An estimated eight percent (approximately two million) of children in the United States are affected by one or more food allergies. With a true food allergy, an individual's immune system overreacts to food that is usually harmless. This response by the immune system can be life-threatening within
a matter of minutes.

Food allergy is a serious and potentially life-threatening medical condition affecting up to 15 million Americans. One in every 13 children has a food allergy—that’s about 2 in every U.S. classroom. And every 3 minutes, a food allergy reaction sends someone to the emergency room. The most common food allergens are peanuts, tree nuts, fish and shellfish, milk, eggs, soy, and wheat. These ingredients are not always obvious on packaged products.

Allergic reactions can occur with trace exposure to food allergens. There is no cure for food allergy. Strict avoidance of allergens and early recognition and management of allergic reactions are important to the safety of children with food allergies at risk for anaphylaxis.

Anaphylaxis is defined as a serious allergic reaction that is rapid in onset and may cause death" (Simons, 2008). Anaphylaxis involves a wide range of symptoms that can occur in many combinations and is highly unpredictable. It is estimated that four out of every 50 children have a food allergy (Gupta, R, 2011) and children with food allergies are more likely to experience other allergies. Children with the diagnosis of asthma may be more likely to experience an anaphylactic reaction to foods and be at higher risk of death. In case studies of fatalities from food allergy among pre-school and school-aged children in the United States, nine of
32 fatalities occurred in school and were associated primarily with significant delays in administering epinephrine, the only life-saving treatment for anaphylaxis (Sicherer S. & Mahr, T. 2010).

Epinephrine is available through a physician's prescription in an auto-injectable device (Epi-Pen). The severity of one reaction does not predict the severity of subsequent reactions and any exposure to an allergen should be treated based on the child's  Food Allergy Action Plan (FAAP)/Emergency Action Plan (EAP) and Individualized Healthcare Plan (IHP).

View Boerne ISD's Food Allergy Plan FFAF Local Wellness Policy here.

Epi-Pens and How to Use Them

The Boerne ISD maintains a program for the possession and use of epinephrine auto-injectors by the campus nurses. In addition to the nurses, numerous faculty members are trained and instructed on their use as well.

For more information about epi-pens, their use, and their availability, please contact your student's campus nurse directly.

Bacterial Meningitis

Organism, Causative Agent, or Etiologic Agent

Bacterial meningitis is caused by different types of bacteria. Streptococcus pneumoniae, Streptococcus agalactiae, Neisseria meningitidis, Haemophilus influenzae, Escherichia coli, and Listeria monocytogenes are examples of bacteria that can cause bacterial meningitis.

Transmission
Some forms of bacterial meningitis are contagious. The bacteria can mainly be spread from person to person through the exchange of respiratory and throat secretions. This can occur through coughing, kissing, and sneezing. Fortunately, none of the bacteria that cause meningitis are as contagious as things like the common cold or the flu. The bacteria are not spread by casual contact or by simply breathing the air where a person
with meningitis has been.

Symptoms
Common symptoms of bacterial meningitis are high fever, headache, and stiff neck in anyone over the age of 2 years. These symptoms can develop over several hours, or they may take 1 to 2 days. Other symptoms may include nausea, vomiting, discomfort looking into bright lights, confusion, and sleepiness. In newborns and small infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to detect. Infants with meningitis may appear slow or inactive, have vomiting, be irritable, or be feeding poorly. As the disease progresses, patients of any age may have
seizures.

