The Role of the School Nurse
Students on the autism spectrum may have a range of healthcare issues in addition to their diagnosis of Autism Spectrum Disorder (ASD). Conditions which may exist alongside ASD are called co-occurring or co-morbid conditions, and may include seizures, gastrointestinal problems, sleep problems, anxiety, and attention issues. The school nurse can help your child regulate these issues while at school. School nurses can also help care for those children who have toileting and feeding issues. Even if your child doesn’t have co-occurring conditions, there will likely be other expected and unexpected events that will cause your child to interact with the school nurse.
Medication at School
Some children take medications to help regulate behavior or control anxiety, seizures, or other co-occurring conditions. Whether or not medications are taken during the school day, the school nurse should always be kept informed of any over the counter or prescription medications taken by students. If the student does need to take medication during school hours, your school will likely have policies about how your child will receive the medication. For example, most schools do not allow the student to take the medication on their own; the student needs to visit the school nurse, who will administer the appropriate dose. Many schools require that the medication be given to the school nurse in the original packaging – in other words, not brought in a plastic bag from home. You will need to provide the nurse with dosage information. The school nurse should have a medication chart where he or she tracks when medications are taken. This can be helpful information if your child has a reaction or if the medication does not seem to be having its intended effect.
Individualized Health Plan
If your child takes medications at school, has a serious co-occurring medical condition, like seizures, or has another issue requiring health management, your child’s school nurse will create an Individualized Healthcare Plan (IHP) for your child. The IHP may be a part of your child’s Individualized Education Program (IEP) or may be a separate document. The IHP sets forth the type and amount of nursing care required by your child, and can include instruction on self-care and monitoring and working with your child to understand his or her diagnosis and healthcare needs. The IHP should include your child’s history, assessment information, diagnosis, care goals, nursing actions or interventions, and expected outcomes.
The IHP should be signed by you, the parent, and copies should be shared with regular and special education teachers, aides, and administrators as needed. The IHP should be reviewed each year or whenever a change in status is noted.
Getting Sick or Injured
Even if your child is not taking medications and has no other health issues, the school nurse is likely to come in contact with your child at some time. During the school day, students get injured and feel sick; your child on the spectrum is likely no exception. It is a good idea to make sure your child has met and gotten comfortable with the school nurse before an illness or emergency occurs. You should be in contact with the nurse at the start of each school year, either in person, or by giving the nurse information about your child. Update this information as needed, for example, when your child begins a new treatment or medication.
For example, provide the school nurse with information about your child’s injury tendencies. Does your child frequently complain of being hurt or does he or she seem oblivious when bleeding from a scrape? Children on the autism spectrum sometimes experience pain and other sensations differently than other students. They may be extra or under sensitive to pain and are not always the most reliable reporters of when a serious injury has occurred. This problem is intensified by the communication difficulties experienced by many students on the autism spectrum, particularly when under stress.
If your child is absent from school for a health-related reason, be sure to contact the school nurse. Children on the autism spectrum benefit from structure and routine, and missing any time from school can be very disruptive. The school nurse can help your child and his or her teachers prepare for the return. But be observant to see why your child is missing school. Is he or she really sick? Or could there be something else driving the absences from school? Students on the spectrum may be anxious about attending school, which may lead to genuine aches or pains. This doesn’t make them any less significant, but they should be handled differently than a stomach ache caused by a virus. Your school nurse (as well as your child’s pediatrician) can help you determine the true cause. Some students will feign injuries or aches to be able to stay home (or be sent home by the school nurse) in order to do a preferred activity, such as watching TV or playing a video game. Allowing your child to stay home may reinforce the desire to escape an nonpreferred situation, rather than addressing it and finding a solution. Open communication between your family, the school nurse, and other medical providers will be important to making sure your child is healthy and getting the support he or she needs.