Health Services
Certified school health nurses play a key role in developing comprehensive school health programs. These programs aim to improve student health, which in turn strengthens the educational process.
The role of certified school health nurses include:
- Ensuring all children, including those with disabilities, have access to quality, comprehensive school health programs. These programs should be developmentally appropriate, community-driven, family-centered, and culturally competent, addressing the needs of diverse populations.
- Prioritizing prevention, early intervention, and empowering children, youth, and families to manage their own health.
- Fostering collaboration between education, health, welfare, and other agencies (both public and private) to ensure coordinated, integrated, and continuous services in a cost-effective manner.
- Maintaining high-quality services that adhere to nursing theory, standards of practice, and all applicable Pennsylvania laws and regulations.
Screenings
- Growth Screening: Grades K - 12
- Hearing Screening: Grades K, 1, 2, 3, 7 and 11
- Vision Screening: Grades K – 12
- Physical Examination Screening: Grades K or 1, 6 and 11
- It is recommended that students see their personal physician but mandated grade level exams can be done at school by the school physician, Dr. Jeffery Brand. Permission forms, with parent signature are required prior to the examination. if you have a current sports physical, please make a copy for the school nurse and include an immunization update. The State Private Physical Form can be found here.
- Dental Examination Screening: Grades K or 1, 3, 7
- It is recommended that the student see their private dentist but exams can be done at school by the school dentist, Dr. Sheldon Boruchow. Permission forms, with parent signature are required prior to examination. The State Private Dental Form can be found here.
- Scoliosis Screening: Grades 6 and 7
Immunizations
Due to amended Pennsylvania Department of Health school immunization requirements for students in grades K-12, your son/daughter MAY BE EXCLUDED FROM SCHOOL if they are not compliant with the immunization requirements before the first day of school and/or have a valid medical certificate.
If you have any questions about the new immunization requirements, please contact your child’s school nurse, health care provider, or the PA Department of Health at 1-877-PA-Health (1-877-724-3258). Immunization information can also be found on the district’s website or at https://www.montgomerycountypa.gov/1121/Immunizations.
Medications
All prescriptive, over-the-counter (OTC) and homeopathic preparations are to be given at school by the school nurse.
- A signed physician's note is to be on file for each medication.
- A signed parent/guardian note is to be on file for each medication.
- The medication must be in the original container.
Notes expire at the end of the school year and must be renewed for the following school year.
The school district will provide the following OTC medications with permission to dispense by the school physician: Acetaminophen (Tylenol), Ibuprofen (Advil), Pepto Bismol, Benadryl, Coke Syrup, Throat spray/lozenge, Neosporin Ointment.
Please check those to be given on the Student Emergency Form (Spanish Form).
Students are NOT permitted to carry medication in school. This includes all prescriptive, OTC and homeopathic preparations. Violation of this policy will result in disciplinary action which may include recommendation for expulsion.
The school physician may be consulted by the school nurse at any time with concerns regarding medications.
INHALER USE AT SCHOOL
Act 187 of the Pennsylvania School Code allows students to possess and self-administer an asthma inhaler in the school setting under certain guidelines.
STUDENTS who desire to possess and self-administer an asthma inhaler will be required to:
a) demonstrate that he/she is capable and responsible to self-administer the inhaler.
b) notify the school nurse immediately following each use of the asthma inhaler.
c) not allow other students to use the inhaler.
Failure to follow the policy will result in the immediate confiscation of the inhaler and loss of the privilege of possessing the inhaler for self-administration.
PARENTS will provide written permission to include:
a) they agree with the physician order and the school to allow their child to possess and self-administer the asthma inhaler.
b) to relieve the school and school employee of any responsibility for the benefit or consequences of the prescribed medication.
c) the school bears no responsibility for ensuring that the medication is taken.
PHYSICIANS will provide a written permission to include:
a) name of the drug, dose, time to be administered and the diagnosis or reason for the medication.
b) indicate any reaction that may occur to the medication and any emergency response.
c) state whether the student is qualified and able to self-administer the medication.
