The American Academy of Pediatrics (AAP) has issued a report outlining the need for healthcare providers, families and schools to work together to provide action plans to manage the care of children with epilepsy in the school setting. Published online Dec. 28 in the journal Pediatrics, the AAP paper notes that the vast majority of children and adolescents with epilepsy attend some form of school outside the home.
“This paper is an effort to assist pediatricians, and possibly school districts, in designing advance planning to secure the safety of children and adolescents with epilepsy so they can participate in virtually all school activities to their full potential in a safe fashion,” co-author Cynthia Di Laura Devore, MD, of the AAP’s Section on Neurology and Council on School Health, told Medscape Medical News.
According to the report authors, the ideal situation is one in which school nurses write action plans for students with epilepsy based on orders from healthcare professionals. At issue is the fact that each child and each school setting is different, and local and state regulations vary. Some school systems have school nurses in place while others may rely on volunteers to man the school health room, giving rise to liability questions.
In addition, while some children have seizures that are well controlled by medicine, a significant proportion will never achieve complete seizure control. It is for this reason that the AAP wants to make pediatricians and neurologists aware of the logistical and legal issues they may face when devising individual seizure action plans.
“Not all schools have nursing staff readily available in the school building, let alone in the school transportation or school activity settings,” co-author Adam L. Hartman, MD, also of the AAP’s Section on Neurology and Council on School Health, wrote in an email to MedPage Today.
“Legal liability for medical treatment can also vary between jurisdictions. Therefore, these seizure action plans are important so that students can participate safely in whatever programming the schools have to offer,” Harman added.
An action plan is especially important for children with prescriptions for seizure rescue medications – drugs taken ‘as needed’ to stop clusters of seizures or seizures that last longer than usual. Other considerations that should be in the plan include when to administer a rescue medication, how to manage adverse effects, and when to call for emergency services if a seizure does not stop.
The report authors see the pediatrician’s role in creating the individual action plan as critical.
“Pediatricians should be knowledgeable of the resources and limitations within the school districts their patients attend, and they should work collaboratively with the school and the family to develop advance emergency action plans to safeguard students with epilepsy,” Devore told Medscape. “Advance planning should include proper training of those individuals who might be in a supervisory role for the student throughout the day, including transportation to and from school and activities that might occur before or after school,” Devore added.
The report also urged pediatricians and other prescribing professionals to familiarize themselves with local and state regulations regarding the administration of seizure rescue medication by school personnel. In situations of potential liability, an action plan containing instructions on seizure management for unlicensed assistive personnel can ease concerns and help to ensure appropriate care, the authors wrote.
Credit : Dr. Rupin Shah (Consultant Urologist 33Years of Experience)
