school field trip and epi-pen question

[Indiana Rose Lee]

However, if a child is going into anaphylactic shock, I think I'd rish the miniscule concern of cardiac arrest. Death vs potential reaction. It is a no brainer in my book. And, anyone who would watch a child die to avoid potential liability is worthless in my book.

 

[happymommy]

To the OP: My heart goes out to you. My DS is still allergic to milk and eggs, has an epi-pen (thank God I never had to administer it, but he's needed it twice) and outgrew sesame and peanut. He gets seen annually at Johns Hopkins, and was in a research study there that has had him almost outgrown his milk allergy now. DD was slightly milk allergic, outgrew at 2 (just vomiting and diarrhea when I consumed any dairy while she nursed, which was as long as she would, over a year).

Anyway, I think your son is not being treated fairly. He has a disability, and it is life threatening. If there is a nurse at school, and she is the ONLY one that can administer the epi-pen, what happens if she is in the bathroom, treating another child, or (God forbid) doesn't show up that day? That is unacceptable for your son. I hope you can find an advocate (even if you have to hire one) that will fight this. It is insane. Even for the 4 years my son went to a tiny Montessori school where there was no nurse, his teacher had his meds in the classroom, and she was trained and could handle him. At their current school, the whole bag of meds goes with him anywhere, on field trips, at away sports games, anywhere. They are all trained. My kids go to private school, but where we live, it would be the same at the public schools.

Also, my son has been using his inhaler on his own for years. At our school, they can self carry starting in middle school, which is 6th grade, but that is a legal point. I'm sure if I insisted, they would allow him to self carry younger; he just never needs it at school (go figure?). He keeps one in his nightstand, has for years, and knows how much to use. It would take a LOT to overdose on it, and he knows when it works. If it doesn't, he lets me know he needs the nebulizer.

 

[happymommy]

Oh, wanted to add: at age 12, I do not want my son to self administer an epi-pen. It is too risky, and you really need to know where in the thigh to use it (he is skinny, so it is risky to hit a blood vessel). Plus, then they need to be rushed to the ER. I want an adult to take care of that.

Sending hugs

 

[ekatiel]

A 504 plan is a legally binding plan (usually in written form, although it doesn't have to be) outlining your child's disability (in this case food allergies and asthma) and any accomodations that the school needs to make in order to provide your child with "free and appropriate public education". The accomodations in the 504 plan are legally binding, so the school must abide by the plan. Here is a link that tells more about a 504 plan for food allergic children. http://www.foodallergyadvocate.com/Section504IDEA.htm

To set up a 504 plan, you will need to find out who your district's 504 coordinator is. They will help you set up a meeting to get the 504 plan in place. The link I posted above also has a sample 504 plan on the site. I would HIGHLY reccommend getting a 504 plan, and in that plan, you can outline that a nurse or other trained professional will need to accompany him on field trips (by law, accomodations don't have to be "reasonable" financially-- If they aren't going to let the teachers adminster, then they are going to have to come up with some other solution that doesn't impede your child's right to a free and appropriate education).

As for self-carrying the Epi-- this whole thing makes me nuts. First of all, I think self-carrying and self administering are two different things. IMO, even young children should be allowed to self-carry-- that way, the Epipen is always with them, and teachers don't have to remember to take it with them everywhere (which in today's large public schools is the only other reasonable option). However, when the time comes to administer it, most children will not be able to do so (my 34 year old sister was too much of a wuss to self-adminster her Epi just a few months ago-- she had someone else do it). Which is why teachers should ALL be trained on how to administer an Epi.

I hope you are able to get a 504 plan in place. Good luck! --Katie

 

[princessmom29]

However, if a child is going into anaphylactic shock, I think I'd rish the miniscule concern of cardiac arrest. Death vs potential reaction. It is a no brainer in my book. And, anyone who would watch a child die to avoid potential liability is worthless in my book.

Absolutely. I only pointed it out as a possible reason why a doctor might have a problem with a young child carrying. If they self medicated and were not in a reaction it could be dangerous. If you are in anaphylaxsis then the epi wins hands down.

 

[Minniemama350]

Not meaning to argue with you at all. I totally support how you feel. Just want to shed a different perspective. I don't expect you to jump on board, it is just food for thought, BUT

Having shadowed my own child for med reasons(different ones) things to keep in mind:

If you tell them you will not be helping with other children, yours will get a nice day with mom, but not an actual fieldtrip experience. To a kid, half of the fun is going with the class and having a kid partner(I do think you get it, just restating). If you resist helping, they'll put him with just you and no other kids.

