Pay to Pee: A Piss Poor Example of Classroom Management

Have you heard about the Pay to Pee controversy at Cascades Elementary School in Lebanon, Oregon?  A friend brought it to my attention today.  And once she did, it was all that I could think about!  While I frequently think "I should blog about that" and even work up a rough draft in my head, I am rarely still stuck on an idea when I actually have the time to sit down and type it all out.  But this?!  This has my dander up!

Image courtesy of:  kjnnt
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As the mother of two children with GI conditions that are treated with what boils down to liquid diets and frequent bathroom breaks, my first instinct was to consider how such a policy would affect them.  But then I realized that my kids would be fine.  They have a documented medical need to pee every 5 seconds, whether it is convenient to the classroom schedule or not.  But what about their classmates?  

This policy is wrong on so many levels!  

American schools are already teaching our kids to ignore the body's natural hunger cues by introducing unnecessary food into classrooms.  Get a math problem right?  Have a piece of candy!  Someone's birthday?  Let's have cupcakes!  Someone gets a big promotion?  We MUST HAVE CAKE!  Yes, there are exceptions.  My children's school put a stop to parents bringing in sugary treats for birthdays at the start of last school year.  But there are still sugar-packed holiday parties a few times each year.  The students are still rewarded every so often with pizza and ice cream parties for various accomplishments.  Later this week, we will celebrate the promotion (and mourn the departure) of our school's beloved janitor.  I bet you'll never guess what we're doing for him!  And yes, I do mean "we" because as annoyed as I am that it always comes down to food, I am still going to make safe sugary treats for my little overachievers so they can join the celebration.

We all get the urge to move a bit after we have been sitting still for a while  But our children are discouraged from doing so.  They must sit on hard chairs for the entirety of one or more complete lessons.  (When is the last time you sat in one of those chairs without squirming?)  Standing, walking around, and any other medium to large movement that could be distracting to others is prohibited.  Traditional American schools are teaching our children to ignore their bodies' cues to move around in order to ease muscle tension.  The result is to teach them to be sedentary for most of the day rather than incorporating physical activity into their day.  (Can you say rising rates of obesity in children?)

The Pay to Pee policy takes it a step further.  This policy is teaching kids to hold in their stool and urine even when their bodies are telling them to hurry up and let it out.  This sets the children up for bowel and bladder accidents which are embarrassing in the moment and set them up to be fresh targets for bullies.  

Holding in urine increases the risk of urinary tract infections.  Students who are particularly concerned about whether they can make it from one scheduled bathroom break to the next may elect to drink less, leading to dehydration.  Younger children (think kindergarten and first grade) who are stilling working on perfect bowel control have a very real need to get to the bathroom the moment they feel the urge to poop.  Teaching them not to do so sets them up for chronic constipation.  A bowel that is full of stool causes discomfort which is distracting and will lessen a student's ability to learn.  When enough stool has built up, the pressure on the bladder can lead to urinary incontinence.  Those who continue to withhold, either intentionally or because the colon has lost its ability to send messages of urgency can even end up hospitalized due to fecal bowel obstructions.

Now let's look at those kids who, despite their best attempts, must miss classroom instruction to use the bathroom.  While students at Cascades Elementary School are no longer required to pay for bathroom breaks, the school's current policy still allows for recess to be withheld as a punishment for missing instructional time.  What does not seem to have been considered in the policy revision is that physical activity stimulates the bowels.  Therefore, limiting a student's physical activity can actually lead to an increase in the amount of classroom instruction missed due to a decline in bowel function.  

The impact of exercise incorporated into the school day has been documented to result in an increased ability to learn and retain new information.  (Citation to come later...maybe...if it's still on my mind when I have time to sit down and look for it.  It's out there!  Trust me.  Or don't trust me and go Google it for yourself.)

Instead of working with teachers to restructure classroom schedules to build in bathroom breaks often enough to address the needs of the majority of students, the school has encouraged teachers to punish students for listening to their bodies.  Instead of motivating students how require unscheduled bathroom breaks to get to and from the bathroom with maximum efficiency, they penalize them for not doing enough.  

What a load of crap!

Anaphylaxis: Who Gets It?

When I was a kid, I yearned to reach that the mark that, in my family, would make me a "big kid."  That mark was my grandmother's height.  Short with bent shoulders, a face lined with the years, and white hair that looked like cotton candy.  Grandma was the yardstick that my cousins and I used.  Every time we went for a visit, a crowd would gather 'round as Grandma took off her heels to stand next to me for a measurement.  I don't recall how old I was when I finally hit the mark, but I do remember feeling an odd sense of pride, as though I had somehow willed myself to reach the her height.  And every time I saw her after that, she would remind me of a time when she had to look down to see me rather than up.