Permission to possess and self-administer must be renewed yearly.
An Asthma Action Plan should be completed for each student with asthma.
Health Forms
Important Health Information
Diabetes
Type 1 Diabetes Information
This Type 1 diabetes information was developed pursuant to the Pennsylvania School Code (24 P.S. 1414.12) and is for school entities and nonpublic schools to provide to parents and guardians of incoming elementary school students and students entering grade six, beginning with the 2025-2026 School Year.
Type 1 diabetes in children is an autoimmune disease that can be fatal if untreated, and the guidance provided in this information sheet is intended to raise awareness about this disease.
Type 1 diabetes usually develops in children and young adults but can occur at any age.
- Type 1 diabetes can appear at any age, but it generally appears at two noticeable peaks. The first peak occurs in children between 4 and 7 years old. The second is in children between 10 and 14 years old (Mayo Clinic).
Type 1 diabetes affects insulin production
- Normally the body turns the carbohydrates in food into glucose (blood sugar), the basic fuel for the body's cells.
- The pancreas makes insulin, a hormone that moves glucose from the blood into the cells.
- In type 1 diabetes, the body's pancreas stops making insulin, and blood glucose levels rise.
- Over time, glucose can reach dangerously high levels in the blood, which is called hyperglycemia.
- Untreated hyperglycemia can result in diabetic ketoacidosis (DKA), which is a life-threatening complication of diabetes.
Risk Factors Associated with Type 1 Diabetes
It is recommended that children displaying warning signs and symptoms associated with Type 1 diabetes described below, should be screened (tested) for the disease by their health care provider.
Risk Factors
Researchers do not completely understand why some people develop type 1 diabetes and others do not. However, having a family history of type 1 diabetes can increase the likelihood of developing type 1 diabetes. Other factors might play a role in developing type 1 diabetes, including environmental triggers such as viruses. Type 1 diabetes is not caused by diet or lifestyle choices.
Warning Signs and Symptoms Associated with Type 1 Diabetes and Diabetic Ketoacidosis
Warning signs and symptoms of type 1 diabetes in children develop quickly, in a few weeks or months, and can be severe. If your child displays the warning signs below, contact your child's primary health care provider or pediatrician for a consultation to determine if screening your child for type 1 diabetes is appropriate:
- Increased thirst
- Increased urination, including bed-wetting after toilet training
- Increased hunger, even after eating
- Unexplained weight loss
- Feeling very tired
- Blurred vision
- Very dry skin
- Slow healing of sores or cuts
- Moodiness, restlessness, irritability, or behavior changes
DKA is a complication of untreated type 1 diabetes. DKA is a medical emergency. Symptoms include:
- Fruity breath
- Dry/flushed skin
- Nausea
- Vomiting
- Stomach pains
- Trouble breathing
- Confusion
Type 1 Diabetes Treatments
There are no known ways to prevent type 1 diabetes. Once type 1 diabetes develops, medication is the only treatment. If your child is diagnosed with type 1 diabetes, their health care provider will be able to help develop a treatment plan. Your child's health care provider may refer your child to an endocrinologist, a doctor specializing in the endocrine system and its disorders, such as diabetes.
Contact your child's school nurse, school administrator, or health care provider if you have questions.
References:
Centers For Disease Control and Prevention: About Type 1 Diabetes
Cold and Flu
- Prevention - Practice Proper Hand Washing
- Seasonal Flu Facts and FAQs
- Deciding When to Keep a Child Home from School - www.healthychildren.org - American Academy of Pediatrics
Lyme Disease and Tick Removal
Montgomery County Health Department
Questions & Answers about Lyme Disease
1. What is Lyme disease?
Lyme disease is a bacterial infection caused by a spiral shaped microorganism called a spirochete. The name of the Lyme disease bacterium is Borrelia burgdorferi; consequently the disease often is called Lyme borreliosis.
