Childhood allergies and asthma are a growing concern. Allergic conditions are the most common health issue among U.S. children and asthma is the third-ranking cause of hospitalization among kids under 15. It's no wonder parents are worried about sending their little ones off to school. This guide helps parents not only find the right school for their child with allergies or asthma but also offers information on how to manage symptoms and prevent reactions while their kid is away from home. Find some peace of mind and help your child thrive in school.
Allergies and asthma are chronic conditions that children need to learn how to live with. Self-management can be difficult, but approaching these conditions with a positive attitude and embracing a life without limits can set positive expectations and improve quality of life for children.
Dr. David Stukus
Managing allergies and asthma isn't just about safety – both can also have an impact on academic performance. Doing well in school requires working hard, concentrating on schoolwork and paying attention. These tasks can become difficult when a child is dealing with allergy/asthma symptoms or worrying about their next attack. Here's how childhood allergies or asthma can affect academic performance:
When allergies or asthma symptoms become severe enough, a child may have to stay home from school. The CDC notes asthma is one of the top reasons children miss school. And any time a student is absent, they risk falling behind, especially if they miss multiple days. A study in California showed only 17% of kindergarteners and first graders who were chronically absent were proficient readers by the end of the third grade, compared to 64% among those who missed less than 5% of school.
Allergies and asthma don't just affect physical health – they can affect emotional and mental well-being as well. When a child is worried about whether they'll have an allergy or asthma attack during school, it can cause anxiety. This anxiety could also cause some children to withdraw from social or extracurricular activities in an attempt to avoid potentially unpleasant events and feelings. They might also feel embarrassed if they need to see the school nurse in the middle of class or recess. Children may focus on these negative feelings instead of their schoolwork.
Severe or chronic allergy and asthma symptoms can make it difficult to sleep at night. This lack of sleep can mean children are tired throughout the school day, making it hard to concentrate on schoolwork and retain information.
Even if a child's allergies or asthma can be controlled with medication, the side effects can hinder school performance. Children might suffer from brain fog, drowsiness and physical discomfort, such as headache, stomach pain, nausea or dizziness.
When it comes to safety at school, Dr. David Stukus of Nationwide Children's Hospital in Columbus, Ohio says communication is key. "Talk to teachers and administers before the start of the school year to allow time for school personnel to make any necessary preparations," he says.
Here are a few more important tips:
Allergy and asthma treatment can vary greatly so it's important to work with your child's doctor to create an action plan. An effective plan will clearly outline triggers, symptoms and the necessary steps to take when a child doesn't exhibit symptoms, when they exhibit mild symptoms and when they exhibit severe symptoms. An example of a food allergy action plan may look something like this, while an asthma action plan may look like this.
Under the Rehabilitation Act of 1973, life-threatening allergic reactions (e.g. anaphylaxis) are considered a disability, which means children with such severe allergies can't be excluded or discriminated against, and schools must provide accommodations to keep the child safe. These accommodations are filed as a 504 Plan and are typically used for severe food allergies. The plan should be established with guidance counselors, school nurses, your child's teacher and any other school staff who might be contact with your child. It should also be reviewed every year to make sure it's up-to-date, but you can call a meeting with the principal to make changes anytime throughout the year. Kids with Food Allergies has a few different examples of common 504 accommodations.
When meeting with teachers and administrators to create a 504 Plan, it's a good idea to also go over everything else they need to know about your child's allergies or asthma. "Make sure your child has an up-to-date action plan on file with their school each year, which outlines exactly what treatment to administer according to symptoms," Dr. Stukus recommends. He also recommends informing the school of any prescribed medication, such as epinephrine auto-injectors and inhalers. "Any medications prescribed by a physician for use on an as needed basis should be filed with the school, along with current prescriptions," he says.
You and your child's pediatrician are the experts when it comes to your child's allergies or asthma but you'll have to work with teachers, administrators and staff to ensure your child's safety during school hours. You need to be your child's advocate and make sure proper accommodations are in place, but you also don't want to ask for so much that the school becomes overwhelmed and gives up. "Allowing and encouraging questions and active participation from school personnel can be very collaborative and helpful," says Dr. Stukus.
It's crucial for the school to be prepared for allergic reactions and asthma attacks but it's equally important kids know what to do when they're away from home. Start educating your child about their allergies or asthma and teach them how to ask for help. Make sure your child can tell when they're experiencing an allergic reaction or asthma attack and that they know exactly what to do during one. They should also know emergency contact and medication information.