Every family has its measuring stick.  In my father's family, that was Grandma.

For a long time, my younger son seemed to think that having food allergies was typical.  While he has a ton of food allergies related to his EoE, he has never personally experienced anaphylaxis.  For a long time, I tried to convince him that he never wanted to!  But to the little brother that always had to be quiet at the allergist's office;  the one that didn't get to ride in the ambulance;  the one that didn't get to carry an EpiPen, not having life-threatening food allergies was almost like a punishment.  As the only member of our family not to have a need for epinephrine, he felt left out.  He used to ask me all the time when he was going to get to carry his own EpiPen, as though it was some kind of measuring stick.

He thought that carrying an EpiPen was a goal to achieve. 

So I was a little surprised at his recent response to a commercial for EpiPen.

 A soothing voice says, "Avoid allergens first.  Carry EpiPen always."  

We know. (Said without emotion, as though he was really saying blah blah.)

"EpiPen auto-injectors are for the emergency treatment of life-threatening allergic reactions, anaphylaxis, and for people who are at increased risk for these reactions."

We know...  (Mildly annoyed, as though wondering who wouldn't know this.)

"EpiPen is injected into the outer thigh..."   

We KNOW that already!

And in that moment, I was assured that he is well on his way to being a big kid.  He GETS it!  Epinephrine is used to treat anaphylaxis...a life-threatening allergic reaction that requires immediate medical intervention.  Epinephrine is not a license to eat allergens, and it's not a replacement for seeking medical assistance.  He's got it!

No.  He doesn't need to carry an EpiPen.  Epinephrine is not a measuring stick.  It is a life-saving medical device that is used to treat anaphylaxis to keep someone alive so they can receive intervention from medical professionals.

Now when are we - the adults charged with keeping so many little lives going...  When are we going to get it?

Peanuts: To Ban or Not To Ban? - Part 2

In Peanuts: To Ban or Not To Ban? - Part 1, I shared my philosophy for managing food allergies at school.  If you read that piece, then you  know that I do not generally support peanut free schools.  But what about specifically?

If my overachievers have taught me anything, it is that there is always an exception.  Always!  And when you are that medically documented exception, it can be incredibly frustrating.  It can take months or even years to convince doctors that your child really is that allergic.  Let's be realistic.  If you had told me 8 years ago that you could not cook anything in your house with peanuts, tree nuts, pork or eggs without causing your child to develop a rash and/or wheezing...  Well I would have probably called you crazy.  And then, after many months, we figured out that was why our baby was fine when he woke up and miserable before breakfast was even served!  With that in mind, now I am going to share what urged me to post my thoughts about peanut bans at school.

There was a recent post on a Facebook page where readers were asked to weigh in on peanut bans at school.  The responses were mixed and downright heated!  My perception - or maybe it is more of a hope - is that those who are so vehemently opposed have limited knowledge about food allergies.  Or perhaps they have a good knowledge of their own food allergies, but they do not recognize that sometimes there are individual situations that are more challenging than their own.  Below is my main response to the discussion - the information that I felt was important enough to share that I needed to bring it over here to my own space.  To be fair, the statement below is as much about allergen free classrooms and the requirement for party food to be allergen free as much as it is about peanut-free schools in general.

1 in 13 school aged children has a food allergy. That works out to 2 students per TN classroom. That is 2 students per class whose lives are potentially endangered by the presence of peanut protein. 

Food proteins are like germs. They are invisible to the naked eye and easily spread from surface to surface by hands, feet, books, bags and just about anything else. Unlike germs, food proteins are not destroyed or removed by hand sanitizer. The only way to remove food proteins is to wash with soap and water. And by wash your hands, I mean lather for at least 20 seconds per the CDC recommendation. Very few people actually observe that full 20 seconds of lathering!

It's not just about what allergic individuals eat. For some patients, ingesting even a minute amount of their allergen can be deadly. Ingestion can mean that the food enters the bloodstream through the mucous membranes of the mouth, nose or eyes. It can also mean entry directly to the bloodstream if the student has a break in their skin. Even a paper cut can introduce allergens to the bloodstream if there is an allergen is introduced into the cut.

