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The following guidelines should be followed for your child to attend or return to school:

* If your child becomes ill or injured, it is imperative that the nurse's office has 3 legitimate contact numbers on file. The nurse's office must be able to reach parents, guardians, or someone who will be responsible for the child and pick them up in a timely manner.

* Students should be fever free (temperature less than 100 degrees) for 24 hours before returning to school.

* Students should remain at home for 24 hours after the last episode of vomiting or diarrhea.

* Students should remain at home for 24 hours after beginning an antibiotic for an infection, including drops for pink eye.

* If your child has a rash, check with your child's pediatrician before sending the child to school.

Food Allergies

Our immune system protects us from foreign substances such as viruses and bacteria. When an individual has a food allergy their immune system overreacts to harmless substances found in that food or drink causing a reaction.

- There are eight foods that cause 90% of the allergic reactions in the United States:

Milk Eggs Peanuts Tree Nuts Wheat Soy Fish Shellfish

- Two million school age children have food allergies.

- One in five children with food allergies will have a reaction while in school. Peanuts are the most common cause of reactions in the school setting (elementary).

-Children may be allergic to more than one food.

- Anaphylaxis is a severe reaction to an allergen (food, latex, insect stings, medications). Symptoms: Wheezing, throat tightness, nausea, rapid pulse, flushing, faintness, hives.

- If a reaction is to occur, it is usually within two hours of contacting the allergen.

Information received by the Asthma and Allergy Foundations of America: St. Louis Chapter

Asthma

All students with a diagnosis of asthma, or student who require regular use of an inhaler are required to have an Asthma Action Plan filed with their school nurse.

Did You Know?

The National Institutes of Health (NIH) has declared asthma a major health problem in the United States. You may not be aware of it, but:

*About 1 in every 15 children has asthma.

*More than a half a million emergency room visits for children under age 15 are caused by asthma each year.

*Among chronic diseases, asthma is a major cause of missed school days among children 5 to 17 years old.

*Childhood asthma symptoms are often worse late at night.

Common asthma triggers in uncommon places can affect your child.

Even when your child tries to avoid asthma triggers, they can sometimes catch your child by surprise. Here are a few ways you can help prepare for the unexpected:

Respiratory Infections

*It may surprise you, but respiratory infections such as colds, flu- even sore throats- are the number one asthma trigger in young children. So remind your child to wash his or her hands often.

Dust/Dust Mites

*Kids love toys and games, and so may dust mites! Regularly wash stuffed animals and check toys pulled from the back of a closet or the basement for dust. Even new toys may need cleaning to get rid of any dust that may have built up while on the store shelf.

Sulfites

*A type of preservative found in some beverages and snacks, such as dried fruit, could trigger your child's symptoms. Try to avoid serving these foods. When eating out, ask your waiter if your child's meal can be prepared without these additives.

Mold

*Carpooling is pretty common for most families these days... and so is the possibility of car air conditioners hosting some mold. Before piling the kids in, open the windows and run your system for 10 minutes.

What does asthma feel like to your child?

Asthma symptoms vary from child to child.

However, the most common asthma symptoms are:

Coughing- Your child has a persistent cough that is often worse at night or in the early morning. It may interrupt or prevent sleeping.

Wheezing- Your child hears a whistling or squeaky sound when she or he breathes.

Chest tightness- Your child feels as if someone is sitting on or squeezing his or her chest.

Shortness of breath- Your child cannot catch his or her breath, or feels out of breath. Your child may even feel that not enough air is getting out of his or her lungs, like trying to breathe through a straw.

If your child uses only a rescue inhaler for asthma, but still feels these symptoms often, talk to your child's doctor about whether a daily controller medicine to help prevent symptoms should be a part of the Asthma Action Plan for your child.

Information was received from Merck

Head Lice

What Are Head Lice?

Head lice are about the size of the head of a pin. They vary in color depending on the coloring of the infested person. Head lice can, but do not always appear darker on a dark person with dark hair and skin and lighter on a person with fair hair and skin. The lice can be brown, tan, to a cream color. They are very small and do not jump or fly. They will shy away from light. They are difficult to see, so a flashlight, black light, and magnifying glass can be helpful in detecting them. The eggs vary in color and can be slightly larger and they are usually oval shaped. They are attached firmly to the hair shaft.

