Student Illnesses and Medications

Revised June 2, 2009.

Keeping Students Healthy

The CDC recommends reminding children to:
  • COVER THEIR NOSE AND MOUTH with a tissue when they cough or sneeze, and have them throw the tissue away after they use it.
  • WASH THEIR HANDS OFTEN WITH SOAP AND WATER, especially after they cough or sneeze, use the bathroom, and before handling food. If water is not near, use an alcohol-based hand cleaner.
  • NOT TOUCH THEIR EYES, NOSE, OR MOUTH. Germs often spread this way.
We would also add these reminders:
  • Check your child for lice once a week, and contact the Health Office if you find lice or nits. The most effective control is careful, repeated inspection of the child's hair and scalp by parents.
  • Students need to get plenty of sleep and physical activity, drink water, and eat good food to help them stay healthy in the winter and all year.

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What To Do If They Become Sick

  1. Your child should stay home from school if he or she has a fever, vomits or has diarrhea within the past 12 hours, appears lethargic, or has a persistent cough. If your child is sick and goes to school, you place others at risk for getting sick as well.
  2. Before returning to school after an illness, your child should be fever-free for 24 hours and have enough stamina to manage a full day of school activities including P.E. and recess. If your child is taking an antibiotic, he or she should remain at home for the first 24 hours. Please notify the Health Office if your child tests positive for strep infection.
  3. All medications should be brought to the health office by a parent. Do not send in medication in your child's backpack.

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Important Information for all Parents Regarding Medications

Medication administration is an important issue in schools. Some students require medications at school in order to survive. Others need medications in order to learn. Occasionally, students require antibiotics during the day following a bacterial infection.

The goal of the Merriam School Nurse is to administer only those medications that are absolutely necessary during the school day. All other medications should be given at home either before or after school.

State law requires a written order by a licensed prescriber and written parental permission before any medication can be administered to students, including over-the-counter medications. You can obtain forms for this purpose from the School Nurse, or from most health care providers.

All medication MUST be in the original labeled container and be labeled with the student's name. The School Nurse will NOT administer expired medications, medications delivered in unlabeled containers, and medications in inappropriate containers such as ziploc bags. For the safety of all students, no medications are to be carried to school by students. (The only exception to this rule is for Junior High and High School students who are allowed to carry inhalers or Epi-pens after certain requirements are met.)

With your help, the School Nurse can provide a safe, supervised environment for students who require medications at school. Feel free to contact the Merriam School Nurse, Betty Mazzone RN, at (978) 264-4700, x3752 with any questions.

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Communicable Diseases

The Massachusetts Department of Public Health (DPH) recently revised several aspects of the reporting and containment requirements for communicable diseases. In summary, healthcare providers, including school nurses and school physicians, are required to report to the Board of Health and/or DPH numerous communicable diseases.

From such reporting, the local Board of Health may then use its powers to isolate and quarantine. The DPH defines these two basic concepts as the following:

  • Isolation: the separation of persons who have a specific communicable disease from those who are healthy for the purpose of stopping the spread of that disease.
  • Quarantine: the separation and restriction of movement of persons who, while not yet ill, have been exposed to a communicable disease and therefore may become infectious and spread the disease to others. Quarantine may involve exclusion from school for a specific time period.

The minimum quarantine periods for the following illnesses as they specifically address school students/employees are:

  • Chicken Pox (Varicella): 10th to 21st day after exposure
  • Measles: 5th to 21st day after exposure
  • Mumps: 12th to 26th day after exposure
  • Non-Congenital Rubella: 7th to 21st day after exposure

If a student is not immunized due to religious or medical exemptions and has been exposed to a communicable disease, the parent/guardian will be notified explaining the exclusion requirements prior to the exclusion period. The child may only attend school with a doctor's letter verifying vaccination or a blood test showing immunity. If you have any questions regarding communicable diseases and your child, please contact your school nurse, or the Massachusetts Department of Public Health at 617-983-6800.

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From The School Nurse: Fifth Disease Information

What is Fifth Disease? It is a mild rash illness that usually affects children, and is commonly seen in late winter and early spring. It is caused by Parvovirus B19, which lives in the nose and throat, and can be spread from person to person. The first stage of illness consists of headache, body ache, sore throat, low-grade fever and chills. These symptoms last about two to three days and are followed by a second stage, lasting about a week, during which the person has no symptoms at all. Individuals are most infectious before the beginning of their symptoms. In children, the third stage involves a bright red rash on the cheeks, which gives a "slapped cheek" appearance, and may be followed by a "lacy" rash on the trunk, arms and legs. The rash begins 17 to 18 days after exposure, and may appear on and off for several weeks with changes in temperature, sunlight and emotional stress. Adults may not develop the third-stage rash but may experience joint pain, particularly in the hands and feet. The disease is usually mild, and both children and adults recover without problems.

