Back to School Basics: 5 Common Health Questions

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Aug 12, 2023.

Getting back to school leaves many parents and students with lots of questions pertaining to health and prevention, especially for parents sending their child off to school for the first time.

How do parents utilize the school nurse? What about severe peanut allergies? Maybe your child needs an EpiPen at school.  Should you start giving our kids a daily vitamin to boost their health? What if they get head lice? Read here as we tackle these back to school questions, and more.

1. Are common OTC head lice products effective?

Reliable over-the-counter (OTC) treatments are available without a prescription for head lice treatment, but their effectiveness is diminishing. According to studies, head lice are developing resistance to the common OTC treatments, like permethrin, so prescription products may be needed for resistant episodes.

Over-the-counter Sklice (ivermectin lotion, 0.5%) is former prescription medicine now available over-the-counter at the pharmacy. It works better than permethrin and has less resistance. It is a single use lotion for treatment of head lice infestation in patients 6 months of age and older. Sklice (and its active ingredient ivermectin), have not been shown to be safe or effective for the treatment or prevention of COVID-19 and are not FDA-approved for this use.

If lice are still present the day after treatment with OTC head lice products, consult with your doctor for additional advice. A prescription product known as:

• Natroba (spinosad topical suspension)

is available, and may be more effective for resistant head lice. Do not use lice treatments more than recommended by your doctor or on the package label. Always get a doctor’s advice for use in children under the age of two.

Head lice are found worldwide. Head lice are not known to spread disease, although extreme itching can lead to a secondary bacterial infection. A major myth is that head lice affect only those with poor hygiene and low-income. In fact, head lice play no favorites, and anyone can get infected, although preschool and elementary children are most at risk.

2. How can parents talk with their school nurse?

Parents should set up an individual meeting with a school nurse at the beginning of the school year if they have concerns about their child’s health at school.

Your school nurse is an important part of the team at your child’s school. They are your advocate for a healthy child and a healthy school environment. A student with an acute or chronic illness with an unmet medical need will have a hard time learning.

The school nurse provides expertise and education to students, staff and families in the area of healthcare and mental health, can perform limited health screenings and vaccine reviews for students, and provide temporary care or a referral for your child in case of illness or injury on school property.

• The school nurse is integral in developing a medical action plan for your child if he or she has asthma, or severe allergies like food or bee stings.
• Meet with your school nurse and doctor to determine school-specific policies for self-administration of medications by your child (for example, asthma inhalers or EpiPen use). All schools must abide by laws regarding use of medications at school.
• Children diagnosed with attention deficit hyperactivity disorder (ADHD) should also have a family discussion with the school nurse and determine if an individualized educational plan is required.
• Even though the pandemic has subsided, the risk for outbreaks still exist. Lean on your school nurse to provide school-specific directions for COVID or influenza questions when needed. Many COVID rules are made at the state, local or school level to help protect the community.

3. My child has severe allergies or asthma. Can they carry their medications at school?

According to the American College of Asthma, Allergy and Immunology, all 50 states have laws protecting students’ rights to carry and use asthma and anaphylaxis (severe allergy) medications at school. Children who are at risk of an asthma attack at school should carry a fast-acting bronchodilator such as albuterol (Proventil HFA, Ventolin HFA, ProAir HFA). Those at risk of anaphylaxis should carry an epinephrine injector like EpiPen.

Currently, there are about 5.1 million children under the age of 18 with asthma. In 2019, 44% of children age 18 and younger who had asthma reported having one or more asthma attacks in the past year. Asthma is a common reason children miss school.

• Children of all ages with asthma should have an asthma action plan, as developed in conjunction with their doctor. Be sure your child’s teacher, school nurse, sports coaches and baby-sitters understand and have a copy of the asthma action plan, too, and review it with them.
• If your child plays sports, address if there is a need for exercise-induced asthma medications with your doctor.
• Asthma is a highly treatable condition with good outcomes, but can be deadly if not properly treated.

Food, bee stings, latex, medication and other allergies should be addressed, as well. Those with a life-threatening allergic reaction (anaphylaxis) should carry an epinephrine injector (for example, EpiPen, EpiPen Jr, Adrenaclick, Auvi-Q, Symjepi or generics) to use in emergencies. Anaphylaxis can occur within seconds to minutes after exposure to an allergen.