Having said that, I would definitely keep fighting for change and a law that will allow a teacher to administer an epipen. I would absolutely have no issue with being asked to administer one. I feel confident that there is a provision for this somewhere in IDEA, but not sure where.

 

[jscott27]

Amoung other things, it increases heart rate and blood pressure. Sometimes so much so that it is fatal. I am a biochemist. I have studied the biochemical pathways involved and read the literature. Do your research. Unecessary epi IS a danger and IS more likley to cause cardiac death that properly used epi.

I guess you must know more than the American Academy of Pediatrics, then, because they disagree with you. Here's a link to the AAP clinical report on use of epi. Some quotes from them:
"Consequently, physicians should always instruct these individuals to err on the side of injecting epinephrine rather than waiting too long."

"In contrast to transient pallor, tremor, anxiety, and palpitations, which are common and anticipated pharmacologic effects of epinephrine, serious adverse effects are generally not a concern for otherwise healthy children"

"Prompt administration of epinephrine for anaphylaxis is key. Sampson et al described 6 children with fatal reactions to food, all of whom had asthma, previous reactions to foods, and delay in treatment with epinephrine. "

Epi is only considered a problem for healthy children when "when epinephrine was given in overdose, especially when it was administered intravenously in an overdose, given at an inappropriately high concentration, or infused too rapidly." None of which apply in the case of epipens prescribed following the manufacturers instruction.

Delays in using epinephrine is believed to have resulted in deaths (see the Sampson reference), and other "adverse effects are generally not a concern". Fear of using epi is sited as a problem both by the AAP and the AAAAI (see AAAAI position paper).

Should it be used without good reason? Obviously not, but both the AAP and AAAAI suggest that children with a medical need be allowed to carry it on their person.

 

[princessmom29]

I guess you must know more than the American Academy of Pediatrics, then, because they disagree with you. Here's a link to the AAP clinical report on use of epi. Some quotes from them:
"Consequently, physicians should always instruct these individuals to err on the side of injecting epinephrine rather than waiting too long."

"In contrast to transient pallor, tremor, anxiety, and palpitations, which are common and anticipated pharmacologic effects of epinephrine, serious adverse effects are generally not a concern for otherwise healthy children"

"Prompt administration of epinephrine for anaphylaxis is key. Sampson et al described 6 children with fatal reactions to food, all of whom had asthma, previous reactions to foods, and delay in treatment with epinephrine. "

Epi is only considered a problem for healthy children when "when epinephrine was given in overdose, especially when it was administered intravenously in an overdose, given at an inappropriately high concentration, or infused too rapidly." None of which apply in the case of epipens prescribed following the manufacturers instruction.

Delays in using epinephrine is believed to have resulted in deaths (see the Sampson reference), and other "adverse effects are generally not a concern". Fear of using epi is sited as a problem both by the AAP and the AAAAI (see AAAAI position paper).

Should it be used without good reason? Obviously not, but both the AAP and AAAAI suggest that children with a medical need be allowed to carry it on their person.

that still does not address the stats on properly used epi versus improperly used. They are saying that the risk of anaphalyxis outweighs the risk form the epi, and I am NOT disputing that. I don't think you understand what I am trying to say. All I am saying is that there is a risk of cardic death from epi. It exists and has happened with an epipen. The risk is greater when it is administered when not needed. Does that justify not allowing a child to carry, I don't know. I am not a doctor and cannot make that determination. All I wanted to do was point out that the risk does exist, and could be a potential reason for a doctor to be hesitant about a child carrying. I did not set out to make a medical determination about it at all. Words like "generally not a concern" mean that the incidence of adverse reaction is low, but not nonexistent. The risk does exist,and it is greater when the epi is given to a nonreacting child. That is the entire scope of my statement. I am NOT trying to argue for or against self carrying by children, only to point out a potential reason for a doctor to not be comfortable with it.

 

[jscott27]

All I am saying is that there is a risk of cardic death from epi. It exists and has happened with an epipen. The risk is greater when it is administered when not needed.

I do understand what you are saying, but my point is that in healthy children this really isn't an issue. The AAP paper even talks about kids who were given larger doses (epipen rather than the jr) and while they had more of the common symptoms, it doesn't say anything about fatalities from it. For people with other issues noted for the drug, then there is an issue.

Not to mention, the likelihood of a young child using one of these when not necessary is extremely low. I have a MUCH bigger fear that my DS5 will fight it too much making it difficult to administer if the need ever arose. Most kids aren't real keen on getting shots, and the idea of shoving a ~1" needle into their thigh and then holding it in place for 10-15s doesn't thrill them.