The next time you see a group of kids, watch closely. How many have food smeared on their faces or their clothes? What surfaces do they come into contact with? (Door handle, desks, pencil sharpener, white board markers, pencils, walls, etc.) Who touches those surfaces next, and then what surfaces do they touch? How many of those kids do you see wiping (or picking) noses or rubbing their eyes? Don't forget to make note of the thumb suckers and nail biters! Every one of these situations creates risk for students with life threatening food allergies - especially if they are reactive to trace proteins.

Now consider this. If a student in your child's class develops anaphylaxis due to the accidental ingestion of peanut protein, your child is there to see it. Your child will see another child struggle to breathe, the administration of an epinephrine injection, potentially CPR and mouth-to-mouth resuscitation. Your child's classroom will be invaded by adults entering to assist. They will watch their classmate being loaded onto a gurney and wheeled off to be loaded into an ambulance. They will wonder whether their classmate is going to die. And it is very possible that, despite emergency measures taken, that child could die anyway.

Do you really want to explain to your child that their friend experienced a life-threatening, and potentially life-ending, allergic reaction because you didn't think it was necessary to send something other than peanut butter to school for your child to eat?

Again, I do not support blanket bans.  I feel quite strongly that peanut free schools are not necessary for the vast majority of kids with peanut allergies.  Generally speaking, I feel that this is an accommodation that is more about making adults feel better than actually keeping students safe.  But I do support limited bans that are put in place based on physician-documented medical need for avoidance of an allergen.

What it comes down to is this.  If a physician determines a medical need and the school agrees to make an accommodation for that need, it is not my place as the parent of a different child to second-guess the team that made the decision based on medical data.  It is my duty as a member of the school community to support our educators as they are charged with meeting the educational and medical needs of each student in their care.

Peanuts: To Ban or Not To Ban? - Part 1

One of the hottest debates about food allergies is whether or not peanuts should be banned from schools.  Some parents of allergic kids are insistent than schools should not serve or allow peanuts in any form.  Period.  Other parents of allergic kids feel that is overkill.  Parents of non-allergic kids also have varying opinions.  The most vocal seem to feel that a ban on peanuts somehow violates their child's civil liberties.  (I'm still waiting for someone to show me where the right to eat peanuts is listed in the Constitution or any other body of laws!)  

My own opinion is that peanut bans are generally not necessary, and that they tend to create a false sense of security.  (Is there someone checking labels on every bit of food that enters the school to enforce the policy?)  I also tend to get annoyed because my overachievers have life threatening allergies to foods that could never be banned.  Today's example...chicken.  Can you even imagine the uproar that would occur with a ban on chicken fingers?!?!?!  Of course, chicken is really not an apples to apples comparison.  Peanut allergy is more common than chicken allergy, and it also causes anaphylaxis at a greater rate.  But still.  Life would be way easier if we didn't have to look for chicken protein eeeeeverywhere!  (Seriously.  Outside of desserts, chicken broth is ubiquitous.)

My preferred approach is to give allergic students the accommodations that are medically needed, while resisting the temptation to put accommodations in place that are more about making the adults feel comfortable than providing actual safety.  In my ideal world, accommodations will vary based on severity of the allergy plus the student's age, stage of develop, and maturity level.

The youngest students and others who lack the cognitive ability to understand or fully avoid their allergens will need more accommodations than others.  Also in this group would be those that are very reactive to trace proteins, those who are allergic to many foods, and those who are prone to intentionally eating allergens.  These students may require classrooms that are food free, or at least free of specific foods.  It may be necessary to implement some degree of hand washing to ensure that food allergens are not inadvertently introduced to the classroom via cross-contamination.  Depending on the specific allergy, it may be necessary to limit what supplies are used for lessons and art projects.  Think of it like this.  If you can set up a "safe home base" for the allergic student, then you've got an area where the student and the teacher can relax a bit about food allergies and focus instead on learning.  Additional accommodations will likely be needed for whenever these students leave the classroom and are therefore at more risk from their allergens, but for the bulk of the school day the concern for food allergy reactions is pretty low.

My 8 year old falls into the category above for several reasons.  In addition to an allergen free classroom, he requires specialized seating arrangements for lunch and considerations at other times when he is outside of his own classroom.