Who Gets Head Lice?

Anyone, no matter how clean they are, can get head lice. If the conditions are right and contact is made with an infested person or object, head lice can be passed on. Head lice infestations are often found in schools, camps, and institutions. Children frequently become infested due to the close contact with other children. Long hair is not a factor in the transmission of head lice.

How are Head Lice Spread?

Head lice are spread by direct person-to-person contact. They can also be spread by way of combs, brushes, caps, and bedding. Head lice can be spread as long as lice or eggs (nits) remain alive on the infested person or clothing.

How Can I Clean the House, Car, & Personal Items?

*All personal head gear (hats, hair clips, ribbons), scarves, coats, towels, and bed linens should be washed in hot water and then dry in the dryer on the hottest temperature setting available.

*Clothing, bedspreads, blankets, pillows, or stuffed animals that cannot be washed should be dry cleaned or sealed in a plastic bag for a period of two weeks. Don't forget the book bags, and those in kindergarten the kindermats.

*Vacuum everywhere. It is recommended that all rooms and furniture be vacuumed. Carpets, mattresses, upholstered furniture, and car seats should also be vacuumed.

*Sprays can be used, but may not be tolerated well by everyone. Please consult a physician prior to using sprays if you have any concerns or questions.

What is the Life Span of Lice and Nits?

Head lice need warm, moist conditions of the scalp to live. Lice that fall off the scalp die within 48-55 hours. Eggs (nits) that have fallen off the scalp do not hatch at or below room temperature. Therefore, they do not play a major role in the spreading of head lice.

What are the Symptoms of Head Lice? How Long Do Symptoms Appear After Infestation?

Itching and scratching of the scalp are usually the first signs of head lice. The life span of a louse is approximately one month. A louse can lay up to 5 eggs per day. The eggs take 7-10 days to hatch and then another 8-9 days to become mature louse. It may take several weeks or longer for symptoms to become bothersome enough to cause concern.

How Do You Check for Head Lice?

* You will want to check by a window, because natural light makes them more visible.

* If this is not feasible, use a lamp with at least a 60 watt bulb or flashlight.

* Using a magnifying glass may help.

* Begin by lifting and separating the hair behind the ears and the nape of the neck.

* Continue to check entire head, even if nothing is found behind the ears and nape of neck.

* It is easy to mistake dandruff, dried hair spray, or bits of dead skin for nits. The difference is that these are easy to remove from the hair by blowing or brushing. It will be virtually impossible to remove nits from the hair except with a fine toothed comb or pinching with fingers and removing by hand.

What is the Treatment for Head Lice?

Medicated shampoos or creme rinses are used to kill lice. Some of these products may be purchased over the counter while some may require a prescription from a doctor. Package instructions should be carefully followed. Some children and adults may have a reaction to the ingredients in these products. If you have any concerns about a product, please consult a physician prior to using the product. Some of the products may require a second application. A nit comb should be used to remove all eggs. A reinfestation may occur, if all nits are not removed. To help loosen nits, a 50% vinegar and water solution may be used as a rinse. Then, wrap hair in a vinegar soaked towel for at least 30 minutes. This can help with the removal process.

What is the Mayonnaise Treatment?

A mayonnaise treatment can be used instead of the pediculocides.

*You must use 100% mayonnaise.

*Apply generously to dry hair, make sure that all hair shafts and scalp are saturated.

*Cover head with plastic wrap or shower cap and leave covered for at least 2-4 hours.

*Rinse with warm water and shampoo hair.

*Nits must be combed out with nit comb or removed by hand.

*After removing nits, thoroughly dry hair with a blow dryer.

*Finally, recheck hair again for nits.

When Can Students Come Back to School?

A student must be "Nit Free" before readmitted to school. All nits must be removed from the hair. The nurse WILL NOT remove nits. The Hillsboro School District has had a NO NIT POLICY since 1989. The student MUST be accompanied by an adult to the nurse's office. The nurse will check the student before they are permitted back to class or on the bus. Once they are cleared by the nurse, a pass for class will be issued to the student.

