New school policy

[CMdeux]

I think that it depends, however, on whether or not you have a kid that has frequent need for benadryl.

I mean, if I removed benadryl entirely from DD's action plan...

while on the face of things, that seems "better" since it would mean that nobody would EVER consider that the 'first line' treatment for a reaction...

it would simultaneously have two side effects that (IMO) would erode any benefit significantly:

a) DD would be FAR more likely to 'under-report' symptoms if she knew that it was "all or nothing."  With a kid that already has under-reporting of symptoms or shyness a problem?  That is NOT an insignificant problem to exacerbate-- it could lead to catastrophic delays in seeking help.

b) in lightly contaminated environments (and let's be honest here, for some kids, MANY environments are "lightly contaminated" pretty much all the time), low-level symptoms will mean that the student has to determine for him/herself just when those rise to "bothersome ENOUGH" to seek help.  So it seems to me that while Epi-only makes things EASIER for teachers and other staff, it certainly makes them considerably MORE complex for the student with the allergies.


SO no, I am not a huge fan of "no benadryl for anyone" as a blanket policy.  But I have my reasons.

[rebekahc]

Right, but if you have a child who would not self-administer Benadryl (and simply has it in the med bag for convenience of the person who does make that decision), then, IMO, it shouldn't be in the med bag at school because the teacher shouldn't be making the Benadryl decision - only the life-saving decision.  Also, no child would be allowed to self-administer Benadryl at school - the nurse would have to do that, so for mild symptoms the nurse would have to give the Benadryl anyway.  With the teacher and non-medical staff it is all or nothing no matter what. 

[notnutty]

My DS does not self-carry Benadryl at school because there is nobody in the classroom (or really the school) who is educated enough to know whether Benadryl should be given or epi.  If an allergic reaction is suspected, GIVE EPI!

[CMdeux]

But my question is, then doesn't that put ADDITIONAL onus on the child/the parents to REMEMBER TO ADD IT BACK whenever the child is somewhere OTHER than school?

See, that's what I'm getting at about it being a sticky point from a management training perspective.

It's like teaching a child to TAKE OFF a medic-alert bracelet for a team sport because it's more convenient than the coach remembering to tape it.

[CMdeux]

Right, but if you have a child who would not self-administer Benadryl (and simply has it in the med bag for convenience of the person who does make that decision), then, IMO, it shouldn't be in the med bag at school because the teacher shouldn't be making the Benadryl decision - only the life-saving decision.  Also, no child would be allowed to self-administer Benadryl at school - the nurse would have to do that, so for mild symptoms the nurse would have to give the Benadryl anyway.  With the teacher and non-medical staff it is all or nothing no matter what.

Agreed-- but doesn't the need to remove it from a self-carry pack of meds basically say  that teachers can't be relied upon to do what they have been TOLD not to do??  (give benadryl)

I dunno.

Maybe it's because DD isn't in that kind of school setting, but I have allowed HER to decide when benadryl is appropriate and to self-medicate with it since she was about ten.   She'd lose a lot of instructional/activity hours without it.   

[rebekahc]

I see what you're saying, but I still can't wrap my head around having a med on a child that they and the cargiver can never use anyway.  I think not having Benadryl in the bag when it can't be used except by the nurse isn't the same as a coach wanting to take of the med alert bracelet for convenience. 

ETA:

Agreed-- but doesn't the need to remove it from a self-carry pack of meds basically say  that teachers can't be relied upon to do what they have been TOLD not to do??  (give benadryl)

I though the OP said the school was requiring all self-carry kids to add Benadryl to their med bags - not the other way around.  So basically I'm saying, "What's the point?  Here are reasons why I think that's a bad idea."

Maybe it's because DD isn't in that kind of school setting, but I have allowed HER to decide when benadryl is appropriate and to self-medicate with it since she was about ten.   She'd lose a lot of instructional/activity hours without it.

In a school setting a child - even an 18 year old student - is never allowed to self-administer meds except epi and inhalers.  So, even though your DD or my DS has been able to self-evaluate and administer Benadryl for years, she or he would not be allowed to do so at school.  They would still have to go to the nurse and ask for it.