With time and experience, students can begin to take over little pieces of responsibility from the adults around them.  Those who can be trusted to eat only safe foods may be able to transition to more independence.  (Ex: Move from peanut free table to the main lunch table with an end seat where adults can monitor them for the development of an allergic reaction.)  Once kids can remember to keep their hands away from mucous membranes, they may be able to have limited skin contact with their allergens.  (Translation: They do not to suck thumbs, bite fingernails, pick noses, rub their eyes, create open wounds by picking scabs, etc.)  It may be possible to accommodate these students by substituting safe foods for allergens that are used in classroom activities.  (Ex: counting with Smarties rather than M&Ms)  These students may be able to sit wherever they want for lunch, with friends prepared to signal for a lunch monitor if an allergic reaction begins.

My 6 year old is now able to sit with his peers for lunch.  He doesn't read labels, but he knows to look for the safe symbol that I add to foods that are free of his allergens.  He continues to bite his nails and pick his nose like most boys his age, so he continues to require an allergen free classroom.  He is more independent than big brother partially because none of his allergies are anaphylactic in nature.

As students move from early elementary school and then to junior high and high school, their Allergy Action Plans can and should be adjusted to prepare them for the eventual reality of living on their own with food allergies.  But just as we transition our children from making their bed to cleaning their room to larger household chores, we need to help our kids transition from an adult-led control of food allergies to the self-management that is necessary for teens with food allergies to experience a full life while also attending to their medical needs.

Continued in Part 2

Why Schools Need Stock Epinephrine

You probably know by now that I support the availability of epinephrine auto-injectors in all Tennessee schools for use during unanticipated anaphylactic emergencies.  I write an Op Ed recently on the subject.  It was published The Tennessean on July 31.  Below is a link to the piece.

http://www.tennessean.com/article/20130731/OPINION03/307310093/Tennessee-Voices-New-law-cuts-risks-students-serious-allergic-reactions 

Back to School with Allergies is HARD!

Last week if you'd talked to me, here's what you would have heard:

It's the end of the summer and - for the love of my kids - school has got to start soon!!!

Don't get me wrong!  I love my kids, and I am thankful that I am able to stay  home with them. (Really!) We've had a ton of fun this summer playing outside, catching bugs and generally just being silly together.  But we are all seriously ready for some time apart!  Like several hours every single day for a while.  Plus the Little Overachievers need the schedule that we're forced into during the school year - the one that conflicts with my Delayed Sleep Phase Disorder (Remember my surprise Night Out back in December?) and therefore does not exist during the summer months.

Right up through last weekend, I was ready to go through the motions to extend last year's accommodations and tweak them for a new grade level.  I figured that I would meet with the allergist and pediatrician to get new prescriptions for EpiPens and rescue inhalers, as well as a new Allergy Action Plan and other paperwork that must be signed by someone with thee all important M and D behind their name.  I would drop that stuff off at school, do back to school shopping, meet with New Teachers, and then celebrate my first kid free morning since school let out for the summer.  All a matter of rubber stamping, right?

WRONG!!!

To be fair, the hard part really is done.  When I first inquired about starting Overachiever #1 in a public preschool back in 2008, I was fairly convinced that his allergies were too extreme to even consider putting him in school.  But I knew that I could not allow my fear to prevent him from experiencing a normal childhood, so I had to try.

When I first met with the school, I was determined to give everyone the benefit of the doubt.  But I was also prepared for a battle, should one come to me.  In reality, everyone at the table wanted what was best for my son - including the district official that initially feared aloud that homeschooling could be the only safe option for a child with so many food allergies.  We talked through every moment of the school day, from first to last bell.  We worked out details of transportation, where the EpiPen would be kept, who would be trained to administer, how allergens would be kept out of the classroom, how Teacher would identify allergens, and on and on and on.  For 5.5 hours, we worked on a plan that would allow my "allergic to the world" child to attend school with his peers.

Setting aside my fears and letting my allergic child go to school for the very first time...  THAT was the truly hard part!

The hard part really is past!  Now it's just a matter of making updates each year to ensure that the accommodations we have in place are still medically necessary.  Allergic students need to take on a little bit more responsibility for managing their allergens as they grow up, and they can only do that if we refrain from putting or keeping accommodations in place that are more about our comfort than true medical need.

So how do we know what is a true need?

First and foremost, we can take ourselves out of autopilot.  Accommodations that were in place last year may still be needed.  Or maybe - just maybe - we can drop or tweak them a bit.  My son's doctors are in the best position to help me figure out where medical need ends and personal comfort begins.

This year I decided to try something new.  For the last few years, I have driven 3 hours each way to have school paperwork filled out by the allergist that helped me with the transition to preschool, and then to kindergarten.  Of all the doctors on my son's current medical team, he is the only one that has truly seen just how allergic my boys are.  But we have a new allergist, and he seems to be a really good fit for us.  In 9 months, he has earned a great deal of my trust.  I decided to test him (and me!) by asking him to help us with school paperwork.