2. How is Lyme disease spread?
Lyme disease is spread by the bites of certain ticks. The deer tics, Ixodes dammini, are responsible for transmitting the infection in the northeastern and central
3. How do ticks carrying Lyme disease differ from other ticks?
The most important distinction is size. The vector ticks of Lyme disease are much smaller than dog ticks and cattle ticks. The nymphal stages of Ixodes dammini which are chiefly responsible for transmitting infections to humans are black and no bigger than a pinhead. The adult tick, which may transmit infections in the fall, are only slightly larger.
4. What are the early symptoms of Lyme Disease?
The earliest signs of Lyme disease are flu-like symptoms (fatigue, fever, headache, muscle and joint pains, and a very characteristic skin like rash called erythema migrans. This rash generally appears as a red, circular patch that expands slowly, often to a very large size. The center of the patch may clear as the rash enlarges. resulting in a ringlike appearance. The rash may be warm but is not painful.
5. What are the later manifestations of Lyme Disease?
Some of the symptoms of Lyme disease may not appear until weeks or months after the initial onset of illness. The infection may inflame the heart, leading to disturbances of the heart rhythm. Lyme disease may affect the nervous system causing muscle weakness of the face and limbs or pain and numbness. Meningitis, an inflammation of the covering of the brain may occur resulting in a stiff neck and severe headache. In later stages of the disease, arthritis may develop, and the joints may become red, swollen and painful.
6. How is Lyme Disease diagnosed?
Lyme disease is diagnosed from its clinical features and with the aid of serological (blood) tests. Often the serologic test does not become positive until several weeks after the onset of illness.
7. Can Lyme disease be treated and cured?
Most Lyme disease patients treated in early states of the disease, when only rash and flu-like symptoms are present, will respond favorably to therapy and remain well. Even among patients not treated until later stages of the disease, the majority respond to therapy. In a small proportion of cases, symptoms may recur and additional courses or antibiotics are necessary. Permanent damage to joints can occur in a small number of patients.
8. What antibiotics are used to treat Lyme disease?
Tetracyclines (tetracycline, doxycycline) and penicillins (penicillin, ampicillin) are usually used in treating early stages of Lyme disease. Intravenous penicillin and ceftriaxone are commonly used to treat patients in later stages of the disease. Other antibiotics and drug combinations are under evaluation.
9. Are there special problems if Lvme disease occur?
Lyme disease acquired in pregnancy may lead to infection of the fetus. Although some cases of fetal infection resulting in malformations and miscarriage have been reported, there have been no reported instances of an adverse outcome when the expectant woman was adequately treated.
10. Where does Lvme disease occur?
Lyme disease occurs in a near worldwide distribution in Europe, northern Asia and
11. Is Lyme disease spreading?
Yes, the tick vector of Lyme disease is now present in areas of the country where it had not been recognised previously. The tick can be spread by birds, deer, and by humans transporting pets, including horses.
12. Where am I likely to be exposed to ticks carrying Lyme disease?
The tick vectors prefer wooded areas and overgrown fields. However, in many suburban areas where residential lawns and parks are located within or near woods, ticks may be found in the borders between maintained areas and woods, and even among ornamental plantings and on lawns. Local health departments, park or extension services may have information on the local distribution of ticks.
PRECAUTIONS TO REDUCE YOUR RISK OF EXPOSURE TO TICK-BORNE LYME DISEASE
- Whenever possible, avoid areas that are infested with ixodes danmini or other vector ticks of Lyme disease (Ixodes pacificus on the Pacific coast).
- Wear light colored clothing, so that adherent ticks are visible. Inspect yourself frequently for adherent ticks and remove them.
- Wear long pants and long-sleeved shirts, and tuck pant cuffs into socks. Tape the tops of socks over pant legs. Avoid wearing sandals.
- Use repellents on clothing and/or skin. Repellents; containing DEET may be used on clothing and skin. In some states, permethrin, an insecticide that kills ticks, is available for use on clothing. This product should not be used directly on skin. Follow label directions and avoid excessive use.
- There is some evidence that the longer an infected tick stays attached, the greater the likelihood that it will transmit infection. Inspect yourself frequently for adherent ticks and remove them promptly. These ticks are very small, as tiny as a pinhead, and may be difficult to find.