From OP (bold mine):

They will also require him to carry a single does benedryl AND have a prescription on that also!?!?!?!?

[maeve]

True....




BUT-- and bear with me, because I'm going to play devil's advocate here momentarily...

isn't that ACTUALLY asking a family to modify what they (and their physician) have determined is the best means of TEACHING the child appropriate self-advocacy and responsibility for the allergy??

Use an analogy--

suppose that (at least for the school) it is EASIER if a diabetic child doesn't carry a BGC monitor on their body... and instead ONLY carries glucagon tablets?  It does, after all, 'remove' the decision-making option for everyone but the nurse. 

While I can see why that is more convenient for the school,

I can also see that if it is ultimately in the child's best interests to self-carry certain items related to overall good management, then the SCHOOL is the party that needs to figure out how to make THAT work for them-- not the other way around.

KWIM?

I'm looking at this as the parent of a child who is increasingly having to be fully responsible for her own medications, however.  NO WAY would I concede for her to "remove" items from her medication pack just so that someone else had rules that were simpler.

Totally valid points.  I have forgotten to remove the prefilled Benadryl spoons in DD's purse.  I'm not going to because she carries that purse on the weekend and we might be likely to use the Benadryl should she have a contact reaction.  If the school happens to discover that she has the Benadryl in her purse, I'll play dumb.  It hasn't been an issue right now. 

My bigger fish to fry right now:  getting DD's EpiPens out of a locked box at aftercare.  A box locked with a combination lock.  Seems according to the law in VA, I'm going to need a doctor's note indicating it should not be locked up.  So I have a call in to Hopkins right now (along with a request for a note to her pediatrician clearing her for the flu vaccine).

[maeve]

But my question is, then doesn't that put ADDITIONAL onus on the child/the parents to REMEMBER TO ADD IT BACK whenever the child is somewhere OTHER than school?

See, that's what I'm getting at about it being a sticky point from a management training perspective.

It's like teaching a child to TAKE OFF a medic-alert bracelet for a team sport because it's more convenient than the coach remembering to tape it.

I completely agree and this very thought dawned on my this week when I remembered that I'd forgotten to remove the Benadryl from DD's purse.  We've always just had a go-to med pack will all her meds (inhaler, Epis and Benadryl), and I would like it to remain that way because it's easier for training the child to just grab their med pack.  The reason she's carrying this year is to learn to do this for herself; it's not about what's convenient for the adults around her.

[YouKnowWho]

Another devil's advocate here.

We have Benadryl on our action plan for DS2 because he gets full body hives for no known reason and DS1 has contact reactions to gluten and egg.  So yes, I am okay with nurse transporting Benadryl to them (nurse comes to student in allergic reactions).  But it's to be used for hives only.  We had to have the dr sign off on the benadryl as a result (highly recommend giving the Benadryl issues that he writes scrip for diphenhydramine by the way).

Otherwise, two or more symptoms or symptoms without hives, it's Epi. 

So I guess, I am saying that it could depend on the student's previous reactions and if hives or environmentals are an issue.

[CMdeux]

I see what Rebekah and Maeve are getting at here, too, though--

it's REALLY weird for the school to require a non-prescription medication when a physician hasn't required one to be included in the action plan... and weirder STILL for them to then insist on labeling it with a prescription label when it's an OTC medication to begin with.

That's just ODD.   



Glad my point about management being about the long-term interests of the child wasn't misunderstood there.  It's why we ALWAYS have DD carrying a cell phone, too.  Does she "need" to do that?  Well, no-- most of the time, she's with a responsible adult continuously, or at least has been until this past year.

But there is a part of it that is about training HER for the lifetime ahead of her.


I guess my instructions to DD would be fairly "don't ask-don't tell" w.r.t. benadryl in a high school setting.  Then again, we don't HAVE any school nurses.  So it truly would be a matter of all-or-nothing otherwise.



My point, though, I think is still valid-- and that is that it is really not appropriate for the school to be dictating allergy management to individual families and students like this. 

 

If they DO NOT carry benadryl, then there hardly seems a good reason to START for the school's convenience. 

[AllergyMum]

it's REALLY weird for the school to require a non-prescription medication when a physician hasn't required one to be included in the action plan... and weirder STILL for them to then insist on labeling it with a prescription label when it's an OTC medication to begin with.
 