 

[momz]

concerning the OP's initial question regarding if she will or will not be required to chaperone.....

Let's say for instance there was another parent chaperoning who happens to be a nurse or a doctor. Would you expect that person to spend their day with your child alone? It hardly seems fair to expect another parent to do something that you yourself are not willing to do. (I'm referring to your intention of refusing to chaparone any child buy your own).

I completely understand why teachers are not willing to be the person responsible for administering epi. After all, they have many other children to be responsible for as well. If their attention is focused on one child in a crisis, then who knows what kind of mayhem the others will be getting into in the mean time. Also...teachers are teachers...not medical providers.

It would be convenient for you if a medically trained parent happenned to be a chaperone, but you just can't expect it for every field trip. These parents have jobs too.

Having a child with medical issues isn't easy. And many times you as the parent have to be more available to your child than you would if the medical problem wasn't a factor (did that make sense?). I wish you luck.

 

[luvmy3]

concerning the OP's initial question regarding if she will or will not be required to chaperone.....

Let's say for instance there was another parent chaperoning who happens to be a nurse or a doctor. Would you expect that person to spend their day with your child alone? It hardly seems fair to expect another parent to do something that you yourself are not willing to do. (I'm referring to your intention of refusing to chaparone any child buy your own).

I completely understand why teachers are not willing to be the person responsible for administering epi. After all, they have many other children to be responsible for as well. If their attention is focused on one child in a crisis, then who knows what kind of mayhem the others will be getting into in the mean time. Also...teachers are teachers...not medical providers.

It would be convenient for you if a medically trained parent happenned to be a chaperone, but you just can't expect it for every field trip. These parents have jobs too.

Having a child with medical issues isn't easy. And many times you as the parent have to be more available to your child than you would if the medical problem wasn't a factor (did that make sense?). I wish you luck.

You are missing the point, I'm not being asked to chaperone. I am being told that I need to acompany my own child, there is a difference. And I could easily turn the situation around and ask what happens to my child if he eats something with a nut in it and I'm too busy taking care of the mayhem of the other kids I'm chaperoning? I have been on enough fieldtrips to know that they aren't all the angles we think they are when they go on their trips
Also I never said or expected that any other parent should be responsible for my child, in fact I wouldn't ask that of any other parent in the class. However, I do not think its unreasonable to expect a teacher to be trained and know how to administer the epipen especially if he/she has students in her class whose life may depend on it. You are right they are not medical prioviders, but they are responsible for every student's safety and health while they are in their care. Would you want your child in a school where every teacher didn't want that responsiblilty?
I have already sent in the permission slip listing myself as a chaperone, and I have emailed the teacher so she will know that I am available to take a group, and not just my ds.

 

[momz]

Good for you OP for doing the right thing for your child.

My opinion is that the teacher's job is to teach, anything other than that is above and beyond. There are too many possible scenarios of medical needs that could occur in any given classroom to expect the teacher to also be a nurse. That would require 2 degrees.

I also think that try as they might, the teacher is not substitute for a parent. I think that teachers in general are asked to do a lot. And certainly, they care deeply for their charges, but...they could never care for your child the way that you can. This is a special circumstance, and I feel for parents that are in this situation.

 

[htmom]

I think if I was in your situation, I would attend a board meeting and suggest all the money poured into fieldtrips be reallocated to train some more staff to attend to the children if an emergency arises!

 

[disneycruising]

I think if I was in your situation, I would attend a board meeting and suggest all the money poured into fieldtrips be reallocated to train some more staff to attend to the children if an emergency arises!

Great idea!

 

[momz]

something to think about. There have been numerous suggestions that the solution to this is to simply "train the teachers". Well...there are laws about who can and cannot administer medications. Even EMTs are not allowed to administer most medications and they have much more training in this area than teachers.

Also, there is the problem of liability. Keep in mind that liability insurance for professions that have the priveledge of administering medications doesn't come cheeply and would certainly incur a greater expense than the field trips.

In additon the time and cost of training and licensing the teachers in another profession is prohibitive.

Let the teachers do what they do best, and don't add to their already overwhelming list of responsibilities.

 

[htmom]

But if not the teachers why not some other staff in the building? They go on aprox 11 field trips, and charter busses sometimes! Obviously this is not some district that has money woes! LOL
I always thought that the safety of children should come before all the other "nice to have things"
Its almost like how I'd rather go to Disney than take my blood pressure meds that cost an arm and a leg. LOL

 

[KayW]

When we go on field trips and we have a student with allergies that may require an epi-pen or if a child is diabetic the NURSE or a designated NURSE attends with us. Try that route.