How is it treated? There is no specific treatment for Fifth Disease. Health care providers may suggest treatment to relieve some symptoms. There is no vaccine to prevent Fifth Disease.

Must a child stay home? Children with Fifth Disease do NOT have to stay home. By the time they are diagnosed with the rash, they are no longer contagious.

What should you do? Watch for symptoms and notify the school nurse if you suspect your child has Fifth Disease. If you are pregnant, or have a blood disorder or weakened immune system, tell your health care provider about possible exposure. Finally, always be careful about hand washing, especially after touching discharge from the nose and throat and before eating or handling food.

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From the School Nurse: Tick Facts

What are ticks?

Ticks are bugs that feed on the blood of mammals, birds, and reptiles. Deer ticks and dog ticks are found throughout Massachusetts and may spread different disease-causing germs when they bite. Ticks are generally found in grassy, brushy, or wooded areas. Ticks do not fly or jump. They attach to animals or people that come into direct contact with them.

  • Deer ticks: Both nymph (young) and adult deer ticks will bite humans. The highest risk of being bitten by a deer tick occurs throughout the spring, summer and fall seasons. However, adult deer ticks can also be out searching for a host any time winter temperatures are above freezing. Deer tick nymphs are the size of a poppy seed and deer tick adults are the size of a sesame seed.
  • Dog ticks: In general, only the adult dog tick will bite humans. The highest risk of being bitten by a dog tick occurs during the spring and summer seasons. Adult dog ticks are about the size of a watermelon seed.

How can I protect my family from tick bites?

  • The single most important thing you can do is check yourself for ticks once a day. Favorite places ticks like to go on the body include areas between the toes, back of the knees, groin, armpits, neck, along the hairline, and behind the ears. Remember to check your children and pets, too. Remove any attached tick as soon as possible.
  • Use repellents that contain DEET on exposed skin and those that contain permethrin on clothing. Be sure to read product labels to ensure safe and proper usage.
  • Stick to main pathways and the center of trails when hiking.
  • Wear long-sleeved, light colored shirts and long pants tucked into socks. This will keep ticks away from your skin and make it easier to spot a tick on your clothing.
  • Talk to your veterinarian about the best ways to protect your pets from ticks.
  • There is currently no human vaccine available to protect against Lyme disease or any other tick-borne disease found in Massachusetts.

What should I do if I find a tick on myself or my child?

  • The tick should be carefully removed as soon as possible. The longer an infected tick remains attached to a person or animal, the higher the likelihood of disease transmission.
  • Use fine point tweezers to grip the mouthparts of the tick as close to the skin as possible. The tick should not be squeezed or twisted, but pulled straight outward with steady, gentle pressure.
  • You should not apply kerosene, petroleum jelly, nail polish, or a hot match tip to remove the tick; these measures are not effective and may result in injury.
  • Notify your health care provider if you've been bitten by a deer tick, or if you develop a rash or other flu-like symptoms following a tick bite.

Further information can be found at www.mass.gov/dph and www.cdc.gov.

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From the School Nurse: Selected Facts About the Flu

(Summarized by APS/AB School Nurses from the Massachusetts DPH website 2007)

What is the Flu?
The flu is caused by the influenza virus, which infects the lungs, nose, and throat. The virus is easily passed from one person to another by coughing and sneezing. For most people, the flu makes them feel very sick, but they generally get better in about a week. In New England, flu season usually begins in December and lasts until April.
Symptoms of the Flu include:
Sudden onset of high fever (102-104 °F; 39-40°C) lasting 3-5 days, headache, muscle and body aches, exhaustion which can last 2 weeks or more, and dry cough. Some people may be unsure if they have a cold or the flu. Colds are usually milder and do not come on suddenly. Cold symptoms include stuffy nose, sneezing, sore throat, and cough.
Treatment of Flu symptoms:
Rest in bed. Drink lot of fluids. Take acetaminophen or ibuprofen. Stay home for at least 3-5 days after you get sick so you don't pass the flu to others. Call your doctor for any of the following reasons: fever that does not get better after 3-5 days; difficulty breathing; chest pain; cough lasting more than 7-10 days and/or accompanied by mucus that is green, rust-colored, or bloody; you are not able to drink enough fluids.
Reducing risk:
Get a flu shot every year. Wash your hands with soap and water or use an alcohol-based hand sanitizer. Cover your mouth with a tissue or your arm when you cough or sneeze. Avoid touching your eyes, nose, or mouth. Avoid close contact with others who are sick.

For more information about the flu, please go to this site.

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From the School Nurse: Diabetes – Understand the Warning Signs

Diabetes is one of the most common chronic diseases in children. In the United States 1 in every 400 – 600 children has Type I diabetes. (National Diabetes Education Program).