My sons old day care required that we get a note from his allergiest because we did not want him to use benadryl as part of his allergy plan.  I thought it was the dumbest thing I had ever heard to require someone get a note from a doctor to not have to use a medication that their doctor did not want the child to use.

[MamaMia]

I think for children who self-carry everywhere having Benadryl in the bag is a good idea if it's something they need or might use. 

However, at school in an emergency, they don't need the Benadryl - just the Epi.  They can get Benadryl later from the nurse if the doctor wants the child to have it after/along with the Epi.  For mild Benadryl-only symptoms the child and/or teacher should not be the ones giving it - the school nurse should, so they wouldn't use the self-carry Benadryl anyway.  For anaphylaxis, Epi is what's important - the Benadryl is just for comfort and it can wait until the nurse administers it, so no need to self-carry it then either.   

During our 504 review meeting prior to the start of the school year, the staff suggested when we were discussing DD's self-carry that we not put Benadryl in her purse.  Their thought was that if Epi is what should be administered in the event of a reaction, that not having the Benadryl in the pack would eliminate the choice of someone giving her Benadryl in lieu of Epi.  (I'm probably not explaining that well.  Their point, and I think it's a good one, is that it makes the decision process of what to do in a reaction easier, quicker, and really more correct.)

I totally get that point.  However in our situation, I have 2 who self carries both w/antihistamines too.  My oldest is a teen and stays after school for sports.  Frequent skin reactions, rashes, hives that are non-life threatening but needs to have Benadryl since clinic is locked and sports trainer is not qualified to administer antihistamines.  It's a need for us for sure.  I guess it depends on your particular situation.

[MomInMD]

Thank you for such thoughtful comments during this confusing time for us!  After thinking this through, we are going to change our DS's health plan to state that he requires the epi-pen only in the case of a reaction.  Our son has only had one reaction when he was 2. (he is now 10) He has never needed benadryl to stop any sort of mild reaction since.   He has no other allergies but peanut and tree nut. Knowing the reaction he had when he was 2, and knowing what his tests results showed with Dr. Wood, I feel that if he is having a reaction he will need the epi.  I don't "think" that we will ever be talking about a mild reaction with DS.  I do not want anyone making the judgement call to only give him benadryl and see what happens.  This is what I am terrified of happening if someone sees benadryl with the epi.  This is our thoughts as to our DS's situation.  I know everyone is different... 
Still have not seen this new contract that I will need to sign.  Will let you know when I do.
My husband is still upset that they will require the teachers to be trained monthly.  He feels it will just aggravate them, and possibly have bad consequences. I sure hope that doesn't happen! 
I did get the labels for the epi, and have put one on the one he carries.
A funny story since someone mentioned the medical bracelets...my son has worn a metal chain bracelet for years.  He plays soccer and has been required to take it off for games.  Once we forgot, and he went to make a goal  (he was probably 4 or 5) and landed in the net where his bracelet got stuck!!!  Talk about a game stopper and complete embarrassment for DS!  It took me a while to get him free!  We have happily taken it off for games ever since!   

[ajasfolks2]

Slightly going off topic, but related in this thread:

this entire discussion, for me, adds more fuel to the fire for bonafide NEED for in-school-all-day SCHOOL NURSE.

There is NO one-size-fits-all management plan for ANY human with life-threatening allergies and/or additional allergies.

The unpredictable immune system response combined with the unpredictable follow-on response of any other major body organ or system AND the unpredictable individual response to the medications/treatments available makes this condition problematic to manage for ONE child/human . . . let alone the numbers now in schools.

[CMdeux]

   I agree.

No nurses in schools OUGHT to = homebound instruction for kids with life-threatening medical conditions which require management during school hours. Period. 

Asking school secretaries and classroom teachers to shoulder nursing duties (as in evaluation of symptoms and data, followed by appropriate administration of medication) isn't fair or right-- or realistic-- for anyone.

Because in case anyone forgot... they are already supposed to be doing a full-time job as their REGULAR job anyway... and it isn't 'nursing'. 



How my state doesn't understand how they are playing with fire here I will never know.