Asthma and the Schoolchild

Since school is the child's home away from home, it is one of the most important environments for children.  School officials must make a conscientious effort to understand asthma and its impact on the child with asthma.  Appropriate measures must be taken to meet the needs of the asthmatic.  Since there are approximately 3 million asthmatic children under the age of 15 in the  U.S. , the problem is a real one.

In order for the asthmatic child to function normally at school, all concerned (the child, family, physician, school personnel) must work together to prevent and/or control asthma at school.  It is important for the child to have both a positive and a healthy educational environment.

What should a parent do?

They should make the school personnel aware of the child's asthma.  To do this, they should meet with the teacher, school nurse and perhaps the principal, at the beginning of the year.

1. Explain to them that the child has asthma, what medications he/she must take and what side effects they have.  The child with asthma should be treated “normally” like the other children.
2. Encourage the teachers to allow the child to take his/her medications as required without making it “a big deal.”

There are common school problems faced by the child with asthma

• Increased Asthma Symptoms.    One problem is high absenteeism because of increased asthma symptoms or from doctors' appointments.  Sometimes teachers will send a child home because they think the cough/wheeze/shortness of breath/runny nose is “contagious”.  A well-informed teacher will lessen this problem.  In some cases, extra tutoring will be needed.  However, at all costs, the child should be kept in school.  Total education in the home could have a negative psychological effect on the child.  As long as usual daily activities can be carried out, try to send the child to school even if there are minor asthma symptoms.  Good communication between the parents and school officials will enable the mildly ill asthmatic to attend school.  In order for this to occur, it is essential that the child be able to take his/her medication at school and that the parents be easily reached in case of an emergency (i.e., wear a beeper or carry a cell phone).

Sometimes, a child with asthma will use his asthma as an excuse not to attend school or participate in specific school activities.  Parents and teachers need to recognize this and discourage this behavior.

• Medication Side Effects.   Side effects from medication can be a real problem.  The side effects may include headache, hand tremors, stomachache, lethargy (also caused by the middle-of-the-night attack, etc.) and these may alter the child's ability to learn.  Many of the medications also may affect the child's concentration level and may alter his/her handwriting.  The teachers must be aware that asthma medications that may alter the child's ability to perform and/or behave properly.  Parents should be told of any problems so they can be dealt with by appropriate changes in the child's asthma management program (i.e., medication dosage changes, medication changes).

• Physical Education and Sports.   Participating in physical education and on organized sports teams sometimes creates a problem for the asthmatic child.  Proper education of all concerned should help avoid embarrassment and/or the avoidance of exercise.  Certain environmental conditions (cold, dry air, wind, smog, increased levels of allergens, presence of a viral upper respiratory illness) may cause more asthma symptoms with exercise.  The child and teacher/coach should know which medications to administer to prevent exercise-induced asthma.  It is important not  to avoid exercise but to properly prevent or reduce exercise-induced asthma.  Before starting a school physical education class, the child's physician should write a letter to the physical education teacher/coach outlining the nature of exercise-induced asthma, prevention techniques, caution signals and explaining the child's asthma management program.  The school needs to help the asthmatic child participate in physical education and sports and trust that he/she knows their own limitations.

• Other Problems.   There are other problems that an asthmatic child who is allergic may encounter at school.  Sometimes the classroom might contain such allergens and irritants as pets, dusty carpeting, old blackboards or the presence of mold.  Proper classroom ventilation is essential especially when working with chemicals: art projects, science projects, etc.  Sometimes avoidance requires a change of classrooms.

Some children with nasal allergy have associated ear problems which could interfere with their hearing.  Teachers should be instructed to look for evidence of hearing loss including inattentiveness, trouble following directions, behavior changes, and signs of worsening work performance.

There are children with asthma who are sensitive to food or to food preservatives.  For schools which operate a cafeteria, parents need to discuss the problem with the cafeteria personnel.  On certain days, the child may have to bring his/her own lunch.

Thus, for the asthmatic child to function normally at school, teamwork is required.  The family, school officials and the child with asthma must all work together.  This team effort will help create a positive and healthy school environment for the child

** Adapted from the Asthma & Allergy Foundation of  America  and the Allergy and Asthma Network