  • Type 1 (Insulin Dependent) diabetes is most common in youth.
  • Type 2 (Insulin Resistance) diabetes is most common in adults but is on the rise in youth.

"Diabetes is a chronic disease that impairs the body's ability to use food properly. Insulin is a hormone produced in the pancreas that is necessary for the body to convert food into energy. In people with diabetes, either the pancreas doesn't make insulin, the body cannot use the insulin properly, or both. Without insulin, glucose (sugar) builds up in the blood." (American Diabetes Association)

Early detection and knowledge of the warning signs is your greatest weapon against the disease and its complications. Behaviors a child might exhibit in school that could indicate undiagnosed diabetes are:

  • Excessive urination (frequent trips to the bathroom especially in close sequence, bedwetting)
  • Excessive thirst (frequent trips to the water fountain)
  • Irritability
  • Lack of energy, fatigue, drowsiness
  • Rubs eyes, complains of difficulty seeing the board
  • Difficulty paying attention

Other symptoms may include:

  • Sudden vision changes
  • Fruity/sweet odor to breath or urine
  • Increased appetite
  • Rapid or unexplained weight loss
  • Nausea, vomiting or abdominal pain
  • Tingling or numbness in the legs, feet or fingers
  • Frequent infections of the skin, cuts that are slow to heal
  • Darker patches of skin usually in neck folds
  • Itching of skin and/or genitals

Note: Many of these symptoms can be related to illnesses that are not associated with diabetes. Only a healthcare professional can provide appropriate diagnostic tests and treatments.

References:

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From the School Nurse: Sun Safety for Children

Childhood sunburns can increase your child's risk of developing skin cancer as an adult. Even a suntan can be harmful to children. Tanning is an outward sign of internal skin damage. Research shows that much of the damage to skin is done in the first 18 years of life. Protecting skin and eyes during these early years can reduce the risk of some types of skin cancer by up to 78%. Melanoma is a cancer of younger people and can start as early as adolescence.

Youth and Skin Cancer

  • 50% of lifetime exposure to UV light occurs during childhood and adolescence.
  • It can take less than 10 minutes for a child's skin to burn.
  • Children with severe sunburns are at an increased risk for skin cancer.
  • A person born today is twice as likely to develop malignant melanoma compared to someone born only a decade ago and 12 times more likely as someone born 50 years ago.
  • Being sun safe is the first step to reduce the chances of getting skin cancer later in life.

Teach Children Sun Safe Habits

Children learn healthy habits best at a young age. It's important to begin protecting your children from the start and to teach them the importance of sun safety. With sun damage accumulating over a person's lifespan, beginning sun safety habits at a young age should be a priority.

  • Maximize protection between 10 a.m. and 4 p.m.
  • Wear sun-protective, light-colored clothing including long-sleeved shirts and pants made of tightly-woven fabric.
  • Wear a wide-brimmed hat that protects head, face, ears, and neck. If a baseball cap is worn, make sure to use sunscreen on ears and neck.
  • Wear UV-protective sunglasses with 99%-100% UV absorption.
  • During peak sun hours (10-4 p.m.) seek shade. Shadow rule-if your shadow is shorter than you, the sun's rays are at their strongest and you should seek shade.
  • Encourage children to play in shaded areas, especially during peak sun hours.
  • Use a sunscreen of SPF 15+ and apply a generous amount (about a palmful) 30 minutes before going outside.
  • Reapply Sunscreen every 90 minutes or after swimming, towel drying or perspiring, even if the label says the product is waterproof. Don't forget the lips and ears-both areas burn easily.
  • Strongly discourage the use of tanning beds.

Further information can be found at the Shade Foundation and the CDC on skin cancer.

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Important Notice For 6th Grade Parents And Guardians

The Massachusetts Department of Public Health has the following requirements for all students entering Grade 7 in September 2009:

  • MMR: 2 doses or 2 doses of measles and one dose of mumps and rubella.
  • Varicella: A physician-certified history of chicken pox disease or one dose of vaccine for students under 13 years old or two doses of vaccine for students over 13 years old.
  • Hepatitis B: 3 doses.
  • Td/Tdap: One booster dose of Td (tetanus/ diphtheria and acellular pertussis) if it has been more than five years since the last dose.

A copy of an up-to-date physical exam will also be required for all students before entering Grade 7.

Many of the above vaccines may have been administered while your child was in elementary school. Please check with your Healthcare Provider to be certain that your child's immunizations are up-to-date and documented in his/her record. Send a copy of the exam and updated information record to your elementary school health office and the information will be included in your child's health record when it is transferred to the Junior High School in June.

If you do not have the necessary paperwork completed before the end of school, send it to the school nurse at the Junior High School by August 28, 2009.

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