Teacher and administrators have a lot of things they need to remember, so they might have trouble keeping track of the allergies, medications, dosing guidelines and medication side effects for all students. To help, your child should carry an information card at all times. It should list allergies, medications, triggers, side effects, medication administration rules, emergency contact information and the doctor's phone number.
Exclusion from social activities is a big concern among parents of children with allergies or asthma. You may want to ask the principal or teacher to notify other parents that there's a child in the classroom with certain allergies and make them aware of specific accommodations such as food restrictions when bringing snacks for the entire class so your child doesn't feel left out. If problems arise, work with the school to resolve them, not the parents or children.
If your child has severe asthma or a life-threatening allergy, online learning or home school might be an ideal option and can also offer peace of mind to worried parents. Attending regular school may be an option once your child is older and their peers have a better understanding of your child's health concerns.
Choosing the right school for your child is a difficult task, even if they don't have asthma or an allergy. Selection will come down to the school's ability to keep them safe. The following tips can help parents determine if a school is right for their child:
Parents should keep an open line of communication with their child's teacher and allow for questions and feedback regarding their strategy to avoid reactions and treat symptoms when they occur.
Once a good school is found, keeping your child safe at that school might require constant adjustments. "Parents should keep an open line of communication with their child's teacher and allow for questions and feedback regarding their strategy to avoid reactions and treat symptoms when they occur," says Dr. Stukus says.
About 40% of children in the U.S. suffer from allergies, according to the Asthma and Allergy Foundation of America (AAFA), Anyone can be allergic to almost anything, from dust to insect stings to shellfish, but some allergies and asthma conditions are more common than others.
A food allergy is an allergic reaction to something a person has eaten. Many people confuse a food allergy with food intolerance but the two are very different – a food intolerance leads to gas, abdominal pain or diarrhea, whereas a food allergy leads to an immune system reaction that involves releasing antibodies and histamines to fight the "invader".
Dr. Stukus says the most common food allergies affecting children are milk, egg, peanut and tree nuts (walnuts, pecans), but other common triggers include soy and wheat.
Avoidance of the trigger is the best prevention. However, identifying allergens isn't always easy. Consulting an allergist and keeping a detailed food journal may be necessary. Students with severe food allergies may need to carry an epinephrine auto-injector. Dr. Stukus also recommends holding food free celebrations in the classroom so kids don't accidentally eat allergens from homemade treats. Food free celebrations can also help prevent social isolation for students with food allergies who may not be able to enjoy the same snacks and treats as their classmates.
Spokin is an iOS only app offering restaurants, hotels, recipes and other resources based on your specific food allergies, location and experience.
This app reminds allergy sufferers to bring their epinephrine auto-injector whenever they leave their house. Available on Android.
If a child experiences itching, redness and swelling to something they've been in contact with, they may have a skin allergy. There are several types of skin conditions but the most common are Eczema, hives and contact dermatitis.
An allergist/immunologist can identify specific allergies and develop a treatment plan to alleviate symptoms. Common over-the-counter treatment options include hydrocortisone cream, calamine lotion, antihistamines and similar steroid treatments.
This app offers various home remedies for skin allergies on the face and body. Available only on Android.
Stay up-to-date on skin allergy information and find products that are safe to use. Available online or on iOS.
Humans naturally have an unpleasant reaction to insect stings and bug bites but that doesn't necessarily mean one is allergic. An insect sting allergy is far more severe because the body's immune system overacts to the insect venom – instead of an itchy or painful area of skin, an individual may suffer from breathing difficulties, hives or anaphylaxis (a potentially life-threatening reaction that impairs breathing and causes the body to go into shock). Life-threatening allergic reactions are rare – according to estimates from the American College of Allergy, Asthma & Immunology (ACAAI), it occurs in 0.4% - 0.8% of children.
For some individuals, allergy shots may work to reduce the body's allergic reaction. If symptoms of anaphylaxis develop, immediately inject epinephrine and/or visit the emergency room.
Latex is common in many medical and dental supplies as well as consumer products. Allergic reactions to can be serious but are rarely fatal.
Avoidance is the primary method of prevention. It's best to inform medical professionals of your allergy when receiving medical care.
Treating an allergic reaction might involve taking corticosteroids or antihistamines. More severe reactions will require epinephrine injections and/or a trip to the emergency room.
