By: Mary Beth Miotto, MD, MPH, FAAP
An estimated 25% to 43% of children in the U.S. take medications to treat different health issues. This includes millions of kids living with
asthma,
diabetes,
epilepsy,
ADHD and other ongoing conditions. Millions more may use prescription or over-the-counter medications for a few days or weeks to manage
seasonal allergies, occasional pain or a lingering cold.
When a child's treatment plan calls for them to take medication during the school day, this means careful coordination with the child's doctor and the school health staff in charge of storing and administering medications. Read on for more information and tips to help the process go smoothly.
For millions of kids, medications are key to school success
Because children spend a lot of time at school, making sure they receive the medications they need to feel alert, balanced and healthy is part of academic success.
Following the right medication regimen reduces the chance of sick days that
disrupt learning. It also empowers kids to feel their best at school and home, helping them stay organized, listen intently, relate well to their peers and follow through on classroom and homework assignments.
It takes a team to administer medication safely at school
Parents and families play a central role in sharing key medical information with their children's school and delivering supplies, properly labeled, to the staff who will administer them. Schools provide trained (and often specially licensed) staff members who store medications, administer doses and keep an eye on children for adverse reactions or any other concerns.
Each step in the process is carefully coordinated to make sure that:
Kids get the correct dose of medications at the right time.
The prescribing doctors' instructions are carefully followed by school staff.
Parents and caregivers are kept informed of any issues—and have the freedom to contact school staff whenever questions or concerns come up.
Safety and fair treatment for all students who take medications at school
Having clear, detailed procedures for school-administered medication protects kids from mistakes that can affect their health. We want to prevent kids from missing a dose, receiving too much medication or accidentally taking medicine meant for another student. With a large share of students taking prescription and over-the-counter drugs every day, steps that ensure safety and consistency are crucial.
These procedures don't end at the school door or the end of the school day. Policies should spell out what happens when kids need medication on field trips, sporting events, academic competitions, school-sponsored travel and other off-campus or after-school events.
Making sure that all students have the chance to thrive is also essential. Kids who live with chronic illness, special health care needs,
trauma or
social conditions that threaten their health should have the same chance at academic success as peers who don't face these challenges. Making sure that children get the right medicine in the right dose at the right time gives each child the opportunity to do well in school.
Your child's school medication team
As a parent, you're part of a coordinated team that will oversee medications taken at school. This team also includes your child; other adults who care for your child (grandparents, after-school caregivers and others); your child's primary care doctor and the doctor's staff; and the school health team, including school nurses and support staff.
The role of school nurses
In many schools, health teams are led by
registered nurses (RNs) with extensive medical training and knowledge of medications, including risks and side effects. Sometimes,
licensed practical nurses (LPNs) play this role or a similar one.
School nurses often act as the main coordinator between home, school and community prescribers—meaning the doctors who write prescriptions or recommend over-the-counter medications for your child. Prescribers may include your child's pediatrician, a psychiatrist or another specialist who focuses on a specific health condition. For example, kids with diabetes may see an endocrinologist who monitors their metabolic health and progress.
Not every school has a full-time nurse. In some cases, staff members who have received special training may manage medication programs, either full-time or part-time. Some schools have large health teams that include licensed nurses and staff members who work together to administer medications.
School-based health workers are often the first to see improvements in a child's health—or worsening symptoms that suggest the need for quick action.
Your job as a parent: 7 steps in coordinating with the school medication team
1. Work closely with prescribers and pharmacists. The school health staff will need written instructions from each prescriber, outlining how and when meds should be taken. If your child's doctor (or specialist) feels it's best for one or more doses to be given at school, ask them to write the prescription in a way that the pharmacist can divide the medication (liquids or pills) into separate containers, each labeled with instructions: dosage, time of administration and any relevant warnings.
2. Bring medicines to school yourself. All medications should come to school in the hands of an adult and get handed to another adult. Don't expect your child to carry medication unless they are fully ready to handle this responsibility (see our advice for tweens and teens below). If an older child will carry medicine to school, make sure school policies allow it and ask the school health team to notify you of any concerns.
3. Fill out and deliver any required forms. Any prescription or over-the-counter medications—including vitamins or supplements—need written authorization from a licensed prescriber, along with your consent for your child to take them at school. Ask your school health staff for any forms they need you to complete. Make sure they're on file before school starts.
4. Keep medications in their original containers. Never send medication to school in envelopes, foil, plastic bags or unlabeled bottles. Labels should show:
The child's name
The name of the medication
Dosage to be taken
Time it should be taken
Route of administration: by mouth, inhaler, injection, etc.
The prescriber's name
Prescription date
Medication expiration date
5. Check all forms filled out by prescribing doctors. Though requirements might vary by state, school district or individual school, generally your child's health team will need to know:
When the prescription was ordered
The child's name
The reason for the medication
The name of the prescription or over-the-counter drug or supplement
Dosage
Time of administration
How to administer: by mouth, nasal spray, injection, etc.
How long your child will need to take this medication
Possible side effects
Special instructions: for example, take medication with food or drink plenty of water
Whether or not your child can administer their own medication
Keep in mind that the school health team is usually not authorized to decide when an "as needed" medication should be given. Prescribers should clarify by stating, for example, "every 4 hours as needed for pain."