So Monday morning, I spent the morning with this new and mostly trusted allergist.  We talked about how the ultimate goal is to remove pretty much all of the restrictions over time because, by the time a typical child hits junior high, he should be able to manage his food allergies with very little required from the school beyond Epi training.  (There will always be exceptions!)  But we aren't there yet.  The allergist went over last year's accommodations with me, line by line.  I told him what areas I thought we could change and why.  He gave some suggestions for tweaks that I'd not considered.  We came to a consensus on the accommodations we both want the school to agree to, and then we started working on a new Allergy Action Plan.  (Translation: He started working on a new AAP while I dissected his patient education, requiring him to explain everything that differed in the least from what I'd been told by other doctors.)

After allergy and Xolair shots, we dashed home so that I could update my electronic files.  Then I printed off my new document and we headed to the pediatrician.  There we repeated our morning.  We went through last year's plan.  I reviewed changes that the allergist and I wanted the school to make.  The pediatrician agreed.  We are all on the same page.

Now I wait for both doctors to write letters to the school addressing a list of specific concerns that need to be addressed for the school file.  When they are done, they will call me so I can pick up the letters and hand deliver them to the school.  In the meantime, I have emailed the school with the changes that the doctors and I would like to see made to this year's accommodations.  I have also requested permission to meet with Teacher prior to the first day of school.  Now I wait for their response on both points, and the process will potentially begin anew.

So much for rubber stamping the paperwork!

What I tend to remember during the summer is that last week of school in the spring when we all have everything down pat, including the uncanny ability to call or show up just when we are needed.  What I remember in the weeks before school starts every fall is that getting accommodations in place before school starts is hard work!  

I am looking forward to school more than ever.  Only now, school needs to start so I can hurry and get to the "we've got this" phase where everything comes just a little bit easier!

Stock Epinephrine for Tennessee Schools (VIDEO)

8-year-old demonstrates how to use an EpiPen in the video below

New law allows schools to keep EpiPens in cases of emergency: The law authorizes all Tennessee schools to voluntarily stock epinephrine auto-injectors, better known as EpiPens.

Reasonable Concern vs. Anxious Allergy Mom

When Overachiever #1 was younger, it was difficult for me to imagine him ever living a normal life.  How could my "allergic to the world" child ever survive in a world that revolved around food?!  I like to say that I was a bit anxious.  Those who were forced to deal with me at the time would probably choose a more colorful description.

With the help of FAAN (now FARE) and some seasoned allergy moms, I was quickly schooled in label reading, cross-contamination, the need to plan ahead for everything, to always carry an Epipen, and to actually open my eyes to my surroundings so that I could spot danger before my little man found it for himself.  I learned that reasonable precautions or accommodations can be determined based on medical data.  (When my baby ingests or has X rubbed on his skin, a watchful physician can note objective findings such as a rash, wheeze, immediate vomiting, etc.  Therefore, we insist that people wash their hands before holding baby and ask them to refrain from kissing him.)  Those are very different from the precautions that I may be tempted to demand based on my fear of what "might" happen.  (I've never actually seen it happen, but what if someone eats X and then breathes on my son and he has trouble breathing?!  My son cannot - under any circumstance - be around X!!!)

To help me figure out "reasonable" vs. "anxious" concerns, I imagine a line that divides the two.  That line is, of course, rather gray.  And its location is different for those foods that have caused breathing difficulties or multiple system allergic reactions than for those foods that cause only a mild rash with ingestion.  The line has moved over time.  A crawling baby is going to find more allergens than a baby content to sit in a swing.  A typical 5 year old is going to be able to take some responsibility for avoiding their allergens if they are given guidance and oversight by an adult.  An 8 year old can take on more responsibility.  I imagine the line will shift significantly in another few years, and I will continue to prepare for that.  But I am not going to worry too much about the future just yet.

As we head into a new school year, I find myself once again looking for that line between reasonable and anxious.  What accommodations are medically necessary?  Which ones can we relax a bit based on age, increased responsibility and some improvement to allergic response?  Those answers are not easy to come by, so we are scheduled to sit down with some trusted physicians.  Then we will meet with the school.  Despite feeling a bit anxious, I am confident that together - as a team - we can determine the vigilance necessary to keep Overachiever #1 safe in this world filled with allergens without establishing restrictions that are all about making the adults feel safe.

