In what seems like the blink of an eye, summer is nearly over and it's time for back to school. Along with gathering school supplies and packing lunches, parents also need to think about their child's health while in school. It's understandable that some parents may be wondering what the COVID protocols will look like this year and how to decide when to keep their child home from school.
So Yahoo Life reached out to five school nurses from across the country and asked them to share what they want parents to know to help ensure that their kids are healthy and ready for the school year.
No. 1: Consider testing for COVID before back to school and after holiday breaks
How schools handle COVID-19 this school year will differ from last year. "It's not going to look exactly like it did last year at this time," president of the National Association of School Nurses Linda Mendonca, who lives in Rhode Island and spent 25 years as a school nurse, tells Yahoo Life. That's because the Centers for Disease Control and Prevention (CDC) recently updated their COVID guidelines for K-12 schools, easing previous requirements, including removing the recommendation to have cohorts and dropping routine screening testing in K-12 schools unless there are high levels of COVID in the community.
"The CDC has let up a lot on their recommendations from last year," Shauna DeBlieck, a school nurse in Erie, Ill., tells Yahoo Life. But not everyone is happy about it. Robin Cogan, a school nurse in New Jersey who runs the blog The Relentless School Nurse, tells Yahoo Life by eliminating physical distancing and not requiring masks in schools, coupled with stalled vaccination rates in elementary school-aged children, "all of those layers of protection we used in school to keep everyone safe are now being removed."
Instead, some experts say the updated guidelines now shift the focus to individuals and families deciding what works best for them based on their risk profile and COVID rates in their community. "I always believe that the parents should do what they believe is right and go with their gut," says DeBlieck. "If they feel the kids were exposed or the kids are becoming symptomatic, then it wouldn't hurt to double check" by testing for COVID.
In fact, the CDC still recommends testing anyone with symptoms of COVID-19 as soon as possible after symptoms start. Mendonca says it's important for parents to be "on the lookout for signs and symptoms of COVID," which include cough, fever, runny nose, sore throat, muscle aches, headache and fatigue.
The CDC also recommends that staff and students "get tested prior to returning to school following major breaks" — such as summer and holidays — "due to increased travel and social interactions," Rosemarie Dowell, nurse and health services coordinator in the Palo Alto, Calif., Unified School District, tells Yahoo Life.
DeBlieck points out that timing matters when it comes to testing. That's because testing too soon, such as right after coming back from vacation, can lead to a false reading. "When returning from a trip, if the child contracted COVID while away, it is very likely that the test would not catch it until three to four days later, so sometimes testing them early would give a false reading," she explains. "I personally believe testing should be held off until the person is having symptoms."
No. 2: Make sure your child's immunizations are up to date
Staying up to date on routine vaccinations is crucial to prevent illness from many different infections, according to the CDC. Each state has a list of required immunizations for students attending school, Elisabeth Barclay, a school nurse in Ill., who runs the blog, Diary of a School Nurse, tells Yahoo Life.
"If these requirements aren't met, then parents are typically asked to provide a physician medical contraindication note or a religious exemption letter signed by the physician," says Barclay. "School nurses are usually the ones tracking student immunizations and asking parents to help them reach state compliance."
If a student has gotten behind on vaccinations because of the pandemic, parents should make sure the child is up-to-date and get them to a primary care provider, says Mendonca. "If you're unsure if your child is missing immunizations or don't have access to a regular health care provider, your child's school can help," says Dowell.
No. 3: Alert the school nurse if your child has a health condition or requires medication at school
Barclay says that parents should share with the school nurse health conditions, such as asthma, diabetes and seizure disorders, and severe allergies, including food allergies, that might impact their child during the school day.
"There may be times the school nurse requests an action plan be completed, too — this plan provides medical details specific to the student," Barclay says. "Also, plan ahead — if medications need to be administered during the school day, there are many times a special form the child's doctor and parent need to complete prior to this happening. Parents should be prepared to deliver the medication to school in the original container with a current pharmacy label, if it's a prescription."
