children, additional information can be sort from your local authority or school nursing team. This will cover how to obtain consent from their legal guardian, how to store the medicines safety though it is important that the care plan you have is accurate and you are comfortable in supporting medicines taking.
School activates such as swimming are encouraged with the right support in place such as utilizing a swimming pool that has lifeguard support and that the lifeguard is made aware of the diagnosis. When swimming it is also advised to have an allocated person to watch the child in the pool e.g. a parent could watch the child whilst in a group swimming lesson.
Contact sports such as football and rugby are fine unless specified otherwise in the school care plan.
Q2. I am a teacher not a nurse. Why do I need to know about epilepsy?
Education and health should work together as much as possible so that children with long term conditions are included in education and all activities.
There will be guidance provided to the school by health colleagues to support the school to do this.
This useful website will help the school to create a policy document: https://www.gov.uk/government/publications/supporting-pupils-at-school-with-medical-conditions--3
Q3. Should my student have a care plan in school?
Yes – The care plan should be completed by the school nurse or epilepsy nurse. We advise that this I completed in calibration with the parents and child and that they give consent for this plan to be used.
Q4. Does my student need extra time to complete tasks in lessons and for exams?
Extra time and conditions for exams maybe a requirement for children and young people who are diagnosed with epilepsy – Please seek your support from your school SENCO or allocated staff member.
Q5. Will a child with epilepsy need additional support in lessons?
This is dependent on the child’s educational ability and cognitive development. Having a diagnosis of epilepsy does not necessarily mean that the child or young person will be academically behind his/her peers especially if the condition is well controlled.
However, a child who has poorly managed epilepsy and may be having frequent absences during lessons may need extra encouragement to consolidate their learning at the end of each lesson and ensuring that homework tasks have been fully understood.
Q6. Will I liable if something goes wrong whilst the child is in my care?
All the usual guidelines and protocols should be followed in the same way as they would for any child in your care, so that if there was an emergency situation an ambulance should be called. While there is no special liability regarding the child who has seizures, you do have a duty of care to provide the necessary support as demonstrated to you at the training and stated in the child’s school care plan. Providing this support could give the child or young person a really good chance at completely recovering from a seizure.
Q7. Who do I go to if I need support in school regarding epilepsy?
There are a number of people you can contact to gain support. Parents/carers are a good source of information and know their child the best. You can also contact your allocated school nurse or epilepsy nurse. You can also consult other staff members who work with that child in school and who have attended the epilepsy training.
Q8. Will my student have behavioural difficulties?
Caring for children and young people is often challenging as children develop their own sense on being which can be complicated through having a long term condition.
For children with epilepsy, changes in mood or behavioural difficulties can be influenced by their underlying condition, social circumstances and medical treatments. Some medicines can alter mood and behaviour.
If you are concerned about a child’s or young person’s behaviour we would recommend discussing this with their parent or carer and if needed seek support from the school nurse or team co-ordinating their epilepsy care.
Q9. Should my student be disciplined like the other students?
You will find that because your student has a diagnosis of epilepsy the temptation is to be more lenient towards them. This, however, may not be helpful in the long run and can lead to behavioural difficulties.
We do advice that as much as possible your student is treated the same way as other children both at home and school.
This will help your student to normalise his/her condition and lead as fulfilling a life as possible. There are some safety issues that may need consideration but you and your student will get use to these pretty quickly.
Q10. Can the student still participate in sport with epilepsy?
Yes. We encourage all children and young people to take part in all sport in school and social settings.
We often get asked if swimming is ruled out, however we advise swimming in a supervised swimming pool is best and informing a lifeguard before you get in. When swimming it is also advised to have an allocated person to watch the child in the pool e.g. a parent could watch the child whilst in a group swimming lesson.
For more advice on individual activities, please click here: https://www.epilepsysociety.org.uk/sport-and-physical-activities
Q11. What training is on offer to schools?
Training should be offered to school regarding epilepsy and seizure management on a yearly basis by the school nursing service in Lambeth and Southwark. The epilepsy nurse can offer training tailored to the individual child.
There is no subsitute for face-to-face support but this link will provide some extra additional advice: http://learn.epilepsy.org.uk/first-aid-for-seizures-in-schools/#focal