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CHILDHOOD ASTHMA: SCHOOL
The parents of an asthmatic child face two important decisions in relation to schooling. One is whether their child is fit to go to school on that particular day, and the other is what precautions need to be taken actually at school.
The individual decision on whether to go or not will depend to a large extent on the index of severity. A child who has been awaken half the night coughing and wheezing is generally in no fit state to go to school the next day. If a cold has led to wheezy bronchitis and the phlegm is turning yellow, it is probably best to allow the child to rest at home. Each mother or father will have their own method of telling; perhaps the speed and ease of washing and dressing, how quickly breakfast is eaten, the sallow tired look, the tinge of blueness in the lips or the pitch of the wheeze. They will know how to balance these criteria against the manipulations of the child. Is homework complete or is there a disliked lesson on that day? Is it games day? If both parents are going out working, then other factors come into play; how will the boss react to another day off? Which parent should stay with the child?
In the end, all these sometimes conflicting forces will result in a decision. Often it will naturally lean towards the side of caution and it will be very irritating on some occasions when the child runs around quite happily all day without much sign of a wheeze. One should remember when this happens that asthma is a potentially life-threatening condition and it is far more important to have a live child than a happy employer! Parents have a built-in protective reflex towards their own children and this should be instinctively followed. If you feel your child isn’t fit to attend school then that is usually the right judgment.
Julie and Simon presented different problems when it came to making a decision about school. Julie was in her first term and was much less able to manage her own asthma than an older child. For this reason it was much better in her case to be cautious and keep her off at the slightest sign of a wheeze. In fact her attacks were relatively infrequent and often Julie had recovered sufficiently by lunchtime to go in for the afternoon.
Simon, being older than Julie, was in a different situation altogether. One of the major causes of his attacks was the stress involved in returning to school after the holidays. His parents were therefore reluctant to let him stay off school as it only seemed to prolong the problem. They asked me if there were any definite guidelines I could give them as to whether it was safe to let him go.
I have stressed the importance of the peak flow meter in monitoring the control of asthma in children. Often a fall in readings precedes the start of an attack and using the meter is the only reliable way of telling how breathless the child is becoming. At rest – perhaps sitting at the breakfast table – the breathing may seem quite normal, but as soon as there is any exertion like walking to school the wheezing may be much more apparent. The peak flow meter will give the true picture more clearly. Simon’s normal level on the scale was 400. Under no circumstances should he be allowed to go to school if his reading fell below 300, more than a 25 per cent reduction. This reading means moving on to the plan for treatment of an attack. If his level was somewhere between 300 and 400 then it would be reasonable to let him attend school, as long as his peak flow is stable. In other words it should be measured three or four times between waking up and leaving the house to ensure it isn’t falling towards the danger level.
*60/211/5*