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Flashdance and Food Allergies?


Every now and again someone will post a picture on social media around “throwback Thursday” or such that takes me back to my childhood.  Sometimes it is an old family picture that reminds me of life growing up with my parents and two sisters, and sometimes it’s a picture from my school days that for a few moments helps me to remember what it was like to be a kid.  If I allow my mind to wander down that path, I stop to consider all the things that are vastly different than when I was a child.  No continuous access to a phone! Passing notes in school, doing research in a library, cheap gas, big hair and neon. I look back on those things fondly, even the big hair. :)  When I consider some things that my kids will never experience, I have to confess it makes me a little sad.  There was something about Saturday morning cartoons that just always made that day one to look forward to…………

Sometimes I consider those changes in the context of my job.  In all my years of schooling, I never knew of any student to have a life-threatening allergy.  It just didn’t happen.   And  later when I started working in school health  it was still rare. Thirteen years later it seems that there are several children with life threatening food allergies in every school and chances are ……..  in your classrooms and schools.  The amount of hair spray used since the 80’s isn’t the only thing that has changed.

A process for dealing with a plan to manage life threatening food allergies is essential for every school and classroom where children have allergies. There are simple measures that can be taken to help make your school and classrooms a safe learning environment for even the most severely allergic child. And these are easy measures to institute.

First, check your school and district policy for food allergies.  Some states are strong in this area, others not so much.  But the Centers for Disease Control and Prevention have published some “voluntary guidelines” for schools to follow.  This document can be found at:

It is an excellent resource for schools to utilize.  You will also want to follow your district procedures for referral through ADA or IDEA when it comes to students with life threatening conditions. That process will vary according to the need.

You can do some things that will make a big difference in your classroom:  talk to the parents of the child with allergies to see if it’s okay to send a letter home to other parents letting them know there is a student with a life threatening condition in your class.  Ask them not to send that product with their children (ex. if the allergy is peanuts, then ask for no peanut butter containing products).  Ideally all parents would honor that request but there are many many variables which come into play.  So what you CAN do is make your classroom a “nut free” zone.  Don’t allow kids to eat those items in the classroom, and have a plan worked out  as to how eating in the cafeteria will be handled  (that’s a topic for another blog).

Post “Peanut free Zone” (or tree nut) outside of your classroom and inside as well.  Only allow parents to send in prepackaged foods with labels (no homemade treats) so that you can look to see what ingredients have been included.  Always make sure students wash their hands after eating to get rid of any residual oils (hand sanitizer will not do the job) and make sure that the student (and you) have access to his/her epi pen!! You will also want to be sure that a school nurse has trained you to recognize the signs of an anaphylactic reaction, and on the use of that particular brand of pen.  And finally, always be on the lookout for signs of bullying- which can be a common occurrence for children with severe allergies.   Often those incidences can be minimized by providing other children with education about food allergies.

For a free checklist that may be helpful to make sure things have been addressed in your room go to  It is meant for the classroom level (and not the other areas of school where modifications may need to occur)  but can give you an “at a glance” of some key areas.

Students learn best when they are healthy and safe, and even though the level of care in classrooms has changed over the last several years, the needs of children haven’t.  If we want to ensure success for all children, then a few simple steps can help make the classroom a much safer environment.




Bugs and Gaps- what’s the connection?


eva_general[2]Achievement gaps.  Those reports, the watch lists, and strategies to help ensure all students are successful.  I wish that we could add “attendance gap” to the list but that’s a topic for another day…

So what do bugs have to do with gaps?  Maybe quite a bit.  When I started in school nursing, I came across lists that a savvy former nurse had kept regarding follow up for students diagnosed with “live lice”.  Her record-keeping was quite telling.  Children were being excluded from school for weeks at a time, the school bus would refuse to pick them up, and there weren’t enough nurses to do all the checks so there were really no guidelines as to who was diagnosing the children. I imagined her frustration as she had to deal with the issue day in and day out.  Why were these practices so telling? At the time, the district had one of the highest dropout rates in the state.  I couldn’t help but believe that had a lot to do with the way kids were made to feel about school early on.

Anyone who has been subjected to standing in a room full of kids having their heads checked, and then later asked to go home from school can understand the dread associated with these practices.

