Pharmacists can step up counseling and advocate for best practices for children with chronic illnesses.
Results from an American Psychological Association survey show that teenagers feel more stress than adults during the school year.1
Life becomes even more complicated for the estimated 27% of children with chronic health conditions because constant vigilance about their health creates additional challenges. The effects of chronic illness can range from minimally to severely limiting. Some children may require frequent doctor visits or hospitalizations, affecting academic performance, school attendance, and mental health.
Approximately 20% of children take at least 1 prescription medication.The responsibility falls to guardians or parents to administer these treatments. But in school, they are not present to manage children’s medications. Medication administration in school is a complex issue, involving many challenges and special considerations.
Adults can be forgetful, and some do not possess the medical knowledge to understand children’s illnesses. How can we expect children to assume this responsibility in school?
GUIDELINES FOR MEDICATION ADMINISTRATION
Federal law requires schools receiving government funds to make accommodations for students with disabilities. However, the law is fuzzy about medication administration in schools. Some states have created standards for school districts, but the final responsibility belongs to school boards.
In September 2003, the American Academy of Pediatrics (AAP) released a resource to guide school districts when creating policies and procedures. TABLE 1 summarizes the AAP’s recommendations.
CHILDREN, MEDICATION, AND SCHOOL
TABLE 25-8 highlights common pediatric chronic illnesses and treatments. Medication nonadherence at school may cause serious consequences. The child may feel too ill to participate, not be able to focus, or even require an emergency department visit. Hospitalizations may increase costs for the family and health care system. Other consequences include pharmacological interactions, therapy failure, or toxicity.2
The World Health Organization reports that just 58% of children are adherent to medications for chronic illnesses.2
Ensuring pediatric medication adherence and well-being requires identifying barriers to medication administration in school. These barriers include a lack of the following: full-time school nurses or trained health care professionals, medication supply from patients, and stock emergency medications such as bronchodilator inhalers, epinephrine, and naloxone.9
Health care professionals, parents, and school administrators have limit-ed control over the school’s budget and finances. Consequently, these barriers may be difficult to overcome.
However, parents and providers may advocate for schools to establish specific policies or stock emergency medications, rather than requiring students to have their own. Laws allow students to possess anaphylactic medications, but stock epinephrine auto-injectors are lifesaving for those who experience allergic reactions with no previous history.9
Despite limited resources, school administrators can seek alternative methods of improving medication administration procedures.
Pharmacist involvement in schools is minimal, but they can still be valuable resources for children, parents, and the school system.
PHARMACY IN THE SCHOOL SYSTEM
With or without health insurance, 40% of patients report struggling to afford medications.10 In these situations, pharmacists can potentially alleviate medication cost using insurance resources or referrals to manufacturer assistance programs. Furthermore, pharmacists can work with primary care physicians to find alternatives or simpler regimens that may even avoid medication administration at school.11
Additionally, patient counseling correlates positively with decreased administration errors and better outcomes.11Patient counseling rarely includes the child, but pharmacists should educate parents and children, as soon as they are able to understand basic information, which can be as early as age 7 years.
Allowing children to self-administer medications teaches autonomy and independence.
Pharmacists should emphasize dosing frequency, drug names, and proper administration techniques to encourage self-sufficiency. Common medications that children can and should self-administer include asthma medications and insulin.12
Medication administration in schools is a complex issue. However, with proper education, planning, and procedures, children with chronic conditions can avoid serious com-plications, learn to successfully manage their health, and thrive in school.
Alexandra Bieniek is a PharmD candidate at the University of Connecticut School of Pharmacy in Storrs.
1. American Psychological Association survey shows teen stress rivals that of adults. News release. American Psychological Association. February 11, 2014. Accessed July 15, 2021. https://www.apa.org/news/press/releases/2014/02/teen-stress
2. Al-Hassany L, Kloosterboer SM, Dierckx B, Koch BC. Assessing methods of measuring medication adherence in chronically ill children-a narrative review. Patient Prefer Adherence. 2019;13:1175-1189. doi:10.2147/PPA.S200058
3. Qato DM, Alexander GC, Guadamuz JS, Lindau ST. Prescription medication use among children and adolescents in the United States. Pediatrics. 2018;142(3):e20181042. doi:10.1542/peds.2018-1042
4. American Academy of Pediatrics Committee on school health. guidelines for the administration of medication in school. Pediatrics. 1993;92(3):499-500.
5. Dealing with ADHD: what you need to know. FDA. Updated October 12, 2016. Accessed July 15, 2021. https://www.fda.gov/consumers/consumer-updates/dealing-adhd-what-you-need-know
6. Hogan AD, Mahr TA. Update on pediatric asthma treatment options, doses, label changes. American Academy of Pediatrics. July 1, 2020. Accessed June 17, 2021. https://www.aappublications.org/news/2020/07/01/focusasthma070120
7. American Diabetes Association. 13. Children and adolescents: Standards of Medical Care in Diabetes—2021. Diabetes Care. 2021;44(suppl 1):S180-S199. doi:10.2337/dc21-S013
8. Seizure treatment. Nationwide Children’s Hospital. Accessed June 17, 2021. https://www.nationwidechildrens.org/specialties/epilepsy-center/seizure-information-for-parents/seizure-treatment
9. Butler SM, Boucher EA, Tobison J, Phan H. Medication use in schools: current trends, challenges, and best practices. J Pediatr Pharmacol Ther. 2020;25(1):7-24. doi:10.5863/1551-6776-25.1.7
10. Nguyen A. Survey: Americans struggle to afford medications as COVID-19 hits savings and insurance coverage. GoodRx. March 22, 2021. Accessed July 16, 2021. https://www.goodrx.com/blog/survey-covid-19-effects-on-medication-affordability/
11. El-Rachidi S, LaRochelle JM, Morgan JA. Pharmacists and pediatric medication adherence: bridging the gap. Hosp Pharm. 2017;52(2):124-131. doi:10.1310/hpj5202-124
12. Hutchinson K. The A-B-Cs of kids and medication: re-schooling pharmacists and families for best outcomes. University of Connecticut School of Pharmacy. September 15, 2017. Accessed July 20, 2017. https://clippingsme-assets-1.s3.amazonaws.com/cuttingpdfs/1168489/058ee8ff9384cca485efd274ba1a6ab9.pdf?