• A study published in the the Annals of Allergy, Asthma and Immunology found that even when the epinephrine device had been prescribed, parents or caretakers frequently failed to use it in the face of a potentially fatal allergic reaction.
• A medical records review showed that roughly two-thirds of children had a known history of anaphylaxis, and nearly half had been prescribed an EpiPen-type device; however, only two-thirds who received a prescription had the device at the time of the reaction.
• Recent price reductions should enable patients to more easily afford these products.

It's important children learn to carry their epinephrine and that parents regularly follow up on its availability. Train teachers, babysitters, and anyone else who will be in charge of the young child on the proper techniques for administration of emergency medications. Be sure to train older children on proper use if they will be administering the medication to themselves.

Parents also have the right to request a 504 Plan to manage severe allergies or asthma at school. Section 504 of the Rehabilitation Act of 1973 is a Federal law designed to protect the rights of individuals with disabilities in programs and activities that receive Federal financial assistance from the U.S. Department of Education.

• Developed by the school in conjunction with the parent and child, a 504 Plan is a written guide that details the child’s medical needs, actions and precautions needed to manage the child's severe allergies and how it will be addressed at school.
• Other important areas that may be added include how food is served and stored, the frequency of hand washing, classroom cleaning, and other issues related to prevention of severe allergies.
• The plan also addresses how your child can participate safely and equally alongside their peers during the normal school day.

4. Do children need to take a daily vitamin?

Clinical studies are calling into question the value of a daily multivitamin in adults, and health experts recommend that multivitamins are not needed in most young children and teens who are growing normally. Food provides the best source of nutrients, and regular meals and nutritious snacks should provide adequate vitamins.

However, in children and young adults that are not getting adequate nutrition -- for instance if they have severe food allergies, are a strict vegan, or have a delay in physical and developmental growth -- a vitamin supplement may be needed. Check with your pediatrician if you feel your child is not thriving and growing properly with their current diet. Chewable tablets are available for children who have difficulty swallowing pills. Vitamins can also have drug interactions, so be sure that a drug interaction screen is run if your child takes other medications.

Vitamins can be toxic if taken in excessive doses. This is especially true of the “fat-soluble” vitamins A, D, E, and K. “Megavitamin” therapy, to help lessen the effects of a range of conditions -- from ADHD to dyslexia -- is dangerous and has no proven benefit. Even vitamin C, normally a very safe water-soluble vitamin, cause headaches, diarrhea, nausea, and cramps when consumed in mega doses to offset the symptoms of a cold.

Vitamins can also be toxic -- even deadly -- to a toddler or infant who accidentally consumes them from a bottle left on a counter or nightstand. Iron is especially toxic. Prenatal iron supplements, which often look like shiny red, brown or green candy discs ("M&Ms"), are often to blame. Keep all vitamins safely out of the reach of children.

5. How are food allergies handled at school?

Allergic reactions to food are the most common cause of anaphylaxis in community settings, according to the U.S. Centers for Disease Control and Prevention (CDC). Most schools have special protocols on how to handle food allergies and anaphylaxis. If your child has a severe food allergy, such as to peanuts, you should discuss this with your school nurse, teachers and administrators, and determine the school’s protocol for handling food allergy emergencies. Once you understand the school’s policy, review it with your doctor to be certain it will meet the needs of your child.

Avoiding foods that cause severe allergy is the most important step in preventing an anaphylactic reaction. Your child should understand which foods to avoid, and know how to recognize the symptoms of anaphylaxis, which may include:

• hives or redness of the skin
• tightness in the throat
• nausea
• dizziness
• breathing problems
• a decrease in blood pressure and/or fainting

For a life-threatening anaphylactic reaction, it is important that the child can have access to an epinephrine auto-injector, such as an EpiPen. Some schools now have state-mandated rules to stock epiniephrine, which can be used in children who have a first-time allergic reaction.

Training school employees on epinephrine use is important. Epinephrine auto-injector training devices are available for free, and everyone who may need to use it, whether on themselves or someone else, should be trained.

Students who know they have an allergy can bring their own epinephrine autoinjectors to school and keep the medication with them. Your doctor will write a prescription for an epinephrine autoinjector and you can have it filled at your pharmacy.

As many as one quarter of people who have an anaphylactic reaction will have continuing symptoms after the first dose, so keep two doses of epinephrine with you at all times. Get to the hospital as quickly as possible after using your first dose. You will need to alert your school and school nurse about your allergies and need for epinephrine prior to the first day of school.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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