Does it happen this day and age? Absolutely.  Scan the internet for policies related to head lice in school districts and see what practices exist.  The Centers for Disease Control and Prevention, American Academy of Pediatrics and Harvard School of Public Health have been quite clear regarding the harm of no-nit policies and school exclusion for head lice, yet districts continue to send children home.

If you look at the children in your classroom or school struggling academically, often they are the ones with the most obstacles to overcome.  That’s why the identification of “gaps” even exists.  Those families living in poverty often end up living in close quarters with other extended family, sharing rooms and beds and have circumstances where lice is easily transmitted from one child to the next. Sometimes getting treatment is difficult, and since lice are often resistant to the products Medicaid and CHIP insurances are most willing to  cover, the problem is not easily corrected.  Parents are then often accused of neglecting to care for their children.

I had a parent (a local minister) call  one time wanting to know what I was going to do to take care of the “lice problem” at his daughter’s school.  In conversation I found  the “problem” was that his 6 year old daughter was telling him  a girl in the class had head lice and she wasn’t being treated.  His complaint was that the district did not have a “no nit” policy to make sure his child wasn’t exposed.  I explained to him that the school nurse would do follow up with children who have lice and his daughter would not know that he/she had been checked.  I also explained that nits cannot be passed from one person to the next.  His response?  “I don’t want my daughter around THOSE children!” (Also bear in mind he was getting his information on what was and wasn’t being done from the perspective of a 6 year old!!)

In our jobs there are just “children”.  Children who all deserve a chance.  When we set them up to miss school repeatedly, we set them up for failure.  When they fail, they become a burden to local resources in our communities and the cycle is perpetuated.

There is a way to deal with head lice, using national guidelines and science.  It doesn’t mean ignoring the issue altogether- it means following up in a way that helps resolve the problem.  It means taking a look at other practices that might be impacting the gaps in our schools and finding new approaches to intervene. The most basic of which is not looking for ways to keep them out of the classroom.

I find it helpful to use a flow chart to help keep on track with students that have ongoing issues with lice.  The flow chart allows a nurse to document what treatments have been utilized, along with what teaching has occurred for parents.  It won’t cure the issue- anytime children are together in one place (and can put their heads together) we will have head lice.  But it can help ensure proper treatment and support for children to be where they learn best, in school!

A copy of the flow chart mentioned above can be found at:

Lice is often to blame for high emotion and distress.  Hold firm to your mission of advocating and supporting all children. Follow the guidelines and  remove barriers which can help in your work to reduce gaps in the children you serve.



Diabetes Tips


Things have sure changed since I went to school.  Some may say for the good, some may say for the worst but either way life is different than I knew it. I was raised in an era where the lunch ladies made home cooked meals, the president’s wife wasn’t worried about how much sodium we had and it was unusual to see an overweight child.  We never heard of peanut or tree nut allergies, there didn’t need to be laws allowing student to carry their epi pens and (gasp) we really did walk to school no matter what the weather.

I wouldn’t trade those years for anything.

I was also a student with type 1 diabetes. And as I see what children encounter with their diabetes in schools I am thankful I grew up when I did.  I took my insulin at home, in the morning and evenings, watched what I ate and when I did check my blood sugar it was at home.  There were no school staff reviewing numbers making me feel “good” or “bad” based on a reading I often couldn’t control.  My sister and friends looked out for me, and the one time I drank a regular Pepsi in front  of a teacher she called my dad (who also happened to be a principal).

Diabetes care has advanced tremendously since that time, but it’s also made things a bit more challenging for both students and teachers.  For students, it has to feel somewhat like being under a microscope.  Over the years I have had well-meaning staff do things that would make any child hate to come to school.  Checking blood glucose becomes an ordeal as does taking insulin.  Counting carbohydrates is a challenge and well-meaning people question what kids are eating.  With that, I would just like to offer school staff a few thoughts about children with diabetes from the perspective of someone who has been around the block a bit.

1- Diabetes is always there.  Kids do not get a day off.  24/7 children with diabetes are living with this often exasperating condition.  Please do all you can to make their routine “normal”.   Depending on the age and developmental ability of kids some are fine checking blood glucose in the classroom.  Often they know much more about their bodies than anyone else. Give kids as much flexibility as you can in making those decisions.

