Asthma is one of the leading reasons for children to miss school because of illness. Sometimes the causes of why a child's asthma is making him sick may be related to the school itself. Maybe there are no complete individualized student asthma action plans on hand to provide guidance when students' symptoms flare up. Or maybe the school ventilation system is not as clean and dust-free as it should be. Or perhaps mold has established itself under the window where your child's desk is located.

Making sure your child's health is protected at school is more than just the role of the school nurse. It actually is the role of all staff at your child's school — from the principal to your child's teacher to the facilities manager.

And, it's your role, too, in keeping school officials apprised of your child's health and pointing out potential triggers found in the school that could cause asthma symptoms.

School Asthma Action Plan

Before your child even enters the school classroom, you can assist him by doing a little homework yourself. First, make sure you send into your school an asthma action plan for your child that includes daily management guidelines and emergency provisions in case of an asthma attack. This asthma action plan should be developed and signed by your health care provider or physician.

The plan should include your child's medical information, along with what specific steps should be taken in case of a medical emergency. Information also should be included on:

• Medications your child needs during school hours, along with medications that are required off the school premises or after school hours.

• Correct dosages of the medications, along with when they are used, how they are used, and the anticipated results.

• A specific plan of action provided for the school staff in case of an acute asthma emergency.

• Your child's optimum peak flow reading.

• Guidance for monitoring peak flow in case of an emergency, explaining what is the normal flow rate (the green zone), along with rates in the caution (yellow) or danger (red) zones.

• Specific triggers identified that can make your child's asthma worse.

• Procedures that should be followed in case of emergency, including when to call your physician and when to call 911.

• Phone numbers (including your health care provider's and your numbers) that should be used in case of emergency.

The plan should be signed by you before sending it to school. The asthma action plan then should be sent to the individual designated at the school who maintains the records, such as the school nurse. This person is responsible for educating appropriate members of the school staff — including teachers — about the action plan. The action plan should be renewed at minimum once each year your child is a student at the school to include updated information related to treatment and symptoms.

Give permission to share your asthma management plan with all the relevant adults (including all teachers) who regularly interact with your child at school. Giving this permission avoids possible violations of the Family Education Rights and Privacy Act that prohibits unauthorized disclosure of a student's records — including health records. Each of the team members needs to know about your child's asthma and how to work together to reduce or eliminate symptoms.

Policies and Backup Plans

You need to know if your child's school is prepared in case an asthma-related emergency arises. Over the years, serious incidents at schools involving children with asthma have occurred because school asthma management policies or backup plans were not in place. This issue has become critical in recent years since many schools now do not have a nurse serving full time.

In one 2006 study, researchers found that many urban and rural schools in one state — Pennsylvania — fell short in following recommended best practices in child asthma management.

While the researchers did not study whether the shortcomings they found in Pennsylvania are present in other states, they noted that poor adherence to national asthma guidelines at school is widespread.

The researchers found in interviews with nurses at the 757 Pennsylvania schools that more than half of the secondary schools and three-quarters of the elementary schools had nurses present less than forty hours per week.

Also, asthma action plans were on file for only a quarter of the children with asthma — and many of those were incomplete. In addition, asthma-related equipment — such as peak flow meters, nebulizers, or spacers — were available for student use in about half of the schools.

What these findings mean is that in addition to having your child's asthma action plan on file at school, you should know what your child's school backup plan is in case the designated person (such as the nurse) is not available in an asthma-related emergency.

Just remember that when an emergency arises, there's very little time to ask questions or hunt for missing directions and medications — especially when it comes to your child.