- In areas where Lyme disease is endemic, ticks may be brought into the home on pets. Inspect animals to remove ticks that are loose in the hair. Consult a veterinarian for appropriate tick repellents for your pets.
Tick Removal Guidance for School Nurses
Act 120 of 2024, which amended the Public School Code of 1949- Health Services, takes effect December 29, 2024 after being enacted into law on October 29, 2024. This amendment requires a school nurse, school physician or designated employee of a school entity to remove a tick from a student in accordance with guidelines issued by the Secretary of Health. After removal, the tick shall:
- Be preserved for the parent or guardian of the student to send to the Tick Research Lab of Pennsylvania for testing if they choose to do so. The school entity shall provide information to the parent or guardian on how to send the tick to the Tick Research Lab of Pennsylvania; or
- Be sent directly by the school entity to the Tick Research Lab of Pennsylvania for testing using the free basic panel tick test.
Pertaining to this Act, "school entity" means a school district, intermediate unit, charter school, cyber charter school, regional charter school or area career and technical school.
If sent by the school entity, upon receiving the results, the school entity shall send the original results to the student's parent or guardian without making a copy of the results or including results in the student's school medical record. The school entity, however, may notate the disease present in the tick without identifying personal information of the child for data purposes.
After the tick is removed from the student, the school entity needs to notify the parent or guardian of the student in writing, using the prompt below as required by law. Additional resources to attach with this notice including guidance issued by the Secretary of Health on proper tick removal can be found here.
A tick was removed from your child today. Ticks can transmit disease and make people sick. A common illness caused by ticks in Pennsylvania is Lyme disease. Not all tick bites lead to Lyme disease. We advise that you record the date on which the tick was removed. It is recommended that you seek medical treatment from your child's doctor promptly if you notice any early signs or symptoms of illness within three {3} to thirty {30} days of the date of removal.
Some people with Lyme disease will get a bull's-eye rash. Others may have an atypical rash. Not everyone who has Lyme disease gets a rash. Other symptoms which may occur during the early stages of Lyme disease include chills, fever, headache, tiredness, stiff neck, joint pain or swelling and swollen lymph nodes. Lyme disease is treated with antibiotics. If untreated, infection may progress to joint, heart, brain or nerve abnormalities.
More information and resources on Ticks can be found on the Pennsylvania Department of Health's website, but please contact your child's physician if there are any medical concerns.
If you have any questions regarding the requirements of this Act, please reach out to paschool@pa.gov.
Milk Intolerance
The United States Department of Agriculture regulates that milk is the only allowable beverage that may be served with the lunch platter. If you wish a beverage other than milk, it must be purchased separately.
If a student is allergic to milk, then a doctor's note must be turned into the nurse and he/she will give a copy to the kitchen. Juice will be the alternate beverage.
Please send the doctor's note as soon as possible to avoid cafeteria problems for your child. If you have any questions, please call your School Nurse.
Head Lice
Head Lice (Pediculosis Capitis)
The Centers for Disease Control and Prevention (CDC), American Association of
Pediatrics (AAP), and the National Association of School Nurses (NASN) all agree that
“no-nit” policies should be discontinued. Head lice can be a nuisance, but no research has proven that it causes spread of disease. Exclusion for head lice is not
recommended by the Centers for Disease Control and Prevention (CDC), the American Association of Pediatrics (AAP), and the National Association of School Nurses (NASN).
Maintaining the child’s confidentiality when a child has been identified with head lice
should be the number one priority. Parents should be notified by phone that the student has been identified with live lice and/or nits. Parents should be notified by phone that prompt and proper treatment is needed. If the child is to remain in school, the School Nurse should discourage the student from close direct head contact with others.
To maintain confidentiality:
- No classroom checks will be performed.
- No classroom, or school wide parent notification letters will be sent by the School Nurse or Administration.
- The School Nurse will check siblings at parent request.
- The School Nurse will make available accurate information regarding diagnosis, treatment, and prevention of head lice in an understandable form upon request.
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Kathleen Thompson, RN, CSN