2- Don’t refer to children as “the diabetic”.  Granted, I hear this more in my nursing peers than I do from other school staff.  As someone with diabetes I am offended when someone tries to define me with that label.  I happened to develop a condition that I didn’t choose but it does not describe who I am.  It’s much less offensive to use language like “the child with diabetes” etc.  Just be aware of the impact of your words.

3- Learn what to do.  The biggest worry in school is low blood sugar (hypoglycemia). Know the signs and be prepared to respond.  I would hope that everyone has nurses in the schools to help provide training (but as we know this is an area sorely lacking in our prosperous country).  If you don’t have someone to train you, talk to parents and access information available for school staff on the American Diabetes Association website.

4- Make sure you have what you need to respond to a low blood sugar reaction.  Parents should supply snacks and supplies but unfortunately not every child has parents who do so on a regular basis.  Rather than spend your time fighting, ask the nurse or principal to get a tube or two of glucose gel.  You can also use cake gel (it must be GEL, not icing, the icing has more fat and takes longer to absorb).  That way you have a cheap and quick way to respond and prevent an emergency situation.

5- Know that if he/she has high blood sugar then there will need to be extra trips to the bathroom.  I’ve heard lots of staff talk about how kids abuse the system to “take advantage”.   There are lots of psychological issues than can come with diabetes that become classroom management issues.  That is a topic for another blog!  But do know that it is very real for a child to need extra trips to the bathroom when blood sugars are running high.

6- Low or high blood sugar levels can interfere with test-taking abilities.  These kind of things should all be addressed in a health plan, and often students with diabetes will also have a 504 plan.

7-Families are taught to count carbohydrates not limit foods.  Children with diabetes have the same nutritional needs as any other child.  They can eat cupcakes and other treats, it just has to be covered with insulin (either via pump or by an injection)- they should have access to the same treats the other students have.

Over my years in school health I have seen the number of students with type 1 diabetes increase.  It’s the rare occasion for schools not to have at least one student with diabetes. Please know they often feel “alone” in their condition.  When I was a child my parents packed me off to “Camp Kno-Koma” for two weeks every summer (I am NOT making the name up- that’s what it was called) where for once I was not the weirdo. We all had to do the same thing and I didn’t feel like everyone was staring.  Be aware of those feelings in your students.  Those thoughts will vary by child but sometimes kids just want to have a “normal” day.

Diabetes care at school is a team effort, and some days are easier than others. The more you know, the more comfortable parents will feel sending their child to school and the more confident you will feel in being able to respond to the needs of the kids in your care!!






Food Allergies in the School and Classroom


In the 13 years I have worked in school health I am amazed at the increase in the incidence of food allergies in children. When I started in a district of just over 4,000 students, we had one maybe two children with a food allergy.  In that same district there are now about 100 children with a documented serious food allergy.  While there are lots of theories trying to explain the change, no sole cause can be identified.  Unfortunately, increases in the incidence of severe conditions at school has not seen an accompanying  recognition of the need to place full time nurses at all schools in our country.

For those of you working in schools with children having allergies, there are some important things to know.  First, a food intolerance is not the same as a food allergy.  Food intolerance can cause symptoms that are undesirable but are not the signs of an allergy and does not put a person at risk for anaphylaxis, which is a life threatening condition.  I have had parents make requests for their children not to receive particular food items because of unpleasant side effects.  For example, I myself do not eat onions.  I CAN eat them, but the stomach pain they cause afterwards doesn’t make it worth the experience.  I happen to love onion rings but they don’t love me back.  The last time I spent two days with a very unhappy stomach my husband just shook his head and said “why do you do this??” It was a good question, and I’ve tried to avoid the same consequences ever since.  Food intolerances usually comes on gradually, may only happen when a lot of the food is eaten, may only happen if the food is eaten often and most importantly, are not life threatening. Food allergies on the other hand are different, they usually come on suddenly, a small amount of food can trigger a reaction, the reaction happens each time the food is eaten and CAN be life threatening.