Bacterial meningitis can be quite severe and may result in brain damage, hearing loss, limb amputation or learning disabilities. The following groups of people are at high risk for bacterial meningitis:
• children between the ages of one month and two years old,
• people who abuse alcohol,
• people with chronic nose and ear infections,
• people who have sustained a head injury,
• people who get pneumococcal pneumonia or widespread blood infection
• people who have a weakened immune system,
• people who have had their spleen removed, or have had brain or spinal surgery,
• people who are on corticosteroids because of kidney failure
• people with sickle cell disease,
• people who live in close quarters with others including military recruits and college students

Neisseria meningitidis and Haemophilus influenzaeType b can spread to other people who have had close or prolonged contact with a patient with meningitis caused
by Neisseria meningitidis (also called meningococcal meningitis) or Haemophilus influenzae Type b. People in the same household or daycare center or anyone with direct contact with a patient's oral secretions (such as a boyfriend or girlfriend) would be considered at increased risk of getting the infection.

Prevention
There are vaccines available that offer protection against some of the bacteria that can cause bacterial meningitis. The pneumococcal conjugate vaccine, pneumococcal polysaccharide vaccine, meningococcal conjugate vaccine, meningococcal polysaccharide vaccine, and Haemophilus influenzae Type b vaccine can assist in preventing infection from certain bacteria that can cause bacterial meningitis.Maintaining healthy habits, like getting plenty of rest and not coming into close contact with people who are sick can also help prevent infection. Using good health practices such as covering your mouth and nose when coughing or sneezing and washing your hands frequently with soap and water can also help stop the spread of the bacteria. If you are pregnant, you can reduce your risk of meningitis caused by Listeria bacteria (listeriosis) by cooking meats thoroughly and avoiding cheeses made from unpasteurized milk.

School Exclusion Criteria
Children with bacterial meningitis should be kept out of school or childcare until they are fever free for 24 hours without the use of fever suppressing medications. Rules for exclusion of sick children from school and childcare are outlined in the Texas Administrative Code, specifically Rule 97.7 for schools and Rule 746.3603 for childcare.

Texas Trends
The condition “bacterial meningitis” was last reportable in Texas in 2012. Meningitis caused by a bacterium is still reportable if the organism or condition is still reportable (e.g., meningitis caused by Neisseria meningitidis, Group A Streptococcus, Listeria,
etc.). The number of bacterial meningitis cases for Texas ranged from 271 reported cases in 2006 to 317 reported cases in 2012. In 2012, of the 317 reported cases of bacterial meningitis, 21 (7%) were caused by Neisseria meningitidis, 17 (5%) were caused by Haemophilus influenzae, 98 (31%) were caused by Streptococcus pneumoniae, and 49 (15%) Group B streptococcus (Streptococcus agalactiae). The remaining 132 (42%) were caused by other types of bacteria.

• Bronchitis: Know When Antibiotics Work
• Ear Infections: Know When Antibiotics Work
• Varicella (Chickenpox) Disease Questions & Answers
• Cold Vs. Flu - Questions & Answers
• TexasFlu.org
• Ask the Experts about Meningococcal Vaccines
• Epstein-Barr Virus and Infectious Mononucleosis
• Conjunctivitis(Pink Eye) Information
• Sore Throat

  Communicable (Contagious) Diseases

Please notify your school if your child has a communicable disease.  The following are guidelines for readmission to school per the TDSHS.  However, a physician’s note stating a particular date a student may return to school will be enforced.

Chickenpox- may return when all lesions are dry (crusty or scabbed over), usually 7-10 days

Conjunctivitis or Pink Eye – may return after treatment has begun

Diarrhea – may return when diarrhea free x 24 hours

Fever – may return when fever-free x 24 hours without the use of fever-reducing meds

Fifth Disease – may return when fever-free x 24 hours without the use of fever-reducing meds

Flu – may return when fever-free x 24 hours without the use of fever-reducing meds

Impetigo – blisters and drainage must be contained in a clean and dry bandage.

Pediculosis head lice – may return after treatment with a pediculicide shampoo

Ringworm – may remain in school, the area must be covered at all times.