Other Alternative Treatments:

Head Lice & Tea Tree Oil- Add 20 drops of Tea Tree Oil to an 8 oz. bottle of regular shampoo for preventative or maintenance use. For intense use, apply about 15 drops of Tea Tree Oil to 1/2 tablespoon of the above shampoo, and massage into child's hair and scalp. Leave this mixture on for 10-15 minutes, then rinse out. Repeat this procedure 2-3 times per week depending on the severity of infestation. Between shampoos, a few drops of the Tea Tree Oil can be massaged into the child's scalp. DO NOT rinse out. Brushes d & combs can be soaked in a solution of 10 drops of Tea Tree Oil to a quart of water, to help sterilize, & prevent further infestation.

Five Step Olive Oil Treatment Plan- Step 1. Use a pediculocide. This will kill most lice. Read and follow the directions on the label. Step 2. Apply olive oil to hair, cover with a shower cap and leave on for 6 hours. Treat hair on days 1,5,9,13,17, and 21. These days coincide with the life cycle of the louse. If you don't use a pediculocide, you should use the olive oil on day 1 & day 2, as well as the designated days listed above. You may do the treatments more often, but don't miss any of the designated days. Step 3. Clean the environment using the house-cleaning methods described in earlier information and on the pediculocide label. Step 4. Leave the olive oil in the hair and, using a good nit comb, comb the hair section by section. Then carefully comb all the hair, removing all the nits. Wash out the olive oil. NOTE: The oil kills the lice by covering the holes through which they breathe. If they aren't completely covered by oil, they may not die. The oil will slow them down, so they can be caught in the nit comb. Step 5. Check dry hair in a bright light, such as sunlight, for any missed nits. All nits must be removed and the nit comb may not get all nits. You may need to literally pick out some of the nits.

ADHD/ADD

What is ADHD?

ADHD is a condition of the brain that makes it difficult for children to control their behavior. It is one of the most common chronic conditions of childhood. It affects 4-12% of school aged children. About 3 times more girls are diagnosed with ADHD.

What are the symptoms of ADHD?

ADHD includes 3 groups of behavior symptoms: inattention, hyperactivity, and impulsivity.

Are there different types of ADHD?

Not all children with ADHD have all the symptoms. They may have one or more of the symptoms. The symptoms usually are classified as the following types of ADHD:

*Inattentive only (formerly known as attention-deficit-disorder (ADD))- Children with this form of ADHD are not overly active. Because they do not disrupt the classroom or other activities, their symptoms may not be noticed. Among girls with ADHD, this form is most common.

*Hyperactive/Impulsive- Children with this type of ADHD show both hyperactive and impulsive behavior, but can pay attention. They are the least common group and are frequently younger.

*Combined Inattentive/Hyperactive/Impulsive- Children with this type of ADHD show a number of symptoms in all 3 dimensions. This is the most common type of ADHD.

How can I tell if my child has ADHD?

Remember, it is normal for all children to show some of these symptoms from time to time. Your child may be reacting to stress at school or home. She may be bored or going through a difficult stage of life. It does not mean she has ADHD.

Sometimes a teacher is the first to notice inattention, hyperactivity, and/or impulsivity and bring these symptoms to the parents' attention.

Perhaps questions from your pediatrician raised the issue. At routine visits, pediatricians often ask questions such as:

*How is your child doing in school?

*Are there any problems with learning that you or your child's teachers have seen?

*Is your child happy in school?

*Is your child having problems completing class work or homework?

*Are you concerned with any behavior problems in school, at home, or when your child is playing with friends?

Your answers to these questions may lead to further evaluation for ADHD. If your child has shown symptoms of ADHD on a regular basis for more than 6 months, discuss this with your pediatrician.

Information from he American Academy of Pediatrics

Sleep Disorders

"Evidence suggests that teenagers are seriously sleep deprived. A poll conducted by the National Sleep Foundation found that 60% of children under the age of 18 complained of being tired during the day, according to their parents, and 15% said they fall asleep at school during the year."

*There are 4 stages in good quality sleep. All 4 are vitally necessary in our natural body processes. We do not fully understand the underlying factors but it has been shown that a decrease in sleep:

-Increases glucose and cholesterol levels which in turn causes a higher incidence of obesity, diabetes, and heart disease.