6. Pick up unused medications. If your child is taking medication for short-term symptoms, collect any leftover meds once they've taken the last dose. If your child will take the same medication throughout the year, pick up any remaining doses before summer vacation (or whenever your school health team requests it). For tips on safely getting rid of expired medicines, read
this article.
7. Ask if your child should have an
individual health plan (IHP). Kids with chronic or serious health conditions can benefit from having an IHP that defines what school health workers will do in emergency and everyday situations, including the administration of meds. (If your child lives with a physical or intellectual disability, a
504 plan may be more appropriate.)
Written plans can confirm the level of staffing needed to support your child in the classroom and during extracurricular activities. IHPs and
emergency care plans (ECPs) should be updated at least every year or whenever your child's health changes.
Can older kids take their own medications at school?
As kids grow and mature, they naturally take more responsibility for their own health. This may mean that tweens and teens start to self-manage their medications at school. Some children, such as those with special health care needs, may not take on these responsibilities until college age or later. Decisions about a child's readiness can be made by parents, prescribing doctors and the school health team—all working with the student to create a routine that's safe, effective and supports their independence.
Federal law encourages schools to allow kids to self-administer emergency medications for asthma attacks and
anaphylactic shock. One reason is that children know their own warning signals, which saves time when seconds count.
Some schools may require health staff to be involved when emergency medications are needed, even if a child carries and uses their own inhaler, epinephrine auto-injector or other device. Check with your school and work with your child to make sure they feel ready to handle an emergency, with or without adult support.
Student and community safety are part of the decision-making process, too. For example, kids should generally not carry controlled substances—such as the stimulants often prescribed for ADHD—or assume full responsibility for taking them at school. Medications like these need to be secured in the school health office for the well-being of all students and staff.
If your child plans to manage their own medications, a self-carry order will document their ability to handle this responsibility at school (or during school-sponsored events). This document gives the student immediate access to medications without visiting the school health office. Kids who manage their own medications will also learn how to seek emergency help from school health professionals whenever they need it.
What about medical cannabis at school?
The Food and Drug Administration has approved some cannabis-based medications for kids with life-limiting or severely debilitating conditions. Some kids take medications derived from cannabis to prevent
seizures, for example. Drugs such as cannabidiol (Epidiolex), dronabinol (Marinol or Syndros) and nabilone (Cesamet) may be part of a child's school medication protocol.
School administration of other forms of cannabis—such as for pain or anxiety—must align with state laws and school policies. Parents and prescribing doctors can find out from the school health team whether a specific cannabis-based substance can be administered at school.
Tips for parents of college students: helping your child manage medications on campus
If your child is starting college or entering a study-abroad program, they may be ready to handle medications on their own. At the same time, they might welcome support from their college's health team as they take on new tasks in a new setting.
Ask your teen to reach out to the right person on the student health staff for information on campus-based medication rules and requirements. (You might need to give a few respectful reminders.)
In the meantime, help them get ready to handle the task of taking medications as directed. This means memorizing:
The brand and generic name of the medication(s) they take
The schedule and dosage
Possible side effects and how to handle them
Special instructions: for example, take with food or don't drink alcohol
Discuss what your child should do if:
They miss a dose
They accidentally take too much medication
They forget to order a refill, possibly running out of their medicine
Their medications stop working or trigger new side effects
They mix medications with other substances, bringing on a negative reaction
If your teen will keep emergency medications (such as an inhaler or epinephrine auto-injector) on hand during college, make sure their roommates, resident advisors (RAs), study-abroad coordinators and the college health center are fully informed. Let this informal "team" know which meds your child uses, how they're administered and where your child keeps them.
Students with complex medical conditions may need extra support during their college years. Consider meeting with your teen and the college health staff to discuss what will make the transition easier and foster good health for academic success.
The AAP cares about school medication policies
As advocates for child and family health, the American Academy of Pediatrics (AAP) supports policies and practices that help kids thrive from infancy through high school and beyond. We have created recommendations for pediatricians and family care physicians that emphasize:
The need for a coordinated team to support children who take medications at school.
Laws, policies and guidelines that encourage cooperation at the family, school and community level.
The role pediatricians and family care physicians can play in helping all children thrive in school settings, including kids who need to take medications at school.
The need to advocate for programs that provide emergency meds such as epinephrine, albuterol, glucagon and naloxone at low or no cost to schools.
Regulations that help school health teams, doctors and families collaborate freely without violating a child's
privacy rights or creating barriers that might harm a child's health.
Whenever you feel concerned about medications and your child, reach out to your pediatrician. They are there for you every step of the way.
More information
About Dr. Miotto
Mary Beth Miotto, MD, MPH, FAAP, is a community pediatrician at the Mattapan Community Health Center in Boston. She has served as medical director of 8 school-based health centers in Massachusetts and is active locally and nationally in collaborative school health initiatives. While focused on the full spectrum of family-centered care, she also specializes in child development and behavior in the medical home, supporting families through the typical parenting challenges from infancy through adolescence while also diagnosing and managing conditions such as autism, ADHD, learning disorders, depression and anxiety. Dr. Miotto contributes to the work of the AAP Council on School Health and other groups within the academy.
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