Bill Signing Ceremony - Epi in TN Schools

Governor Bill Haslam will be signing legislation soon to authorize TN schools to stock epinephrine autoinjectors for use on any student suspected of experiencing anaphylaxis.  Your phone calls, emails, letters and photos are what brought this legislation through!

Please consider joining Governor Haslam and other bill supporters for bill signing ceremony at 1:30 pm Central time on Tuesday, June 4, 2013 at the War Memorial building in downtown Nashville!  If you cannot attend, please consider sending a quick note to tell the Governor what this means to your family.

As I am totally bummed at being unable to attend myself, please direct all RSVPs, questions and letters to Andrea at afanta@kvbpr.com.  That way she can pull everything together and send out any last minute details that you'll need.


5/29/13 UPDATE:
Due to overwhelming response, no further guests can be accommodated in the space allotted for the bill signing ceremony.  Andrea is continuing to collect letters and thank you notes.  She will print these and present them to Governor Haslam at the ceremony.  Please email letters and questions to afanta@kvbpr.com.

Onto the Next Vote!

GREAT news!  Not really breaking news because I was on Spring Break with my Little Overachievers when it happened, but great news nonetheless!!


HB0866 was passed by the TN House Education Committee last week with a great deal of support.   The Senate version of the bill, SB1146, was also passed by the Education Committee.  I have not heard when the bills will be voted upon by the full House and Senate, but I will be sure to share the date when I have it!


Many thanks to those who spread the word about this bill, and those provided direct support through letters and phone calls to committee members!  I would like to give a special thanks to those who were able to represent our community at Legislative Plaza.  I so wish that I could have been there with you!

• Jill Connell, Memphis  
• Alyssa Tucker, Memphis
• Becky Basalone, Knoxville
• Jenine Ward, Murfreesboro
• Connor Ward, Murfreesboro
• Amanda Hargett, Murfreesboro

UPDATE: The bill that would allow TN schools to stock epinephrine autoinjectors for all students perceived to be in experiencing anaphylaxis was passed by the House and Senate of the TN General Assembly on 4/15/13.  Many thanks to all who lent their support to this process!!



LAST UPDATE:
There is a bill signing ceremony for this legislation on 6/4/13.  See this post for more info!  

TN Legislative Update

I received an update late this afternoon regarding the pending legislation that I have been talking about all week.  The original phrasing of Amendment 4828 to HB0866 would have required all schools in Tennessee to stock epinephrine auto-injectors that are basically prescribed to the school rather than a particular student.  The new phrasing authorizes schools to stock this life-saving medication which can be used on any student believed to be experiencing anaphylaxis.  This is still an important change from current law which restricts the use of epinephrine to those students who have a prescription and their own auto-injector on campus.  I have not received confirmation as to whether SB1146 (the TN Senate version of the bill) has received the same modification.  I hope that you will all continue to lend your support to this important legislation!


If you live in Tennessee and you have not already done so, please write letters of support this weekend.  These should be emailed directly to members of the TN House Education Committee and TN Senate Education Committee.  Please include the following details.

• Your first and last name
• Your city and state
• Briefly state why you support authorizing schools to stock epinephrine auto-injectors for use on any student experiencing anaphylaxis
• Ask committee members for their support
• Thank them for their time and service

Questions can be posted below in comments or directed to afanta@kvbpr.com.

UPDATE: The bill that would allow TN schools to stock epinephrine autoinjectors for all students perceived to be in experiencing anaphylaxis was passed by the House and Senate of the TN General Assembly on 4/15/13.  Many thanks to all who lent their support to this process!!


LAST UPDATE:
There is a bill signing ceremony for this legislation on 6/4/13.  See this post for more info!  

Letters to Support Auto-injectors in TN Schools

If you've read my blog within the last few days, then you probably know that there is pending legislation that would require authorize schools in Tennessee to stock epinephrine auto-injectors.  I feel like going into detail about the bill now would be silly because I'm already preaching to the choir.  If you don't know what I am talking about, take a look at my previous entry and you'll catch up quick!

My request tonight is for Tennessee residents to write a letter to the TN House and Senate Education Committee members to indicate their support for the bills that would require stocking of epinephrine auto-injections in all Tennessee schools.  Our legislators need to hear our stories if they are to understand the importance of this legislation!  Below are some suggestions to consider as you write.