It is important to know the difference because quite obviously, the focus and obligation of the school is to be aware and prepared to intervene should a child suffer from food allergies.  Hopefully, your school is staffed with a Registered Nurse who can follow up with parents and health care providers to know if a child has an allergy versus an intolerance to certain foods and a plan is in place to avoid exposure and to intervene if exposure were to occur.  Any food can cause an allergy but there are eight “most common” foods that account for 90% of all food allergy reactions in the United States.  They include: peanuts, tree nuts, milk, eggs, wheat, soy, fish and shellfish.  We tend to hear most about allergy to peanuts and tree nuts. The reason is that most of the other allergens have to be eaten to cause severe reactions.  Peanuts and tree nuts are a little different.  For those with severe allergies, coming into contact with the oil from these products can have devastating consequences.  Peanuts and tree nuts have oils that can remain on surfaces. If a child with a severe nut allergy touches that oil and then touches a mucous membrane (such as their mouth) then they can STILL be exposed to the allergen and have a serious, perhaps life-threatening reaction.

So how do you prepare your school or classroom?  First of all, you will likely receive pressure to make your school or class “nut free” .  This has become a popular trend that is not supported by research or national guidelines.  It sounds like a great idea, and many districts adopt this designation in a well-intentioned manner to help parents feel better about their child attending school. Unfortunately, it’s a very dangerous approach.  How often do we tell parents of children allergic to bees that our school/district is a “bee free” district?  The answer is never, we would not label our school as such because it’s a promise that’s impossible to uphold.   I look at “nut free” in the same way.   Until we can control what every person brings onto a campus every day of the year- we cannot safely call our schools nut free.  I do advocate for schools to be “nut safe”.  That means we take measures to control potential exposures for children on an individual level by taking steps to minimize risk for each child individually.  Nut oils can be a part of many products- sauces, nougats, ethnic foods, granola etc. there are even potting soils that contain peanut oil. Unless every person checks every label of every product brought onto campus every day, a school is not “nut free”.

It’s not just nuts- any life threatening allergen needs to be addressed, but peanut and tree nut allergies are more risky in a school setting because of the potential contact exposure. Milk, wheat fish, shellfish and soy cause reactions when ingested so the diligence needs to lie in preventing children from eating foods containing these ingredients.

So where do you begin?  I recommend the following actions, and that your school/district have a policy for addressing food allergies:

1. Develop a Food Allergy and Anaphylaxis Emergency Care Plan (formerly a food allergy action plan) for every child-  (as a note, most children with severe allergies would qualify for a 504 plan under section 504 of the Rehabilitation Act- those plans are not discussed here today)

2. Educate yourself, educate your peers, educate students– learn about food allergies and how you can minimize student’s risk for exposure- take the Back to School online course designed for school personnel

For elementary students there is a wonderful video called “Binky Goes Nuts” that explains food allergies.  It is available for $9.99 and is a wonderful tool to educate children!

Lots of additional school resources can be found at:

3. Control the environment– post signs on your door and in your classroom saying “peanut free zone” or “nut free zone”.  If the parent of a child with life threatening allergies is agreeable, send a letter  home to all kids in the class asking that  they not to send foods containing the allergen (particularly peanuts and tree nuts) to school with their child.  This is difficult to enforce so don’t expect that all parents will check labels and avoid sending these products! Don’t rely on others to look out for the child in your care.  Offer a separate seating area at lunch, OR if the parent/child prefers, designate an adult to wipe down tables and check what the students around the child with allergies are eating.  Your entire class should wash their hands before returning to the classroom (as they could have peanut or tree nut oils on their hands). Hand sanitizers do not remove this oil and hand washing is recommended action.

4.  Be able to respond– Ask the school nurse to train you on use of the epi pen. Most all states have laws requiring training on the administration of medication from those without a nursing license.  In a school setting you should be trained to use the device.  The epi pen should be available for the student at all times.  It should never be locked in the nurses office or up front somewhere it can be forgotten.  For small children I encourage putting it in an emergency bag that travels with the class.  We often have even younger children with severe allergies carry their epi in a cinch pack or other bag that fits on his/her back and goes from class to class.  There are new Auvi-Q injectors that talk you through step-by-step what to do when you pull off the cap!  Technology has come a long way!!

5. Watch for Bullying–  Be prepared and on the outlook for bullying.  It happens in lots of ways, so make sure that children in your classroom aren’t isolated or outcast due to their condition. In my experience, most of the time the children do well in understanding the issue.  It’s the adults who minimize the hazards of exposure.