Adds Dowell: "Each district and state have different policies and procedures, so it’s best to contact your school directly to find out what paperwork they may require" for administering medications.
When it comes to parents sharing health information about their child, DeBlieck says it's better to share too much than too little. "As a school nurse, I would rather be over-educated on a student," she says. "If I am unaware of a condition, I will research it to find out all I need to know in order for that student to be safe while in my care. For medications, it is good for me to know anything that is on the prescription. At my school, we do require paperwork to be filled out by both the prescriber and the parent giving the nurse permission to administer."
No. 4: Watch for symptoms that signal your child should stay home from school
"Now more than ever it is very important for students to stay home from school when they are not feeling well," says Barclay.
In general, any sickness that a student could spread to others — whether it’s respiratory or gastrointestinal — or that would keep them from having a productive school day is a good yardstick for keeping them at home, notes Dowell. "It can be really hard to judge a cough, but if you feel like you'd give your child medication at home for their cough, then you might as well keep them from school," she says.
Dowell says that students should stay home if they're experiencing any of the following:
A fever of 100.4 or higher until they have been fever free for 24 hours or longer without fever-reducing medications
Cold symptoms like a productive cough, or green or yellow nasal discharge
Vomiting or diarrhea episodes should remain at home for 24 hours or longer
Untreated draining ears or significant earache
Red, swollen, crusted or draining eyes
Significant sore throat
Communicable diseases, like chickenpox, pertussis or COVID-19
When in doubt, check with the school and "don't send your child back to school until you get approval from the school nurse and your child is symptom-free or has improved symptoms," says Barclay.
No. 5: Learn about the signs of monkeypox
The risk of monkeypox in children and adolescents is low, according to the CDC, and Barclay says there shouldn't be a huge concern for monkeypox among children and adolescents.
However, the virus can infect anyone — including children — if they have close, prolonged skin-to-skin contact with someone infected with monkeypox, per the CDC. The virus can also be spread by touching objects such as toys; fabrics such as clothing, bedding or towels; and surfaces that have been used by someone with monkeypox. What's more, young children under age 8 have an increased risk of severe disease if they contract monkeypox, according to the American Academy of Pediatrics.
"I think parents do need to be made aware of what to look for," says Cogan. DeBlieck agrees, saying, "I don't think it's a bad idea" to know the signs. "Any time there is a new illness or disease going around, parents should always know what to look for," she says. "It is better to get a hold on it before it worsens."
Rash is the most common symptom of monkeypox, which can look similar to other common rashes in children, such as those caused by hand, foot and mouth disease, chickenpox and allergic skin rashes, according to the AAP. "It can be tricky because a lot of viruses can present the same, so when in doubt, it's never a bad idea to contact the child's health care provider," says DeBlieck.
The rash can progress to look like pimples or blisters and may be painful or itchy, according to the CDC. Other symptoms include fever, chills, fatigue and headache.
"If children have any kind of raised marks or vesicle that's fluid-filled on their bodies and parents are not sure what they're from, they need to be identified before they return to school," says Cogan. "If they have lesions, we need to know they are not contagious. If they are dry and not weeping, they can return to school."
No. 6: If your child has a mental health issue, let the school nurse know
Along with a student's physical health, school nurses say it's just as important that parents share any pertinent information about their child's mental health. This can include anxiety and depression — "We know that the pandemic really impacted students and really affected all of our mental health," says Mendonca — or big changes in a child's life, such as a death in the family or parents' divorce.
When kids are having a hard time, "it may show up as a stomach ache or headache or fighting or withdrawal," says Cogan. "We could be more supportive if we knew what was happening. We're really there to partner with families. We care about children's success."
Cogan says that school nurses are a "wealth of knowledge" when it comes to resources that can help kids. "We share the same goals — we want our kids to be safe, healthy and ready to learn and for children to flourish — and we can't achieve that goal if we don't have the full picture."
Dowell agrees, saying that "school nurses are here to support your child's physical, mental and emotional health, and we look forward to partnering with parents to ensure no student's health is a barrier to them accessing their education."
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