Much like insect stings, adverse reactions to medications are common but aren't always the result of an allergy. The American Academy of Allergy, Asthma & Immunology (AAAAI) notes only about 5% - 10% of medication reactions are due to an allergy. Oftentimes, people experience a sensitivity to a drug, which can cause allergy-like symptoms but doesn't involve an immune system response.
Informing medical professionals of a medication allergy is crucial. Make sure all doctors and nurses are aware of a child’s allergy and symptoms. Treatment might include epinephrine, corticosteroids or antihistamines.
If a child suffers from an allergy that spans over several seasons, they may be allergic to mold. For some people, a mold allergy is tied to asthma. Mold lives everywhere – indoors and outdoors – but are often found in the bathroom, kitchen and basement. There are some 1,000 species of mold in the U.S. but according to the AAFA, only a few dozen cause allergic reactions.
Avoidance is the best way to reduce allergy symptoms but many types of mold aren't visible to the naked eye. Preventing dampness, lowering humidity and making sure there's good air circulation can help reduce the development of mold spores and mildew indoors.
Treatment includes over the counter antihistamines and nasal steroids. Some individuals may also benefit from nasal irrigation and/or allergy shots.
Pet allergies are common among Americans, even those who are already pet owners. Cat and dog allergies are the most common, but individuals can be more sensitive to certain breeds. Many people believe some dog breeds are "hypoallergenic" but AAFA notes a truly non-allergic pet doesn't exist – if a child is allergic, their body will react to the pet's urine, saliva or dander (dead skin cells).
If unable to avoid animals, children with pet allergies can relieve symptoms by taking antihistamines, nasal decongestants, corticosteroids, allergy shots and leukotriene modifiers. Having a pet without fur or feathers is best (e.g. fish, turtle, snake). Talk to a doctor about possible use of medication before animal exposure to help mitigate symptoms.
Commonly referred to as hay fever, some 23 million Americans suffer from seasonal allergies. This type of allergy occurs during certain times of the year when the body has an allergic reaction to a type of plant pollen or mold. The start of seasonal allergies depends on where you live – for example in regions that don't typically see frost or snow (such as Florida and California), allergy season starts in the winter (January) and goes through early Spring (early April). Across the northern Plains, Great Lakes and New England, however, tree pollen increases in May which signals the start of their allergy season.
Seeing an allergist to determine triggers and keeping an eye on daily pollen counts can help seasonal allergy suffers prepare for and mitigate symptoms. Whenever possible, stay indoors with windows closed and thoroughly clean items that may harbor pollen, such as clothing and furniture. Frequent showering can also help. Treatment depends on the individual and their symptoms but common over the counter antihistamines, nasal decongestants and eye drops can help alleviate symptoms. Flushing out the sinuses with saline can help wash out mucus and hydrate the nasal lining. For some, allergy shots may be the most effective because they gradually expose you to your allergen so your body can learn to tolerate them.
Available on Android, this app helps users get a better understanding of their allergies by tracking symptoms and finds correlations between their symptoms and geo-based environmental data.
Those with iOS devices can receive pollen and mold counts based on actual air sampling. Data is collected by Pollen Certified Counters of the National Allergy Bureau.
This simple Android app provides an easy to understand pollen forecast for your specific geographical area.
According to the CDC, 6.2 million children under the age of 18 have asthma, a chronic, incurable respiratory condition where the airways in the lungs swell and constrict. There are different levels of asthma, depending on the severity of symptoms – mild intermittent, mild persistent, moderate persistent and severe persistent. Some children also suffer from exercise induced asthma (wheezing, coughing or difficulty breathing during physical exertion).
For most children with asthma, symptoms usually appear before they turn five, but because bronchial tubes in young children are already small and narrow, it can be difficult to tell whether symptoms are due to asthma or a cold. If symptoms recur and linger for days or weeks, that may be a signal that a child has asthma.
The frequency and severity of asthma attacks can be reduced by avoiding triggers. Getting the flu and pneumonia vaccines and carefully taking prescribed medication can help as well.
There are several effective ways to treat asthma but most people need two types – quick-relief and long-term control. Quick-relief medications provide relief during an attack and can include oral corticosteroids, medications that relax the muscles in airways such as beta2-agonists, and medications that open the airways to the lungs such as ipratropium. The latter treatment helps to prevent attacks and can include leukotriene modifiers, long-acting beta agonists and inhaled corticosteroids. Children with severe asthma may benefit from allergy shots.