And finally, just a few other thoughts. Pay attention to recess, vending machines, and policies regarding home made treats.  Recently a school nurse approached me because classes at her elementary were having a common recess period and were eating snacks on the playground.  The snacks were coming from home and from a vending machine.  It was an easy fix by changing the rules a bit to say the snack should be eaten before going outside and also the items in the vending machine are not allowed to contain nut products.  But if she hadn’t been looking to see everywhere kids could have food it could have been easily missed.

Food allergies are a very real part of everyday life. Data now shows about 1 in 12 children have a serious food allergy so it’s something you will encounter eventually (if you haven’t already) in your schools.  Keep you attention focused on each child at an individual level and don’t think quick “school wide” policies are the best way to keep children safe.  It takes diligence and ongoing monitoring as do most things in the world of education!!



Those Pesky Critters……….



School is  back in session.  The children gather and lots of little heads are  in one place. With that comes all they bring with them.  Time for reading , writing and head lice.  Yes, lice.  They are in your school, and in your classrooms. You can use this PowerPoint for yourself or to teach others the basics.

When my youngest was in kindergarten, she had blonde hair down to her backside. And imagine my surprise when I found a headful of those lovely creatures one afternoon. It was a good lesson for me in empathy for  families.  It took us quite some time (and a haircut) to be rid of them, despite hours of nit picking, hair combing, an electric lice shocking device, olive oil, and over the counter products. I even had a microscope at home to try to figure it all out.  When I saw her with her baby doll between her knees one day, pretending to pick nits- I knew my approach needed to change.  Many weeks had passed… it was time. One treatment with a prescription product and we were done!  (There are lice that are resistant to some of the over-the-counter products and that’s what we had)!

You discover one or more children in your school or room with head lice.  What are you to do?  The first thing is to keep calm! Lice are a nuisance and a pain but are NOT a health risk. They are not known to carry disease in the United States.   Secondly, if you haven’t already- you should educate yourself on how they are passed from one person to the next.  Despite what you may have been told- they do NOT jump or fly.  Head lice are passed by direct head to head transmission. Meaning, one head needs to touch another.  There are theories that they can live in carpets and various inanimate objects but the evidence says this is just a theory.  And the lice in your school aren’t setting out to look for other places to live. They are perfectly content where they are as long as a human head is involved.  If they get passed along, it’s due to happenstance- they aren’t mounting expeditions looking for a new home!!

When kids get head lice there is a course of action that should be taken, and the ultimate fix often isn’t with just one treatment.  Children should only be treated when live lice are present, nits do not confirm an active  case.  When a child is diagnosed with head lice a pediculicide (medicine which kills lice) should be used. The American Academy of Pediatrics recommends starting with 1% permethrin lotion (Nix) initially.  This product is not 100% ovicidal (meaning it doesn’t kill all the eggs) so a second treatment is needed in 7 to 10 days. What does this mean for folks in school?  That it’s normal to see live lice again after treatment in about a week and not that kids have gotten them again.  There are lots of “natural” products available but medical studies have not supported their effectiveness.  There are several websites supporting things like “no- nit” policies and exclusion of children from school.  Organizations such as the Centers for Disease Control and Prevention and the American Academy of Pediatrics say these policies are counter productive and should not be adopted.  For more information on head lice treatment go to:

Often I see the same children repeatedly dealing with head lice.  This becomes frustrating for schools.  In these situations families need additional support. Hopefully you have a school nurse who can be involved (if you don’t- your school needs one!)  As mentioned earlier, lice can be resistant to over the counter treatment so a health care provider may need to be involved.  In my own situation I know I was doing the “right” things yet it was still difficult to get rid of.  The prescription medicine made the difference.  Sometimes we have to help families understand or get additional help.

You may be thinking that we need to just go straight to prescription medication.  That is not recommended because lice will soon become resistant to those treatments if over used.

In my years of school nursing, head lice has been what has gotten me yelled at the most, by parents and by school staff, and any of you who work in schools can likely say the same. It’s a very emotional issue, and no one wants to have head lice.  The more you educate yourself the better.  Not only to help decrease the spread in your school and classroom, but also when it comes to knowing what to do to help.  When you discover lice in a student, I recommend the following:

1.  Make sure it’s really lice.  That sounds crazy but there have been studies showing that many times kids are diagnosed with “lice” in school when they don’t really have it.

