Every morning Pat Wilson walks down the hall from her office in the Julia Goldstein Early Childhood Education Center through the gym and into a part of the building not typically associated with a school nurse: the kitchen.
There, she checks a list鈥攑osted on the side of the stainless steel refrigerator鈥攐f all the students in the school with a food allergy.
鈥淚t鈥檚 constantly being updated,鈥� Wilson says.
Wilson鈥檚 been a school nurse for 20 years. She鈥檚 the lead nurse in the University City School District just outside of St. Louis, she鈥檚 also president of the Missouri Association of School Nurses. The biggest change she鈥檚 seen in her profession, she says, is the rising number of students food allergies.
It鈥檚 part of a trend that鈥檚 shifting the role of school nurses towards managing the rising number of chronic conditions in children across the county.
Tracking Kids鈥� Allergies
Through school nurses like Wilson, the state of Missouri has collected an almost unparalleled inventory of health information on the state鈥檚 students for the past decade. In that time, they鈥檝e documented an almost 250 percent jump in the rate of students with a life-threatening allergy鈥攎ost of those are food allergies.
Growing awareness could account for some of the rise documented in Missouri, says Marshall Plaut who studies food allergies at the National Institute of Allergy and Infectious Diseases.
鈥淧eople are reporting food allergies more because they are more aware of food allergy as an issue,鈥� he says. But allergies really are rising around the country and across the western hemisphere.
That鈥檚 especially true with peanut allergies, which Plaut says appear to have seen a 200 percent increase in prevalence, although he notes more non-self-reported data鈥攍ike skin tests and IgE levels鈥攚ould be needed to determine an exact number.
Still, the rate is increasing and one reason could be something called the 鈥榟ygiene hypothesis鈥欌�攂asically as young children are exposed to fewer infectious agents growing up, their immune systems don鈥檛 work as well, leaving them more susceptible to developing allergic diseases.
For schools, all of this means there is growing concern about exposing kids to allergens. Nationally about 8 percent of children could have a food allergy鈥攎eaning in every classroom of 30 students, two or three would have one. At the same time, school nurses are seeing a rise in other chronic conditions as well.
鈥淭he numbers are quoted quite often,鈥� says Evilia Jankowski, president of the Michigan Association of School Nurses. 鈥淭hree kids with asthma in every classroom of 30. Two kids with some sort of life-threatening allergies. I think the latest [numbers] I鈥檝e seen for diabetes is like one in 100.鈥�
鈥淥ur numbers are increasing,鈥� she adds, and that鈥檚 reshaping the role of school nurses.
In addition to triaging the scrapes, aches and illnesses that typically send students to the nurse鈥檚 office, school nurses are increasingly taking the lead on coordinating student care between teachers, parents and the school. They鈥檙e educating school staff on emergency procedures like using EpiPens, and even coordinating with cafeteria managers to make sure students aren鈥檛 exposed to foods that could make them sick.
鈥淲e have a huge amount of students with chronic health conditions that we didn鈥檛 have 23 years ago,鈥� Jankowski says. 鈥淭he focus and scope of our work has changed dramatically.鈥�
Keeping Children Safe
For Pat Wilson in University City, that means checking the list of children with food allergies every morning.
One name on the list is Haven Brown, a 4-year-old whose favorite foods include broccoli, carrots and macaroni. But there鈥檚 a long list of foods that could trigger Haven鈥檚 eczema that she鈥檚 learning to stay away from.
鈥淒o you eat fish?鈥� Haven鈥檚 father Joshua Brown asks.
鈥淣o!鈥� she responds.
鈥淩ight, because what happens when you eat fish?鈥�
鈥淚 get scratchy.鈥�
Eggs, yeast and some citrus fruits have a similar effect. When she gets into an itching fit, Joshua Brown says, 鈥渢he learning stops.鈥�
Wilson has put plans in place for students like Haven. She鈥檚 trained the teachers on keeping potentially allergic foods out of the classroom鈥攈omemade cakes to celebrate birthdays are a 鈥榥o-no鈥欌�攁nd on emergency procedures. She鈥檚 in frequent contact with schools parents. And every day she checks the list of student allergies against the day鈥檚 menu.
鈥淚t鈥檚 all about keeping the children safe,鈥� Wilson says. 鈥淭hat鈥檚 just the bottom line, making sure the students are educated and everyone is safe. That鈥檚 my primary focus.鈥�
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