Scabies – may return when treatment has begun

Strep throat – may return after the student has been on an antibiotic x 24 hours, and no fever x 24 hours without fever reducing meds

Vomiting- may return when vomiting free x 24 hours

E-cigarettes are increasingly popular among adolescents, and currently, there are limited options for education and prevention curriculum specifically targeted at E-cigarettes. While the purchase of E-cigarettes by minors is prohibited, the use of e-cigarettes among youth and adolescents is on the rise. This is particularly concerning as the liquid in E-cigarettes contains nicotine, and the chemicals in nicotine liquids are not currently regulated for safety standards, with unknown
health effects. The toxicology of E-cigarettes is uncertain.

The goal is to increase students’ knowledge of e-cigarettes, nicotine, and addiction while mitigating their intended use of the product in the future. Our aim is to empower and educate teachers, parents, and health professionals in the school/after-school setting to equip students with answers about e-cigarettes to make informed decisions.

The  key learning objectives include: knowledge of E-cigarettes and potential harms, understanding and analyzing deceptive advertising techniques, developing and practicing socially acceptable refusal skills and practicing peer modeling
techniques in small groups.

Specifically, the intended outcomes are to ensure that students will:

• Understand that E-cigarettes are addictive, unhealthy and not as popular as they think.
• Resist their own curiosity and peer pressure to experiment with e-cigarettes.
• Influence friends and peers to not use e-cigarettes.

Head Lice (All Grade Levels)

Head lice, although not an illness or a disease, is very common among children and is spread very easily through head-to-head contact during play, sports, or nap time, and when children share things like brushes, combs, hats, and headphones. If careful observation indicates that a student has head lice, the school nurse will contact the student’s parent to determine whether the student will need to be picked up from school and to discuss a plan for treatment with an FDA-approved medicated shampoo or cream rinse that may be purchased from any drug or grocery store. After the student has undergone one treatment, the parent should check in with the school nurse to discuss the treatment used. The nurse can also offer additional recommendations, including subsequent treatments and how best to get rid of lice and prevent their return. Notice will also be provided to parents of elementary school students in the affected classroom. More information on head lice can be obtained from the DSHS website Managing Head Lice.

Headlice Parent Checklist

Guidance from Texas Dept of State Health Services about Exclusion of Students with Lice 

Parent Notification

According to Senate Bill 1566, the school nurse of a public elementary school who becomes aware that a child enrolled in the school has lice shall provide written or electronic notice of that fact to the parents of the child with lice as soon as practical and will notify the parents of each child assigned to the same classroom as the child with lice not later than the 5th school day.  

The student's name will remain confidential in accordance with the law.  We will continue to monitor this particular situation and address it appropriately and timely.

Attached are resources with information about the treatment and prevention of head lice.  Please contact your local physician should you have any concerns about your particular child. 

Sincerely,

BISD Nurses

RESOURCES:

https://www.cdc.gov/parasites/lice/

http://www.dshs.texas.gov/schoolhealth/lice.shtm

2018

De acuerdo con el Proyecto de Ley Senatorial 1566, la enfermera escolar de una escuela primaria pública que se da cuenta de que un niño inscrito en la escuela tiene piojos deberá notificar por escrito o electrónicamente ese hecho a los padres del niño con piojos tan pronto como sea posible y notificará los padres de cada niño asignado a la misma clase que el niño con piojos a más tardar el 5to día escolar.

El nombre de los estudiantes permanecerá confidencial de acuerdo con la ley. Continuaremos monitoreando esta situación particular y la abordaremos de manera apropiada y oportuna.

Se adjuntan recursos con información sobre el tratamiento y prevención de piojos. Comuníquese con su médico local si tiene alguna inquietud acerca de su hijo en particular.

Sinceramente,

BISD enfermeras

RECURSOS:

https://www.cdc.gov/parasites/lice/

http://www.dshs.texas.gov/schoolhealth/lice.shtm

MEASLES

Measles remains a common disease in many parts of the world. Anyone who is not protected against measles is at risk of getting infected when they travel internationally.