2. Check your school/district policies.  Most kids have had lice for a month or more before it’s discovered. The American Academy of Pediatrics and the Centers for Disease Control and Prevention do not recommend they be sent home that day.  You need to know what your policy says but know that it hurts them academically when they are excluded.

3. Make sure the school nurse is involved (I do so hope you have one). She/he is a great support and help for you and families.

4. Let the parent/guardian know.  Hopefully you have a nurse or resource who can help guide them through the best options for treatment.

5.  Know that its normal to see live lice  in 7 to 10 days.  This doesn’t mean they got it “again”.

6.Check your practices or (if you aren’t a teacher) the classroom where the student(s) are- do the kids lay in a spot (such as a special reading place) with their heads all together?  Are their coats/jackets all piled up in one place?  These could be ways to transmit at school!

7.  Know some good referral sources (this is for school nurses as well!)  I teach parents that they should do an over the counter permethrin or pyrethrin (if no allergies), and then to repeat in 7 to 10 days.  If they see live lice in their child’s hair  7 to 10 days after that second treatment I usually refer to their health care provider, or assist the families in getting a prescription medication.

The problem can be a challenge but we are smarter than the critters! Don’t let it be a barrier to your success in school!




Pegs with schoolhouse

One School Nurse + One Behavior Specialist + One School Psychologist =

The Untested ESSENTIALS of Learning

A square peg in a round hole is an idiomatic expression which describes the unusual individualist who could not fit into a niche of his or her society.[1] ^ Wallace, Irving. (1957) The Square Pegs: Some Americans Who Dared to be Different, p. 10.

Above found at

 Most employees of school districts are… [insert a drum roll here]…teachers.  And the customers of their expertise are the wonderful students who walk through the doors of their respective schools each day, ready to learn all the fascinating things teachers have prepared to teach.

[Insert the sound of screeching brakes] Hold on a minute!

What happens if a student walks through the doors of the school and is not 100% ready to learn? What if the student is not even 50% ready to learn? What if the student is hungry? Sleep deprived? Scared because yesterday another student threatened to beat him up? Worried because her mother’s boyfriend threw her mother around the kitchen last night? Angry because her family’s electricity was turned off the night before? Sad because his grandfather is dying? What if the student, himself, is sick? Or has a learning disability? Or has attention span issues? Or…well, you get the point.  The list of hypotheticals is endless.

In an average day in a classroom of 25 students, there are probably at least 5-6 students who have some sort of barrier that interferes with his or her ability to learn academics optimally.  That’s where we come in…The 3 Square Pegs. Our jobs are to provide support services to students, their families, and the teaching staff so that teachers are able to teach, and more importantly, students are able to maximize learning.

What can you expect from our blog? Our focus will be on the multitude of untested essentials that are required for learning to occur.  Head lice? Check. Classroom design? Check. Bully Prevention? Check. De-escalation strategies? Check. And on and on the list goes. These essentials will be in the form of a host of practices at the district, school, classroom, and individual student levels.  With our 60+ years of collective experience in helping teachers teach and students learn, we think we have something to offer.

We are blessed to work in a school district that has vision. To be a small, rural school district with approximately 2,600 students, having a Nurse Practitioner designated as the district’s Director of the Coordinated School Health Program, a School Psychologist functioning as a district-wide counselor to support our excellent guidance counselors, and a Behavior Consultant who is currently the Director of our Alternative Education Program, we consider ourselves rather unique.

Per the meaning of “A square peg in a round hole”, we are unusual individualists who do not fit into a niche of our society (aka, schools). Don’t confuse our “not fitting neatly into our educational society” as meaning that we are not wanted there or that we don’t want to be there! We are welcomed and appreciated by the educators with whom we have the privilege of working. We just happen to think differently in some respects. While we all want the best for our students, our focus is on the many foundational essentials required for learning to even be an option.  Teachers teach.  They are under tremendous pressure to improve achievement and adhere to new national standards. The three of us provide support services, direct and indirect, to our district’s excellent teachers and awesome students. The result? Students who, for the most part, come to school happy, healthy, and ready to learn.  Not BECAUSE of us, but with our help, these students achieve more academic, behavioral, and social/emotional success.

What can you expect in the days and weeks to come? The format of our blog, while it has the common thread of addressing barriers to learning, will shift as each of us take on the responsibility of writing one or two blog entries per week.