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El Paso County Colorado District 49

Working with students medical and nutrition needs

Out of a population of about 15,000 El Paso County Colorado School District 49 students, an estimated 20% to 30% have special medical needs.Patsy Prettyman, lead nurse for the district, said the most common ailments are diabetes, seizure disorders, asthma, severe allergies and mental health conditions. In addition to those, there are special needs students who require tracheotomy care, oxygen, gastrostomy tubes and regular medication administration. Both nursing and nutrition staff play key roles in the daily health needs of these students.There are 15 nurses in the district plus a nursing assistant in each school. Each nurse is assigned two or three schools. Prettyman said the role of the nurse is to connect different teams to support each student in school; the goal is for students to have access to their education without barriers.ìAs school nurses, we are passionate that students have access to their education,î she said. ìThey are involved in school, they blossom and have a successful academic experience. They should not have to worry about their medical needs prohibiting them from accessing all the opportunities that are available like sports, clubs, band, theater, school-sponsored activities.îFor every student with medical needs, the nurse develops a health plan in collaboration with the studentís doctor, parent, teachers, school nurse assistant, counselor, special education team, if applicable, as well as any extracurricular district staff like a coach who has a role in supporting students.The district adheres to State of Colorado standards and procedures for the care of students with medical needs in schools and that includes medication administration. Teachers, nursing assistants and other staff in each school receive training from the nursing staff on daily care of the students and emergency response procedures. ìAn RN cannot work in performing duties for students or delegating without medical orders from the studentís physician,î Prettyman said. ìWe canít administer meds or have rescue meds without a medical provider providing us with orders. Then we follow medical orders just like we would in any other setting like a hospital.îThe classroom teacher is important in the care of students with medical needs and must be prepared to respond to emergencies or administer medications in the classroom and on field trips, Prettyman said. ìTeachers might have to administer medications. We do conduct training for school staff in the administration of rescue meds like epinephrine, rescue inhalers for asthma, rescue for seizure disorder, or for extremely low blood sugar for diabetics who may become unconscious.îSubstitute teachers are provided information pertinent to a class, including any students with medical needs or severe allergies. For a short, one-day assignment, no special training is required of a substitute; however, for long-term assignments, the substitute will have the full training that the classroom teacher receives. Substitutes are advised on how to quickly access school health personnel or an emergency response team for assistance, if needed.Food allergies, especially peanut and tree nut allergies are some of the most common medical conditions that impact both the classroom and the school cafeteria, Prettyman said. Classroom teachers are advised of severe food allergies. She said teachers will notify parents that a certain student in the class has a severe allergy and request that all parents abstain from sending snacks containing that food item with their children. However, the identity of students with allergies are not disclosed to other students or parents. For school parties, teachers recommend parents provide only labeled foods and avoid homemade foods because of potential cross contamination in the home environment.ìIn this district, we call it peanut protected,î said Kristina Flaten, administrative registered dietitian. ìWe donít serve anything that contains peanuts or tree nuts. That takes us out of a lot of modification.î She said decisions are made at the building level when it comes to treatment of food the kids bring for lunch. Some have a separate table designated free of peanut or tree nut food items for students with severe allergies.Flaten said the most prevalent food modification is for students with celiac disease, requiring gluten-free foods. She said lactose intolerance is also a frequent issue. Sesame allergies are becoming more common. A food allergy bill was signed into law in April 2021, called the Food Allergy Safety, Treatment, Education and Research Act of 2021. The FASTER Act added sesame to the list of major food allergens. Effective Jan. 1, 2023, manufacturers will be required to add sesame as an allergen to food labels.Monica Deines-Henderson, director of nutrition services, said that guidance on how meal accommodations are handled are set by federal regulations. ìFamilies are provided a form for their doctor to complete. The doctor cannot just say what a child cannot have; they have to very specifically tell us what we can provide instead of the specific food item. We are not allowed to make up the changes ourselves. It has to be medically directed.îIn the case of a gluten-free diet, Flaten said, as an example, when they are serving pizza, they might substitute a hamburger or chicken sandwich on a gluten-free bun for those students.Flaten said they may not be aware of all student allergies or food sensitivities in the cafeteria setting. They have about 50 students who have requested meal accommodations. ìA lot of times I wonít know about the children if the parent decides to send lunch with them and not through the cafeteria. That probably happens quite a bit.îFor children with diabetes, Flaten provides the nursing staff with the carbohydrate count of all items they serve. ìItís the nursing staff that works with diabetic children because they have to give them the insulin. Based on what the child eats, they know the right dose,î she said.Flaten cautions those with food allergies. She said manufacturers can change the formulation of their foods without informing the public. ìYouíll notice a lot of food recalls will happen when something that gets in there isnít on the label. That ties into that.î She said at the beginning of each school year she calls the manufacturers and asks if they have reformulated products used in the school district. ìItís something people with severe food allergies should watch out for,î Flaten said.

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