The nurse is the "go-to" person in school if your child needs an inhaler or has a scraped knee, a headache triggered by an upcoming test, or a sudden bout of stomach flu. She, and it is most often she, sees your child from a different perspective than anyone else in the building. The responsibilities of school nurses include dispensing medications, maintaining records, and conducting vision and hearing screenings. A major part of their job involves communicating with parents. We thought you'd like to hear from three nurses working on the front lines in vastly different settings. And remember, the school nurse in your child's school is there to help with your questions and concerns.
Sally Seymour is the elementary school nurse at Horace Mann, a selective private school in New York City.
Loretta Heimbecker is a school nurse who divides her time between the Montgomery and Berkshire Public Elementary Schools in rural northern Vermont.
Pam Clark is a nurse for Albuquerque Public School's Developmental Preschool Program. She works with kids who have a range of special needs.
Here are their thoughts on food, sleep, hygiene, stress, allergies, medication, keeping kids home, and immunizations.
First and Foremost Seymour would like to tell parents to "relax." She finds that many parents worry too much--and often about the wrong things. In trying to micromanage their children's lives, they may transfer their own anxiety to their kids. "Kids need to develop the confidence that they'll be okay."
Heimbecker would like parents to know that exercise and nutrition are key to their kids' well-being. She sees these as sensitive issues for many parents. While parents want healthy kids, it's hard to get them to stop serving processed food or to limit their children's excessive electronic-game playing and TV viewing.
Clark's concerns are very basic. She'd like parents to be aware that insurance is usually available to all children in her state, and she refers parents to the appropriate school-based Medicaid office to apply. She also worries that many children do not receive routine or emergency care because of their parents' immigration status, and wants to make sure that every child has "access to and a relationship with a primary care provider." She wants to remind parents that they can make a difference in helping their kids reach their potential.
Food Seymour works to help kids internalize messages about moderation and balance, trust their own body signals, and develop sound, long-term judgment. She feels parents often lose sight of basic nutrition by focusing only on obesity or anorexia. She goes on to note that eating issues are especially challenging in our society, where portions are super-sized and "big birthday cakes have become equated with generosity."
Heimbecker shares Seymour's concerns, and she supports improved school lunches and school policies that ban selling junk food at fundraisers or offering them as student rewards. She views cooking as a springboard for discussion--finding that when kids prepare food, they become more familiar with healthy ingredients. She's concerned about kids who skip breakfast--noting that some wind up in her office with headaches.
Sleep Many kids are sleep deprived, says Seymour. They're up late online or watching TV in their rooms. The next morning they're on the school bus at 7:30 AM. A kid who's exhausted can't concentrate in school.
Hygiene Because her charges are so young, Clark finds it most effective to demonstrate hand washing, tooth brushing, and other healthy nutritional and life-style practices with her preschoolers.
Seymour, too, sees hand washing as key to curbing colds, viruses, and other infections. She suggests that kids learn to sneeze into the nook of their arms and that liquid hand cleaners (Purell, for example) be readily available in classrooms.
Stress "We need to teach kids to relax, to take deep breaths," says Seymour, who often treats kids with stress-related headaches and stomachaches. Kids often confide in her that their stress stems from their social life as well as from schoolwork. She notes that parents may not always be aware of just how much things like tests and birthday parties affect their kids.
Heimbecker comments that kids sometimes come into her office because they need a respite--some time to unwind. Kids may be grappling with difficult situations at home or going through a stressful phase ... for instance, after an unsettling car accident.
Among her preschool charges, Clark finds stress is exhibited in behavioral issues--kids "acting out" by misbehaving or withdrawing in school. She would like to see a greater emphasis on parent education and feels that children's lives "could be greatly improved upon if the state had a parent-education home-visitation program for prenatal and toddler families."
Heimbecker also wants to remind parents of the benefits of play to relieve stress. "Kids need to be outside, using their imaginations. Creative games, board games, active games, and fantasy play all help reduce kids' stress."
Allergies Both Seymour and Heimbecker find that food allergies, notably to peanuts, have become an increasing concern--and that many kids keep EpiPens in the nurse's office to use in case of emergency.
Heimbecker also sees a lot of asthma, made worse by pollutants. Second-hand smoke or allergies to a pet may trigger a reaction, as can smoke from the wood stoves sometimes used in Vermont. She has concerns about air quality, and reminds parents to do "safe renovations" to avoid exposing a child to asbestos and other chemicals.
Medication Heimbecker treats a number of kids on medication for ADHD. She notes that, unfortunately, some parents don't tell the school that a child is on medication. It may not be until a school trip that the school is informed that a child needs to bring an inhaler or medication.
Medication is not without controversy. Seymour observes that there are pros and cons to medication that need to be considered carefully.
There are children in Clark's program with special health needs. She has worked with kids with seizures or gastrostomy tube feeds, and others who require tracheostomy care or have motor deficits that require special equipment and interventions.
Keeping Kids Home Strep throat and pink eye (conjunctivitis) are among the biggest problems when it comes to infectious diseases, says Seymour. She feels that while parents need clear guidelines about when to keep kids home, many working parents face difficult choices--and just hope that their kids don't get sick.
Heimbecker will call a parent to pick up a child from school if a fever goes over 100, and finds that despite the inconvenience, parents are generally cooperative. "There's no point in a child being in the classroom if he can't function." Other problems that require a call home, though not usually an emergency pickup, are rashes, earaches, and bug bites.
Immunizations While immunizations have become controversial, Clark wants parents to know that years of research have gone into immunization recommendations, and she feels it's important for parents to get their kids immunized.
On a similar note, Seymour reminds parents that before immunizations were available, childhood was a "precarious time." She applauds the fact that there are now vaccinations against so many childhood diseases, including recent protection against hepatitis A and B.
The National Association of School Nurses provides information, resources, and education to the nurses who serve our kids. The nurses we spoke to find their work very satisfying but have noted that there's currently a shortage of school nurses.
NASN Healthy Children Handout Learn more about why school nurses are needed, and how your state measures up.
Read 10 Tips for Parents This document was developed by the National Association of School Nurses and the National Parent Teacher Association with support from GlaxoSmithKline.