Fall is filled with the smell of apples, the sound of crunchy leaves, and the sight of big yellow school buses taking kids to school. While most kids are worried about getting just the right binder or finding the perfect pair of jeans, many also worry about food allergies and asthma.
This is a time of concern for many parents whose children have asthma and allergies.
"You are moving to having your child manage symptoms on someone else's turf," says Dr. Mike Pistiner, an allergist with Allergy & Asthma Network and a pediatric allergist with Harvard Vanguard Medical Associates. He is also the father of a child with food allergies.
Fall allergens irritate asthma, and stress can exacerbate the symptoms.
"Kids don't get a lot of colds in the summer," says Dr. Scott Schroeder, chief of the Division of Pediatric Pulmonology & Allergy at Floating Hospital for Children at Tufts Medical Center. "It is usually the third week of September, when kids are in a new environment, swapping spit, and being exposed to new compounds and rhinoviruses, that we start seeing more cases of asthma."
Parents play a critical role in building a collaboration between schools, kids, and their allergist.
"Parents really need to plug in with the school nurse. You need to really understand the Anaphylaxes Emergency Care Plan and Asthma Action Plan. You give this to the nurse and your child so they can both understand it step by step," Pistiner says.
Schroeder reminds parents and kids: "Restart or be religious in using asthma medications as prescribed. Often in the summertime, kids are more relaxed about taking medication because they aren't having symptoms."
An Asthma Action Plan is simply a preprinted form parents give to schools or the school nurse that lists what the child's daily medications are and what to do if a child is having symptoms.
"The Action Plan helps everyone stay on the same page," Schroeder says. "It gives the school nurse a place to record symptoms and responses. Young kids may not always be aware of their symptoms, so this helps parents have confidence that the school nurse is taking care of their child."
Even very young children need to be able to recognize their asthma or allergy symptoms and practice what might happen as they feel different things.
"Role playing is a great way for kids to practice what to do when they have symptoms without it being a real emergency," Pistiner says. "Parents should also practice with autoinjector testers."
Parents can empower children with food allergies by helping them practice skills such as label reading, as they need to be savvy about reading labels, finding hidden ingredients, and avoiding cross contamination. Once kids are able to read on their own, have them read labels as they walk through a grocery store with you. Read labels with young children, and as they grow, quiz them.
"My son is a teen now, and I will hand him something in the grocery store and ask, 'Can you eat this?' so he can learn safely with me as a backup," Pistiner says. "But you need to start young. Even the youngest of kids needs to learn to wash their hands before eating when they have food allergies to avoid cross contact."
In addition, parents need to help establish routines for ensuring children -- especially those very young -- are using their medications as prescribed. "Get into a routine. If you use your inhaler twice a day, use it right before brushing your teeth," Schroeder adds. "This way, kids are ready for school."
Kids also need to advocate for themselves and know whom in the school they can ask for help; this might be the nurse or the head of meal services. Work with the school to find a good fit for your child. In addition, pre-readers need to know to find an adult who can read labels for them.
To help start right in a new school or with a new school nurse, parents can help empower their children with allergies and asthma, as well as help the school nurse.
"Make sure all your medical forms are up to date with a legible and understandable plan," Pistiner says. "It needs to be practical and appropriately follow-able by the nurse and other unlicensed assistive staff, like teachers or substitute school nurses. You should also be sure to send in all the medications your child needs, especially if it is an injector. Ideally send in two."
"Always inform the school nurse if there are issues," Schroeder notes. "Things don't usually happen immediately. A drier cough, a case of the sniffles -- it can easily turn into a bigger issue at school, so just let them know."
"Do not be afraid to advocate and/or educate staff on allergies and safe procedures," says Melissa Beyer of Millbury, a mom to two kids with food allergies and asthma.
"Just because someone is a nurse or because a school has had other children with allergies, don't assume that appropriate methods are in place. Previous parents may not have known to push for certain measures, such as peanut-free tables at lunch or wiping down desks before use if snacks are eaten in the classroom."
If you are starting with a new school, plan ahead and "make sure you ask what plan they have in place for safety for your child with allergies and what paperwork they need to store to administer any allergy meds if necessary," says Kristin Graffeo of Acton, mom to a son with nut allergies. "Doctors usually need a couple weeks to fill out Allergy Action Plan paperwork."
"Definitely plan a meeting and don't be afraid to ask questions as to how things are handled," Beyer adds. "Do art projects utilize empty food containers? Are there peanut-free tables? What about food in the classrooms or school-sponsored events such as ice cream socials? What happens if another child brings an allergenic food into a 'safe zone?' Make a list of questions and situations beforehand so you can go into the meeting prepared. Finally, make sure that any provisions, plans, or accommodations are documented and that you receive a copy."
It is hard to remember everything, especially if you have multiple children with different allergies. "But remember, you as the parent need to be sure you fully understand everything your child's allergist tells you," Pistiner reminds. "You should ask questions and be an advocate for younger kids. Remember, ultimately you are the one training everyone else on your child's plan."
"Meeting and speaking directly to the nurse and classroom teacher about what the child needs will help to give you peace of mind as you send the child to school," Graffeo says.
"As a child gets older, it gets a bit easier," Beyer adds. "They can advocate for themselves and be aware of the presence of allergens, and then take whatever steps are necessary to avoid them. In our case, my kids are also able to carry their own EpiPens once they reach junior/senior high school."
"Remind your child that they have asthma, but it doesn't control their life," Schroeder says. "Empower them."
Families not affected by food allergies also play a part in a safe school.
"Unlike all other chronic medical conditions, food allergies require policies that impact other kids," Pistiner says.
Many schools have instituted a "no home-baked goods" or no "outside food" policies for parties and celebrations. These schools often suggest stickers, pencils, or guest readers as alternative treats. Some schools are choosing to have all learning spaces be completely nut-free. These policies make it easier for students with food allergies and reduce the chances of mistakes. It is also easier to train staff who might not always be on site, such as substitute teachers, coaches, and outside specialists.
"Polices need to be in place to keep kids safe and able to learn. Even though this impacts kids without food allergies, everybody wants kids to be safe and wants them to be great," Pistiner says.