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Supporting Medical Conditions in School

Find out more about how to support medical conditions in school. You can also find out about specific conditions.

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It is important that medical conditions are supported in schools properly.

Legislation

The DfE has statutory guidance on how to support medical conditions in school. This means the guidance must be followed. It supports education settings to meet their legal responsibilities.

Key Points

  • Pupils with medical conditions should have the proper support. This means they have full access to education, including in PE or on any school trips.

  • Arrangements must be in place to support pupils at a setting with medical conditions.

  • Leaders should work with everyone involved with the child. This includes health and social care professionals. This ensures that the medical needs are fully understood and supported.

  • Health professionals should support staff to plan support for those with medical conditions.

  • Lots of professionals play a role in supporting these needs. This support can be universal or specialist.

Support for Medical Conditions

Below is advice for supporting a range of medical conditions in schools.

Asthma or Breathing Difficulties

If your child has asthma, there may be different professionals involved. This usually depends on how severe the asthma is. It is important to remember that some young people have inhalers for other reasons. These include breathing difficulties during hay fever season. This does not mean they have asthma, but this guidance may still be useful.

Asthma can be diagnosed by either a General Practitioner (GP) or Community Consultant.

Diagnosed by a GP

  1. The GP should follow up the diagnosis in their GP practice. How often this happens depends on need and severity. A GP will likely provide an inhaler. These can be given for other medical reasons too. Inhalers can be for either short term or long-term use.

  2. The GP will create a Health Care Plan. This is usually done at the one-year review. These can be completed by schools too. A Health Care plan can be written for the time an inhaler is prescribed for. This includes for other medical reasons than asthma.

  3. Health Care Plans should be reviewed yearly. This can also happen if there is a change in the medical condition. Parents and carers should let the school know of any changes.

Diagnosed by a Community Consultant

  1. St Helier Hospital follow the London Standards for Asthma care. If a child is treated for a wheeze twice or more in a year a Clinical Nurse Specialist (CNS) will follow this up for asthma. If intensive treatment is needed, a referral is also made to the Consultant clinic.

  2. The Specialist or Ward Nurse will complete a Health Care Plan. Parents receive a copy of this, and they should give a copy to the school. This is also completed if a child has been admitted for wheeze more than twice. Schools can also complete this but for complex cases they should work with health professionals.

  3. Appointments with the CNS will be within 2 weeks of discharge. The aim for Consultant Clinic appointments is within 6-8 weeks. This may vary depending on severity or treatment.

  4. Health Care Plans should be reviewed either yearly or when there is a change in the medical condition. Parents and carers should let the school know of any changes.

It is important to remember that the Health Care Plan template used is not important. The information just has to be clear and accurate.

General Advice

  • If symptoms occur during exercise, 2-4 puffs of Salbutamol can be given beforehand. Exercise symptoms can include shortness of breath, cough, tight chest and wheeze.

  • If symptoms are getting worse, the advice is 4-6 puffs of Salbutamol every 4 hours. The maximum amount of puffs in 4 hours is 10. If the young person needs more, they should go to Accident and Emergency.

  • If the young person is having 4-6 puffs every 4 hours for 24 hours, medical advice should also be sought. A young person may stay off school if this is the case.

  • The Specialist Nurse for Asthma will show parents and young people how an inhaler should be used. Train for schools is possible through the School Nursing Service.

Allergies

Allergies can be either mild or severe. Sometimes the GP will keep these under review, or this will be done by someone in the Allergy Clinic.

Care within Hospital

  1. Confirmation of young person's allergy.

  2. Children under 2 years old will have a review about every 6 months to a year. Young people with nut allergies aged 2 or older should be reviewed regularly.

  3. If the young person is known to the Allergy Clinic, they will complete an allergy action plan. Parents get a copy of this, and they should provide a copy to anyone looking after their child. This includes schools. If the review is done by the GP, Health Care Plans are completed by the School Nursing team.

  4. Health Care Plans should be reviewed either yearly or when there is a change in the medical condition.

  5. Health Care Plans can be completed by schools if the allergies are mild and only need oral medication.

There are several plans that can be put in place. These include:

  1. A plan for individuals prescribed EpiPen.

  2. A plan for individuals prescribed Jext.

  3. A plan for individuals prescribed Emerade.

  4. A plan for individuals assessed as not needing AAI.

It is important to note that prescribed adrenaline pens may change. Education settings must be confident that staff are trained in using the right pen.

General Advice

  • Young people with mild or moderate allergies can take antihistamines. There include Piriton or Cetirizine.

  • Young people who have severe allergies and are at risk of anaphylaxis will also need an auto injector.

  • Children under 2 should use Piriton as an antihistamine.

  • Children over the age of 2 should use Cetirizine as an antihistamine.

  • Any one of the symptoms listed below is enough for an auto injector to be used.

  • This is administered into the upper, outer thigh area.

  • You must hold all autoinjectors for 10 seconds.

  • Rub the site gently once the injection has been given.

  • If there is no improvement after 5 minutes since using the auto injector, give another dose. This should be given into the other leg.