Measles starts with a fever, a runny nose, cough, red eyes, and a sore throat. It’s followed by a rash that spreads over the body. Measles is highly contagious and spreads through coughing and sneezing. Make sure you and your child are protected with the measles, mumps, and rubella (MMR) vaccine.

The symptoms of measles generally appear about seven to 14 days after a person is infected.

Measles typically begins with

• a high fever,
• cough,
• runny nose (coryza), and
• red, watery eyes (conjunctivitis).

Two or three days after symptoms begin, tiny white spots (Koplik spots) may appear inside the mouth.

Three to five days after symptoms begin, a rash breaks out. It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet. Small raised bumps may also appear on top of the flat red spots. The spots may become joined together as they spread from the head to the rest of the body. When the rash appears, a person’s fever may spike to more than 104° Fahrenheit.

Wheelchairs/Crutches

Please provide written documentation to your school nurse when any medical equipment, such as crutches or wheelchairs, is needed while at school. Documentation from the doctor who provided the equipment or diagnosed the concern is necessary to ensure that the student has been properly instructed on the use of this equipment. We want to make sure all of our students are safe while at school.

• MRSA (Staph) Infection Information
• Personal Prevention of MRSA Skin Infections

School vaccination rules are in effect for the 2020-2021 school year.  Students should be up-to-date, in the process of receiving vaccines, or have a valid exemption on file when school starts in the fall.  

All students entering the 7th grade are required by the Texas Department State Health Services to have received the following additional vaccines:

• Tdap (if at least 5 years has passed since last dose of tetanus-containing vaccine).
• Meningococcal Vaccine (one dose after the 11th birthday)

Students entering K-11th grade are required by the Texas Department of State Health Services to have received the following additional vaccines:

• Hepatitis A - 2 doses

Please check with your physician as to which vaccine your student has not received. After receiving these vaccines, please bring a copy from your physician's office to your campus nurse. Providing proof from your physician's office of these vaccines to your school nurse prior to the end of this school year will make your student's orientation in August go much more smoothly.

For more information, please visit the Department of Health Services website: http://www.dshs.state.tx.us/immunize/default.shtm

Guidelines for Keeping Sick Children Home From School

A sick child who is unable to participate in school in a meaningful way should be kept home to rest and recover until symptoms resolve. Keeping a sick child home also protects other children, school staff, and visiting community members from contracting an illness that can be spread from person to person.  

• Fever: A child must remain home with fever > 100.4° F and may only return after he/she has been fever-free for 24 hours without fever-reducing medicine such as Tylenol or Motrin.
   
• Diarrhea/Vomiting: A child with diarrhea and/or vomiting must stay at home and may return to school only after being symptom-free for 24 hours.
   
• Conjunctivitis (Pink Eye): Following a diagnosis of pink eye, a child may return to school 24 hours after the first dose of prescribed medication has been administered.
   

 Please be aware of the following guidelines for school attendance.

• If you take your child to a healthcare provider for an evaluation of illness or injury, please be sure to request a written letter stating when your child may return to school and any accommodations required upon his/her return.

A healthy school community requires parents and schools to partner with each other.  To prevent/minimize local outbreaks of contagious disease, parents must keep children who have an illness that can be spread from person to person at home, and BISD school nurses may exclude students with symptoms of a communicable illness from school attendance.

Thank you for your cooperation!

The Texas Department of State Health Services requires students in designated grades who attend public, private, or charter schools to be screened for specific conditions that could impact their ability to learn or impact their health and well-being in the future. The state-required screenings will be performed during the school year by a certified screener who has received additional training and certification to perform the screening.

A screening is not a diagnostic test and cannot identify the specific problem or suggest treatment options. A screening is a very simple test and can indicate if a student would benefit from further evaluation. Any potential problems or concerns identified during the screening will be reported to the parent/guardian and the student will be referred to a professional for further evaluation.