- Sleep deprivation is actually mimicking symptoms of ADD/ADHD in children.

- Decreased sleep actually increases poor classroom performance, traffic accidents, and behavior issues.

* Sleep in Children

- The amount of sleep required by children varies with the age of the child.

- Sleep deprivation yield change in personality, irritability, impulsivity, attentiveness, academic performance, and psychomotor activity.

- Parental guidance is essential from the earliest age to even the teenage years.

- Up to 37% of children in the US, K-4, suffer from some sort of sleep disturbance

*Common Sleep Issues in Children:

- Poor sleep hygiene

- Irregular sleep/wake schedules

- Co-sleeping with parents

- Eating taught as a coping mechanism for sleep interruptions.

- Media (radio, TV, etc) used to "lull" child into sleep

- INSUFFICIENT SLEEP FOR AGE

* "The consequences of sleep deprivation during the teenage years are particularly serious. Teens spend a great portion of each day in school; however, they are unable to maximize the learning opportunities afforded by the education system, since sleep deprivation impairs their ability to be alert, pay attention, solve problems, cope with stress and retain information. Young people who do not get enough sleep night after night carry a significant risk for fall asleep automobile crashes; emotional and behavioral problems such as irritability, depression, poor impulse control and violence; health complaints; tobacco and alcohol use; impaired cognitive functional and decision-making; and lower overall performance in everything from academics to athletics." (NSF, 2008)

For more information on this subject visit the National Sleep Foundation website at:

Information received from: Sleep Across the Ages, Troy Curry, MD, Sleep Medicine and Research Center

Rashes

Common Rashes:

Inflammatory:

1. Eczema-

the itch that rashes (this means that you will have an itch before a rash appears.)

- It occurs with a dry sensitive skin type.

- Most kids will grow out of it (15% of children have it, while only 1-2% of adults)

- The key is to control the itch, and attempt to prevent scratching (Benedryl, Zyrtec, Emolients, Topical steroids, Antibiotics if scondarily infected)

2. Keratorsis Pilaris-

Has rough follicular papules, giving a "plucked chicken" appearance.

- Small white "pimplish lesions with redness around them.

- Do not pick or squeeze at lesions, it will spread.

- Treatment includes Lactic Acid, Salicytic Acid creams, Urea Cream

3. Nummular Eczema-

Raised dry patches, can have clear papules. Mimicks ringworm.

*Remember- Just because it is round doesn't mean it is ringworm!*

4. Allergic Contact Dermatitis-

Multiple causes such as:

Poison Ivy, Neosporin Ointment, Fragrances, Rubber or latex, Cosmetics, Nail Polish, Sunscreens, Nickel Plated Objects

5. Psoriasis-

Itchy, red patches with silvery scales. Most likely to be found on the scalp, elbows, knees, and buttocks. Will often bleed when scales are picked off. Treatments are:

-UV light

- Topical steroids

- Emollients

6. Impetigo-

A superficial bacterial infection usually caused by Staph or Strep. Many types are becoming drug resistant. When yellow crusting appears the child needs aggressive antibiotic treatment orally and topically. Very common in athletes, those with eczema and molluscum.

7. Molluscum-

Caused by a virus, similar to warts. Noted to have pink shiny bumps with centralized dimple. Can be spread easily by scratching or picking. Also spread by close person to person contact or touching a surface with the virus on it. (Toys, towels, wrestling mats, football pads) May resolve spontaneously

*Can my child go to day care or school if he or she has molluscum?

-There should be no reason to keep a child with molluscum infection home from day care or school (CDC guidelines)

- Growths not covered by clothing should be covered with a watertight bandage.

- To prevent infection, wash hands frequently.

8. Hives-

Transient, itchy, pink, swollen, blotchy, eruptions. Common triggers include:

-Pressure or scratching

-Temperature or exercise

-Medications

-Foods

-Plants

Treatment includes antihistamines, and trigger avoidance. Watch for airway or tongue swelling as this is an indication of anaphylactis.

(Information received from "Rashes for School Nurses, Christopher Kling, MD, Dermatologist St. Luke's Hospital Chesterfield, MO)

Received by the Asthma and Allergy Foundations of America: St. Louis Chapter