1. Start now!  Letters need to be emailed to afanta@kvbpr.com by the end of business on Thursday, March 21.
2. Address one letter to the TN House Education Committee, and another to the TN Senate Education Committee.
3. Introduce yourself!  Include your full name and city/state.
4. Briefly state that you support legislation to require epinephrine auto-injectors in Tennessee schools.
5. Ask committee members for their support.
6. Thank them for their time!
    
7. Consider including a picture or two of your allergic family member.  I plan to include one picture of my 8 year old having fun at his birthday party, and another of him in the hospital receiving treatment for anaphylaxis.

Thank you so much for your support of this legislative process!!!  Please post any questions to the comments below.  I will answer them as quickly as I can get to them.


3/22/2013 Update
HB0866, Amendment 4828 was passed by the TN House Education Subcommittee on 03/19/2013.  The wording of the amendment has been changed from "requiring" schools to stock epinephrine auto-injectors that could be used on any student thought to be experiencing anaphylaxis to "authorizing" them to do so.

UPDATE: 
The bill that would allow TN schools to stock epinephrine autoinjectors for all students perceived to be in experiencing anaphylaxis was passed by the House and Senate of the TN General Assembly on 4/15/13.  Many thanks to all who lent their support to this process!!


LAST UPDATE:
There is a bill signing ceremony for this legislation on 6/4/13.  See this post for more info!  

HB0866 Passes TN House Education Subcommittee

Many thanks to all who shared yesterday's entry about pending legislation!  Passage of HB0866 would require authorize all schools in TN to stock epinephrine auto-injectors for use on students experiencing a life-threatening allergic reaction.  Epinephrine is a life-saving medication for patients experiencing anaphylaxis and must be utilized soon after symptoms begin to ensure maximum efficacy.  The TN House Education Subcommittee agreed after hearing testimony today that our schools need should be authorized to be prepared to address life-threatening allergic reactions when our children are in their care and agreed to pass this bill to the entire committee.

Below are the steps that Tennessee residents can take right now to help our TN House Education Committee members recognize the importance of this bill.

• Write a letter addressed to the House Education Committee - TN State Legislature.  Tell them why it is important to you that they pass this bill.  Please include your first and last name, as well as your address (city/state) so they will know you are a resident of Tennessee.  Letters that are emailed to afanta@kvbpr.com by the end of business on Thursday, March 21, 2013 will be assembled and presented together to Committee members.
    
• Consider having your allergic child write their own letter asking the Committee to pass the bill.
   
• Spread the word!  Share this information with your family and friends, your medical team and your social media contacts.
   
• Show your support for the bill by appearing in Legislative Plaza when the bill is presented Tuesday, March 26 at noon.  Please email Andrea at afanta@kvbpr.com if  you are able to attend.
   
• Watch for updates on this legislation.  I will continue to post information here as it comes to me from those working directly with the bill's sponsors.
• UPDATE, 3/20/13 AT 11:00 AM - A similarly worded bill is just starting through the TN Senate.  Please also send letters addressed to the TN Senate Education Committee to Andrea so she can compile those and present them all together for more impact.  I will post again when I have additional information on the Senate bill.

3/22/2013 Update

HB0866, Amendment 4828 was passed by the TN House Education Subcommittee on 03/19/2013.  The wording of the amendment has been changed from "requiring" schools to stock epinephrine auto-injectors that could be used on any student thought to be experiencing anaphylaxis to "authorizing" them to do so.

UPDATE: 

The bill that would allow TN schools to stock epinephrine autoinjectors for all students perceived to be in experiencing anaphylaxis was passed by the House and Senate of the TN General Assembly on 4/15/13.  Many thanks to all who lent their support to this process!!


LAST UPDATE:
There is a bill signing ceremony for this legislation on 6/4/13.  See this post for more info!  

Pending Legislation for Epinephrine Auto-Injectors in TN Schools

The TN House Education Subcommittee will be meeting tomorrow at 3 pm.  On the agenda is HB0866 which would require authorize all public and private schools to stock epinephrine auto-injectors to treat students in the event that their own auto-injector is unavailable or they are having an anaphylactic reaction for the first time while at school.  The bill stipulates that every school shall stock auto-injectors in at least 2 secured but unlocked locations such as the school office and cafeteria.

The bill is written in such a way that a school nurse or other trained personnel may utilize the auto-injectors for anaphylaxis under a standing protocol from a physician.  The prescribing doctor would be exempted from liability "unless the physician issued the prescription or standing protocol with intentional disregard for safety."  The school nurse or school employee administering the epinephrine would also be exempted from liability with the same phrasing.    

Assuming that HB0866 is passed by the Subcommittee, it will be presented to the full House Education Committee at noon on Tuesday, March 26.


