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Making the Case for School Nurses: Changes in Medical Issues

Asthma

What is it?  Asthma is a chronic condition which causes the airways to become narrower, making it difficult to breathe. 

How many children have it?  Nearly 5 million children have asthma, and the number is rising.[i]

What are the consequences? Asthma accounts for 14 million missed school days annually.  It is the third-ranking cause of hospitalization among those younger than 15 years of age.  The cost of treating asthma for those under 18 is $3.2 billion per year.  The number of children dying from asthma increased almost threefold from 93 in 1979 to 266 in 1996.[ii]  How well it is managed has an effect on how well children can function with normal activities such as playing, running, and schoolwork.  It can also have an impact on how well they sleep and their general sense of well-being. 

What do school nurses think of it?  According to a survey, 51% think asthma is more disruptive of school routine than other chronic diseases.  Most think asthma has a fairly significant effect on school absenteeism (3.5 on a 1 to 5 scale).  85% of nurses believe there are students with undiagnosed asthma in their school[iii] 

Diabetes

What is it?  Diabetes is a chronic disease in which the body does not make or properly use insulin, a hormone that is needed to convert sugar, starches, and other foods into energy.   

How many children have it?  Each year, 13,000 youths are diagnosed with Type I diabetes.  Health care providers are finding more and more children and adolescents with Type II diabetes, but the national figures are unknown.  Approximately 1 out of every 400 or 500 young people have diabetes.[iv]

What are the consequences?  Diabetes can cause blindness, kidney disease, nerve disease and amputation, heart disease and stroke.  It is one of the most costly diseases in America ; the annual health care and other directly related costs are $98 billion.[v]

How can school nurses help?  Schools have the legal responsibility to provide students with diabetes a medically safe environment as well as equal access to the same opportunities and activities enjoyed by other students.[vi]  School nurses can help with the training of school staff, make sure they have access to equipment and supplies, and assist with any additional care they may need.

Obesity

How many children are obese?  Between the late 1970s and 2000, the percent of school-aged children 6-11 that are overweight doubled, rising from 6.5% to 15.3%.  During the same period, the percent of overweight adolescents, aged 12-19, tripled from 5.0% to 15.3%.[vii] 

What are the consequences?  Hospital costs among adolescents (6-17 years of age) for diseases associated with obesity increased from $35 million in 1979 to $127 million in 1999 (based on 2001 constant US dollars).  Approximately 50% of children and adolescents who are obese will become obese adults.  Adult obesity raises the risk for diabetes, heart disease, high blood pressure, stroke, gallbladder disease, certain cancers, and osteoarthritis.[viii]

Attention Deficit/Hyperactivity Disorder (ADHD)

What is it?  A person with ADHD has a chronic level of inattention, impulsive hyperactivity, or both such that daily functioning is compromised.  ADHD is one of the most common neurobehavioral disorders of childhood and can persist through adolescence and adulthood.  Currently the causes are unknown. 

How many children have it?  Statistics for ADHD vary.  The American Psychiatric Associations’ Diagnostic and Statistical Manual IV estimate that 3-7% of children suffer from ADHD.  A National Center for Health Statistics Study estimated the number at 4 million children, or roughly 6%.[ix]  Boys are 2.5-3 times more likely to have the disorder than girls. 

Treatment:  Treatment for ADHD includes stimulants such as Ritalin, Concerta, Methylin, and Cylert or the Non-stimulant Strattera.  Treatment can also include behavioral therapy or the combination of medicine and behavioral therapy. 

Emotional and Behavioral Problems

How many kids are affected?

• The 1-year prevalence of anxiety orders in children ages 9-17 is 13%.
• Almost 5 million children ages 3-17 (8%) have been identified as having a learning disability.[x]

• Depression estimates vary.  One report estimates that at any given time, 1% of children and 5% of adolescents suffer from depression.[xi]
• Results of a national survey of pediatricians showed that 19% of pediatric visits involved a psychosocial problem requiring attention or intervention.  Psychosocial problems are the most common chronic condition for pediatric visits, eclipsing asthma and heart disease. [xii]

Other Changing Issues

• Sick Children at School.  Children who in the past would have been kept home due to illness or disability are now often sent to school anyway.  This might be because both parents work and there is no one home to care for the child, or because families have limited or no health insurance and rely on the school nurse as the “family doctor.”
• Special Needs Children. 
• Student sexuality Issues.  In the past, many issues such as pregnancy, birth control, HIV, STDs and sexual orientation were ignored.  Now, schools are more willing to talk about these issues and school health professionals are recognized as part of team to address these issues. 
• Bullying.  According to the American Medical Association, at least one in three children has been bullied or affected by bullying.  School health professionals are often the first to observe this and are trained to deal with it.[xiii]
• Substance Abuse.
• Public Health Issues and Immigrant Student Populations. 
• Medication.  Researchers report that 75% of medications given in schools are administered by someone other than a professionally registered nurse.  When this happens, children are three times as likely to miss getting their medication than when a licensed nurse administers it.[xiv] 

Copyright 2009 © Vermont State School Nurses' Association. All rights reserved.
Last updated: 04/12/2011