This Android app allows users to stay connected with their doctor in between checkups, monitor and assess asthma symptoms and triggers, and take approved clinical evaluations.
Designed by pediatric asthma experts specifically for children and teens, this app helps users manage their asthma care. Users can record triggers and medication, get daily reminders on what to avoid and when take medicine, and stores and initiates users’ personalized asthma action plan when needed. Available on Android and iOS
For children with potentially life-threatening allergies, epinephrine auto-injectors are strongly recommended. These medical devices deliver a premeasured amount of epinephrine into the bloodstream to treat an anaphylactic reaction.
Despite the necessity of these devices, financial constraints can mean not all kids have them. For example, the most common epinephrine auto-injector on the market in the U.S. is the EpiPen (and EpiPen Jr., which delivers a smaller dose of epinephrine). According to the New York Times, filling the prescription once can cost up to $600 for those without health insurance or who aren't eligible for special manufacturer savings plans.
The generic version of EpiPen can cost around $300, as reported by CNN. Cheaper alternatives exist, such as Adrenaclick and Auvi-Q. They are usually sold at much lower cost compared to the EpiPen. According to Consumer Reports, some CVS pharmacies sell the generic version of Adrenaclick for as little as $110. Factor in a $100 discount coupon from the manufacturer and that brings the cost down to just $10.
Keep in mind that epinephrine auto-injectors do expire and need to be replaced every year or two, depending on the specific type. The medication doesn't go bad once the expiration date hits, but it does become less effective and may be unable to produce the desired effects when used.
For children with asthma, a metered-dose inhaler is a must for controlling symptoms. These inhalers deliver a specific amount of medication to the lungs in aerosol or powdered form.
There are two primary types of asthma inhalers. One is fast-acting, which is intended to provide quick relief during an active asthma attack. The most common medication used in fast-acting inhalers is albuterol. Prices for albuterol vary, but user comments on CostHelper suggests parents can expect to pay anywhere from $50 to $150.
The second type of inhaler is a corticosteroid, which is used for long-term asthma management. Common brand names are Flovent HFA, Pulmicort Respules and Qvar. The cost for corticosteroids can vary – non-insurance prices range from about $150 per month for Qvar to almost $800 per month for the highest dose of Pulmicort Respules, according to Consumer Reports.
Several products are now available to help make allergy/asthma management easier and even fun and stylish. When choosing products to keep a child safe in school, it pays to do serious homework. "I strongly encourage parents to use vetted evidence-based resources from professional and advocacy organizations for their information," Dr. Stukus says. "The American College of Allergy, Asthma & Immunology has great information available online. Patient organizations such as the Asthma and Allergy Foundation of American and Food Allergy Research & Education (FARE) also have great resources."
Here are examples of useful products you might want to consider:
Many children have trouble coordinating inhalation with the activation of their metered dose inhaler, which means they don't always receive the necessary dose of asthma medication. The AeroChamber helps ensure they receive the intended dosage.
Aid Puppy is a pouch shaped like a stuffed animal that can be used to hold basic medications and tools in case of an emergency. It's also a great cuddle buddy.
This kid-friendly pouch carries a variety of asthma and allergy medications including epinephrine auto-injectors and inhalers.
This easy-to-clean and chemical-free Baby Buddy Bear is certified allergy and asthma friendly. It can withstand deep cleaning to remove any allergens or asthma triggers.
These special allergy bracelets for children provide a clear way for unfamiliar individuals to become aware of a child's allergies and what to do in case of an emergency.
Designed for kids, this food journal encourages them to write down and draw what they eat. Keeping a food journal can be helpful for those suffering from food allergies.
Some kids may prefer to carry their epinephrine auto-injectors discreetly. This neoprene leg holster for children, teens and adults that can hold up to two epinephrine auto-injectors and can be concealed under long pants.
These safety cards inform first responders of a child's medical condition in situations where the child cannot communicate this information themselves. The cards fit in wallets and phone pouches or can be attached to backpacks, jackets, pants and other clothing.
This case holds only EpiPens. It links to the user's smartphone to notify them if the EpiPen is left behind or is at a temperature that is harmful for the epinephrine. It also provides light and sound alerts to help locate a lost EpiPen.