 

[ekatiel]

Good for you OP for doing the right thing for your child.

My opinion is that the teacher's job is to teach, anything other than that is above and beyond. There are too many possible scenarios of medical needs that could occur in any given classroom to expect the teacher to also be a nurse. That would require 2 degrees.

I also think that try as they might, the teacher is not substitute for a parent. I think that teachers in general are asked to do a lot. And certainly, they care deeply for their charges, but...they could never care for your child the way that you can. This is a special circumstance, and I feel for parents that are in this situation.

something to think about. There have been numerous suggestions that the solution to this is to simply "train the teachers". Well...there are laws about who can and cannot administer medications. Even EMTs are not allowed to administer most medications and they have much more training in this area than teachers.

Also, there is the problem of liability. Keep in mind that liability insurance for professions that have the priveledge of administering medications doesn't come cheeply and would certainly incur a greater expense than the field trips.

In additon the time and cost of training and licensing the teachers in another profession is prohibitive.

Let the teachers do what they do best, and don't add to their already overwhelming list of responsibilities.

A a former teacher, I complete understand the list of things that teachers are required to keep up with. HOWEVER, this situation is a legal issue. Under federal law, her child is entitled to a "free and appropriate public eduation". Her child is entitled to receive the SAME education that other children receive, regaardless of his disability. The SCHOOL is legally responsible to provide a solution for this situation. The SCHOOL is also NOT ALLOWED to refuse an accomodation because of its cost to the district.

OP-- I know you've decided to suck it up and just go on the field trip, but I would be pushing for a 504 plan for your child. Your child needs to have certain accomodations in writing in a legally binding document.

When we go on field trips and we have a student with allergies that may require an epi-pen or if a child is diabetic the NURSE or a designated NURSE attends with us. Try that route.

Excellent suggestion if the school is unwilling to train teachers on administering the Epi. --Katie

 

[tigger813]

I was trained on administering an epi-pen on field trips. I worked with 5th graders and they knew how to administer it but I was trained by the school nurse. Fortunately I never had to do it. I believe the parents had to sign a form allowing me to do it!

 

[luvmy3]

something to think about. There have been numerous suggestions that the solution to this is to simply "train the teachers". Well...there are laws about who can and cannot administer medications. Even EMTs are not allowed to administer most medications and they have much more training in this area than teachers.

Also, there is the problem of liability. Keep in mind that liability insurance for professions that have the priveledge of administering medications doesn't come cheeply and would certainly incur a greater expense than the field trips.

In additon the time and cost of training and licensing the teachers in another profession is prohibitive.

Let the teachers do what they do best, and don't add to their already overwhelming list of responsibilities.

I'm not asking a teacher to become a licensed medical professional. I'm asking that teacher with LTA students be trained how to use an epipen ane be allowed to use it in case of an emergency. It took me all of 1 minute to learn how to use it, and my 8 year old, maybe 5 minutes. As far as liability, I believe it would fall under the good samaritan act. The school will have a much bigger liability issue if G*d forbid a child dies because thety couldn't get to their epipen in time because the district says it has to stay locked in the nurses office.

But if not the teachers why not some other staff in the building? They go on aprox 11 field trips, and charter busses sometimes! Obviously this is not some district that has money woes! LOL
I always thought that the safety of children should come before all the other "nice to have things"
Its almost like how I'd rather go to Disney than take my blood pressure meds that cost an arm and a leg. LOL

I wish, its just that we don't have our priorities straight on where the money we do have goes. Alot of the trips are funded by the PTA, and the parents, though.

A a former teacher, I complete understand the list of things that teachers are required to keep up with. HOWEVER, this situation is a legal issue. Under federal law, her child is entitled to a "free and appropriate public eduation". Her child is entitled to receive the SAME education that other children receive, regaardless of his disability. The SCHOOL is legally responsible to provide a solution for this situation. The SCHOOL is also NOT ALLOWED to refuse an accomodation because of its cost to the district.

OP-- I know you've decided to suck it up and just go on the field trip, but I would be pushing for a 504 plan for your child. Your child needs to have certain accomodations in writing in a legally binding document.



Excellent suggestion if the school is unwilling to train teachers on administering the Epi. --Katie

Thanks to all the advice and info in this thread I plan to. What sad is that it took a thread on the DIS to make me aware of it, I've never heard anything about it from the school

Thanks all!