School nurses are at the frontlines of our children's health in school, but they are often an under-recognized and understaffed group. In my last column, Nina Fekaris, President-Elect of the National Association of School Nurses, provided some great back-to-school tips for parents. In this column, I'll delve into some weightier topics with America's head school nurse.
Michael: What are the top questions school nurses get from parents of elementary-aged kids?
Nina: Parents whose children have medical conditions -- like food allergies or diabetes -- are the ones who have the most questions at the beginning of the year. We (school nurses) work with parents to develop health plans for their kids, to make sure they're safe at schools, and to help parents get comfortable with emergency response protocols at the school.
We also field cafeteria questions, like, "What's the carb count on school menus?" for kids with diabetes, or "How do you maintain safety in the cafeteria for my kids with food allergies / anaphylaxis?" Unfortunately, food allergies and childhood diabetes have been growing enormously. When I began as a school nurse 27 years ago, I only saw a few cases of anaphylaxis, and I had virtually no kids with Type I diabetes. Now, I see severe food allergies regularly, and of the 40,000 kids in my school district, there are 150 children with Type I diabetes.
Michael: Related to the topic of carb counts and childhood diabetes, what are you seeing in terms of schools offering healthier options -- and getting the kids to take advantage of them?
Nina: That's a great question. Parents are also concerned about the amount of sugar served in school lunches, as they should be. Nutrition is so key to kids' behavior, just as it is key to how we feel as adults. If we adults paid more attention to how we feel after eating certain foods, then we could better recognize how these foods affect kids.
We're also trying really hard to change behavior with teachers. One of the favorite rewards to use is food -- candy, in particular -- especially in math classes. Rewarding kids with candy and sugar -- that's not really appropriate anymore. Then you layer on what we discussed earlier about kids with food allergies or diabetes, who can't be around these products. In that respect, there is a "cultural battle" that we're working on to find healthier -- and safer -- ways for teachers to reward their students.
One of my favorite stories is from a colleague, who teaches at a high school in one of the lowest socioeconomic areas of Oregon. None of the students was eating from the salad bar, so she asked if teachers would be willing to volunteer their precious lunch time to go to the salad bar, and sit in the cafeteria to eat with students. The kids approached the teachers and they were intrigued by what the teachers were eating -- many had never eaten these foods. The teachers would talk about what they were eating and why. The teachers enjoyed it so much that they ended up implementing it biweekly. This just shows that, when it comes to eliciting change, it can be a small act -- the power of one -- that makes a big difference.
Michael: In your personal opinion, what are the most pressing issues today in America's schools and early education?
Nina: One of the biggest things confronting us right now is being able to learn how to balance the need for academic rigor with the need for kids to develop positive social and emotional health. Mental health in schools is one of the biggest challenges we face. Recent research shows that positive emotional and social development are just as important as academic preparation, as predictors for future outcomes.
We have to provide the positive behavioral support that kids need to develop skills such as resilience, a sense of fairness, dealing with disappointment, and tolerance to those who are different. Those are all skills that need to be taught at a very young age, so kids can develop healthy coping mechanisms when they get older. We're seeing kids who have anger issues and power struggles with teachers -- at younger ages than ever before. If these skills aren't taught and the kids' needs aren't met early, they're more vulnerable to enter that cycle we want to avoid -- where you see them act out and skip class in middle school, then drop out in high school.
And how does that overlap with the health realm? Well, school nurses often see the kids who are bullied. However, we often see the bullies in our offices too. As school nurses, we're also trying to understand why these kids continue to end up in our offices, and what other factors might be playing into their behavior.
Another factor is that not all schools have access to a school nurse. In many states, it's not mandated for kids to have access. Here in Oregon, we have an average of 1 school nurse per 3,000 students. It's tough, since we're often the first line of defense for prevention and disease management with kids. For example, a school nurse in New York was the first person to identify a new flu outbreak and called the Center for Disease Control to report what was eventually identified as H1N1 (commonly known as "swine flu").
Michael: On a lighter note, what are your favorite healthy school snacks and indoor physical activities?
Nina: For snacks, anything not processed! Carrots, celery sticks, grape tomatoes, cucumbers, and any fruit (that isn't frozen with added sugar) are great. As parents, we try to get kids to eat their veggies by adding other condiments, but we forget to appreciate the flavors of natural produce. Plus, it's easier to prepare without all those add-ons!
In Oregon, we have covered play areas, so kids can go outside most days. We do try to encourage teachers to move all day though, and not just during recess or PE. We try to encourage teachers to include some form of physical activity, and to build it into a daily schedule. Kids can't sit still all day, and this helps the teacher and the overall classroom experience. At my school, some teachers allow kids to stand up during class if it helps them concentrate and process information better. Some of our teachers are certified in yoga breathing, so they'll do two-minute yoga breathing exercises with their students several times a day.
(Author's note: For additional healthy school snacks and physical activity ideas, check out the free resources at http://adventuretofitness.com/games-and-activities.)