You may wonder why this bill is important.  The following are statistics pulled from FARE's website.

• Researchers estimate that up to 15 million Americans have food allergies, including 1 in 13 children.  That works out to roughly 2 children per classroom.
• Failure to administer epinephrine promptly after an allergic reaction begins is a significant risk factor for fatal anaphylaxis.
• Teens are among the group of patients with the highest rates of fatality due to food-induced anaphylaxis.
• Food allergies can begin at any time, even to foods that have previously been consumed with no ill effects.
• 20 - 25% of anaphylactic reactions in a school setting occur when there was no previously known food allergy

Now for the most pressing question.  What can we do to help our House Committee members understand the importance of this bill?

• Show your support for the bill by appearing in Legislative Plaza when the bill is presented Tuesday, March 19 at 3 pm and/or on Tuesday, March 26 at noon.  (You do not have to speak!)  Please email Andrea at afanta@kvbpr.com if you are able to attend in order to work out the logistics.
• Write a letter addressed to the House Education Committee - TN State Legislature stating why you support the bill.  Please include your name (first/last) and address (city/state, at minimum) so the committee members will know that they are hearing from TN residents.  Letters can be emailed to afanta@kvbpr.com no later than Thursday, March 21, 2013.
• Consider having your allergic children write their own letter to the Committee saying what the bill would mean to them.
• Spread the word!  Share this information with your friends, family, physicians and blog readers.

3/22/2013 Update

HB0866, Amendment 4828 was passed by the TN House Education Subcommittee on 03/19/2013.  The wording of the amendment has been changed from "requiring" schools to stock epinephrine auto-injectors that could be used on any student thought to be experiencing anaphylaxis to "authorizing" them to do so.


UPDATE: 
The bill that would allow TN schools to stock epinephrine autoinjectors for all students perceived to be in experiencing anaphylaxis was passed by the House and Senate of the TN General Assembly on 4/15/13.  Many thanks to all who lent their support to this process!!


LAST UPDATE:
There is a bill signing ceremony for this legislation on 6/4/13.  See this post for more info!  

Lunch Bag Mix-Up

When Overachiever #1 first started school, I was terrified.  How could they possibly keep my helpless preschooler safe with so many kids running around and too many adults in charge?!  For the first few weeks, the ring of the telephone sent chills down my spine.  Was that the phone call that I had been dreading?  The teacher, principal and staff were very understanding of my fears.  For the first few weeks, they started every call with "He's okay!  I just wanted to ask you/let you know..."  With time and a great deal of patience on their part, I learned to extend little bits of trust.

It has been four years since my overachieving, allergic to the world child first entered school.  Somewhere along the way, I learned to relax.  His teacher earned my full trust by consistently following the 504 plan that had been so carefully assembled with input from the pediatrician, allergist, teacher, principal, school nurse and, of course, me.  When we encountered situations that were not adequately addressed by the plan, we worked out a short-term arrangement and then scheduled a meeting to formalize how such a situation would be handled in the future.  By the time Overachiever #2 started preschool, I couldn't wait for each school day to start so that I could have a few hours of kid-free time.  What a transformation from those first few weeks!

When the school's phone number popped up on my caller ID today, my first thought was that head lice had found the boys.  (What an ordinary thing to dread!)  Lucky for me, that was not the case.  The school nurse was simply calling to let me know that Overachiever #1 had Overachiever #2's lunch, and vice versa.  This is an issue because Overachiever #1 can only have unflavored Neocate, granulated white sugar, artificial colors and artificial flavors.  Overachiever #2 is able to drink flavored Neocate, and he also has several safe foods.  This sort of mix up is exactly what we need to keep from happening!  Luckily, Overachiever #1 was not in the mood for an ambulance ride and so he immediately told the adult that supervises the nut free table.  She took him to the nurse who who called me to describe the contents of the lunch bags.  She thought she knew what contents went to each kid, but she wanted to confirm that with me just to be sure.

As I said in an email to the school nurse and assistant principal, today's situation is a perfect example of why I am able to leave my allergic children at school each morning with full confidence that they will greet me with hugs in the afternoon.  I am incredibly proud of my little overachiever for doing the right thing!!!  More than that, I am glad that we were able to establish a good relationship with the school and a 504 plan that helped them to address this issue appropriately.  Each school employee that was involved in correcting today's lunch box mix up may simply have been doing their job.  But they did it well.  They are overachievers in our community, and for them I am thankful.