If you do not wish the district nursing staff/certified screeners to perform the screenings, you may substitute a professional examination by a health care provider of your choice. You may also provide an Affidavit of Religious Exemption.  Please contact your campus nurse for information on when the assessments and screenings are conducted so that your student can timely coordinate his or her examination/screening by the health care provider of your choice.

 
Vision and Hearing Screenings

Kindergarten, 1st grade, 3rd grade, 5th grade, 7th grade

Type II Diabetes Risk Assessment (AN) Acanthosis Nigricans

1st grade, 3rd grade, 5th grade, 7th grade

Acanthosis Nigricans is a skin condition that signals high insulin levels in the body. It appears as a light brown or black, velvety, rough or thickened lesion on the surface of the skin. It can be found on the neck, armpits, and over the knuckles. Children who have the Acanthosis Nigricans marker on their skin may be at-risk for developing Type 2 Diabetes. The AN marker does not mean the student has diabetes. A student who is identified as having evidence of the marker will be referred to their health care provider for evaluation.

Postural or Spinal Screenings

School-based spinal screening helps to identify adolescents with abnormal spinal curves and refer them for appropriate follow-up by their primary care physician. Screening can detect scoliosis at an early stage, when the curve is mild and may go unnoticed. Early detection is key to controlling spinal deformities.

In compliance with Health and Safety Code, Chapter 37, all children shall undergo screening for abnormal spinal curvature in accordance with the following schedule: 

• Girls will be screened two times, in 5th grade and 7th grade.
• Boys will be screened one time, in 8th grade.

Students should wear or bring shorts or pants for the exam.  All students must remove their shirt for this exam.  For this reason, we request that grls wear a halter top, tube top, sports bra or swim suit top underneath their shirt on exam day.

EXCEPTIONS AND EXEMPTIONS A student may be exempt from screening if:

• The student is already actively under medical care by an appropriately licensed professional for one or more of the spinal problems for which spinal screening is performed. To claim this exception, the student must submit signed and dated documentation from the licensed professional to the school. The documentation must state that the student is under active, ongoing medical care for specific spinal problems.
• A student’s parent or legal guardian executes an affidavit stating that spinal screening will be conducted by an individual other than the screener used by the school. The school may admit the student on a provisional basis for up to 60 days. The school may deny admission until the screening record of the student is provided.
• The screening conflicts with the tenets and practices of a recognized church or religious denomination of which the individual is a member. The parent or legal guardian must submit to the school an affidavit in lieu of the screening record stating the conflict. The affidavit must be submitted on or before the date spinal screening is scheduled

Dear Parent/Guardian:

Our school will do spinal screenings on_________________ 

State law requires that schools must screen students for abnormal spinal curvature in accordance with the following schedule:

* Girls will be screened two times, once at age 10 (or fall semester of grade 5) and again at age 12 (or fall semester of grade 7).

* Boys will be screened one time at age 13 or 14 (or fall semester of grade 8).

Trained screeners will check your child for signs of spinal problems like scoliosis.

Catching a spinal problem early can make the treatment much easier. Not treating spinal problems can lead to serious health problems.

The screening is simple. Screeners will look at your child’s back while he or she stands and bends forward.

 Important Recommendations:

• Students should wear or bring shorts to school for the exam.
• Girls should wear a thin t-shirt or a sports bra or a two-piece swimsuit top underneath their shirt on exam day.
• If girls are wearing a sports bra or a two-piece swimsuit top underneath their shirt, it is recommended they remove their shirt for the screening.
• Boys and girls will be screened separately and one at a time.

The school will send you a letter if your child does not pass the screening. The letter will tell you how to follow up with a doctor.

This screening is not a medical exam. Your child still needs to see a doctor for checkups.

If you do not wish to have your child screened for religious reasons, you must submit an exemption to the school no later than _____________.

Thank you for your cooperation.

Sincerely,

Your School Nurse

Contact your school nurse for questions or concerns.