Symptoms for auto injector use

  • Persistent cough.

  • Hoarse voice.

  • Difficulty swallowing.

  • Swollen tongue.

  • Difficult or noisy breathing.

  • Wheeze.

  • Persistent dizziness.

  • Pale or floppy.

  • Suddenly sleepy.

  • Collapsing or unconsciousness.

Training

The specialist nurse for Allergy will provide training around:

  • Signs and symptoms of a reaction to look out for.

  • When and how to use an auto injector. A trainer pen is given for practice.

The School Nursing Service provides training for schools. Schools need to keep a record of all staff who need to take part in training. It is important to note that just watching a video is not training.

Diabetes

All young people with diabetes in Sutton will be under the care of a paediatric diabetes team. This team is based within the hospital setting.

Care within Hospital

  1. Diagnoses of diabetes confirmed.

  2. The diabetes team consists of: Consultants, Dieticians, Nurses and Psychologists. This is the Multi-Disciplinary Team (MDT). They support and educate young people and their families.

  3. The team creates a Health Care Plan for managing diabetes in school. They are reviewed yearly in school and updated if needed.

  4. The MDT will see a young person every 3 months. Every year they will also have screening investigations taken. If needed, the MDT will see young people between these appointments too.

Training

  • The Paediatric Diabetes nurse can visit the school for a range of reasons. They are sometimes joined by the dietician. These reasons include a new diagnosis, school trips, or a young person starting on a pump.

  • If there are specific issues, nurses are happy to attend meetings to support. These can either happen at the school or the hospital.

  • There is routine training for schools at the hospital to cover the start of term and change of teachers.

  • The School Nursing service also provide training for teachers on how to manage diabetes in school.

Epilepsy and Seizures

If a young person has suspected seizures, they should speak to their GP. They may refer the young person to the Epilepsy Clinic where a consultant will review them. Any young person with a diagnosis will be under a Consultant Paediatrician.

It is important to note that some young people may have seizures but not a diagnosis of Epilepsy. This means they would have had a review and been discharged. In some cases, they do not need medication.

 General Advice

  • Follow first aid advice in clinical reports.

  • Complete a Health Care Plan.

  • Parents and Carers should update schools about any changes to the seizures.

  • Return to the GP if further health input is needed.

Epilepsy Care at the Hospital

  1. Diagnosis of Epilepsy confirmed.

  2. The Specialist Nurse will meet with the young person and their family. They will usually give their contact details too.

  3. All young people are given an Epilepsy passport. This gets reviewed at every appointment. The school also given a copy of this which can help with the creation of a Health Care Plan.

  4. Health Care Plans must be reviewed on a regular basis.

  5. School Nurses currently complete Health Care Plans for those who need emergency medication.

  6. If seizures are controlled, the young person will have a follow up every six months.

  7. Follow up time can vary depending on need or severity. Sometimes, a young person may need review by a tertiary centre. The consultant will refer for this.

The Specialist Nurse will discuss with you:

  1. Safety advice.

  2. First aid.

  3. When to call an ambulance.

  4. What to do with medications during travel.

  5. Sleep.

  6. Emergency medication if prescribed.

Training

  • The School Nursing service provides training to school staff. This includes on first aid for seizures and buccal midazolam.

  • They also provide training to nursery staff. This is where they have no school nurse support.

Tips for Completing a Health Care Plan

  • Parents and young people should have a say in the completion of the plan. They know the condition and symptoms best.

  • The school or school nurse should receive copies of letters. This ensures they have up-to-date information on the young person's medical condition. This also helps with completing a Health Care Plan.

  • Medical evidence should be provided for any changes to the plan. This includes changes to treatment and medication.

  • The school should keep a supply of medication. They should check the expiry dates of these and if they have enough left.

  • All medication should be labelled and have a dose stated. This dose should match the Health Care Plan and clinical letters. If these do not match, a health professional should be consultant.

  • Young people should be encouraged to manage their own medical conditions if possible. They may need support with this to begin with. The long-term goal is for them to feel confident to seek support themselves.

  • Health Care Plans should be reviewed yearly or if there is a change to the medical condition.

  • Any education professionals working with the young person should complete annual training. They must provide evidence of this if asked.

  • Requests from education settings for information should be made in writing. The letter needs to state that you have consent, what information you want and how this will be used.

  • Plans should be completed as early as possible. It is helpful that this is done before the school year starts if the condition is already known about. This means there is lots of time to contact any professionals.

What should be in a Health Care Plan

  • A description of the young person’s medical needs. This includes symptoms, triggers, signs and treatments. It should also describe any facilities, equipment and devices needed.

  • Details about medication, its dose and how it is given. This should also include when it should be taken, any side effects and whether it can be self-administered.

  • Daily care requirements.

  • Specific support for the pupil's educational, social and emotional needs.

  • Arrangements for school visits or trips.

  • Describe what classes as an emergency, and the action to take if this occurs.

  • Who is responsible in an emergency.

  • Who the plan was developed with.

  • Any staff training needed or undertaken.

For more information, visit the government website [External Link]. You can also find more information on the Medical Needs Policy page [External Link].