Back to School: Advocating for Your Child’s Health

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Anson Koshy, M.D., works with children with attention deficit hyperactivity disorder and autism.  Credit: Felix Sanchez for UTHealth
Anson Koshy, M.D., works with children with attention deficit hyperactivity disorder and autism. Credit: Felix Sanchez for UTHealth

Mega Doctor News

Houston, Texas – If you’re the parent of a child with a significant health issue, this time of year means more than just shopping for a colorful new backpack.

The safety and success of your child at school is the result of your careful planning and forming partnerships with your child’s school and health care professionals.

The overall tip for parents of a child with any significant health issue, such as diabetes, asthma, epilepsy/seizures, food allergies or Attention Deficit Hyperactivity Disorder (ADHD), is to visit your child’s teachers and school nurse before the end of the previous school year, or at the beginning of the new school year.


“Children must have the same level of diabetes management in school that they do at home,” explains Michael Yafi, M.D., director of pediatric endocrinology at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth).

“Parents, health care providers, and school representatives must work as a team,” adds Yafi, a pediatric endocrinologist with UT Physicians and Children’s Memorial Hermann Hospital. “It is a mistake for parents to wait until the last minute to obtain necessary forms.”

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Parents need to complete a Diabetes Medical Management Plan (DMMP) to discuss with the school nurse your child’s diabetes care regimen, especially your child’s symptoms of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar), and how to treat the symptoms.

“No two students manage their diabetes the same way,” Yafi says. “Some students get their insulin using a syringe and vial, while others use insulin pens or insulin pumps. The younger or newly diagnosed kids generally need more help with all aspects of their diabetes care. We tell parents to ask the school nurse if there is a rescue medicine kit available and if personnel know how to give insulin.”

Yafi advises parents to consider completing a Section 504 Plan and the Individualized Education Program (IEP), formal documents that offer help for K-12 students.

A 504 Plan states that a school must provide appropriate accommodations for a child, based on individual needs. The IEP addresses a child’s strengths and goals, and in this case, issues such as who should be trained to provide diabetes care if the school nurse is not available.


Asthma is a chronic respiratory disease that affects a person’s airways. When the airways become sore and swollen, an asthma attack may bring on wheezing, coughing or trouble breathing.

According to Ricardo A. Mosquera, M.D., medical director of the UT Physicians High-Risk Children’s Clinic at McGovern Medical School, “The first recommendation I give parents is to create an Asthma Action Plan to review with appropriate school staff.”

The plan includes:

Your child’s medications (dose and expiration date),
Triggers that make symptoms worse,
Physical activity limitations, if any,
Steps to take if your child does not respond to regular medications, and
Emergency phone numbers of parents and your child’s doctor.
There are two types of asthma medicines: long-term controllers and quick-relievers. Most asthma medicines are taken by breathing them in using an inhaler or nebulizer. The daily inhaler is used for the prevention and management of symptoms. The rescue inhalers are designed for immediate rescue during an asthma attack.

“Parents must understand the difference between these medicines,” he explains. “A rescue medicine is not to be used on a daily basis and the daily medicine should not be considered a rescue medicine.”

When a child has gym class or other physical activities at school, especially in cold weather, ensure the child’s inhaler is readily available.

“We recommend children have an inhaler at home and at school and parents or caregivers should keep one on them for outings to the park or shopping mall,” says Mosquera, a pediatric pulmonary specialist at Children’s Memorial Hermann Hospital.


“Education about epilepsy and seizures is extremely important, whether it is for teachers, classmates or other parents,” says Gretchen Von Allmen, M.D., associate professor of child and adolescent neurology at McGovern Medical School and director of the Pediatric Epilepsy Program. “Learning the facts helps eliminate fears.”

There is a stigma related to epilepsy because of misinformation. “Parents and students can work together to help educate others to make sure the child does not suffer from any bias or bullying,” she explains.

Von Allmen, a pediatric neurologist with UT Physicians and Children’s Memorial Hermann Hospital, has the following tips for parents:

Ask the teacher to discuss epilepsy with the class.
Make sure all adults who supervise your child know seizure safety.
Be aware of seizure triggers (e.g., not being properly hydrated on hot school days; not transitioning from a summer sleep schedule to a regimented school schedule that requires more sleep).
Take medicine on time, regardless of a new schedule with school and activities.
Parents must develop a Seizure Response Plan with their doctor that includes a list of emergency medicines and the type of seizure your child has. There are various types of epilepsy and different types of seizures, affecting children in different ways.

“A parent is the child’s best advocate and there is a balance between overprotecting your child and making sure your child has seizure safety,” she explains.

While there are approximately 3 million children in the U.S. with epilepsy, about two-thirds will respond to medicine and not have seizures, and some may outgrow their seizures.

Food Allergies

In children with food allergies, their immune system overreacts when exposed to a given food and the result produces an allergic response.

There are eight common food allergies for kids: cow’s milk, eggs, tree nuts, peanuts, shellfish, wheat, soy, and fish.

“Most children outgrow allergies to cow’s milk, soy wheat, and egg,” explains Susan E. Pacheco, M.D., a pediatric immunologist/allergist at UT Physicians and Children’s Memorial Hermann Hospital and associate professor of pediatrics at McGovern Medical School. “However, this is not always the case for allergies to shellfish, nuts, peanuts, and fish.”

Although severe food allergies may be lifelong, there is research underway to cure or decrease the intensity of severe food allergies and improve a child’s quality of life.

Pacheco has the following tips for parents:

Notify the school if your child has a history of a severe allergic reaction to food.
Visit your child’s doctor before school starts to get the required prescriptions for emergency medication (an epinephrine auto-injector).
Give the school your Anaphylactic Action Plan (provided by your child’s physician) in case your child has an allergic reaction to a food.
Talk with your child’s teacher about food during classroom celebrations and field trips, as well as safe allergy-friendly snacks and strict rules for “no food sharing.” This also will help in case a classmate has a food allergy.
Teach your child to build age-appropriate skills to manage food allergies.
Complete a Special Dietary Needs Accommodation Form if your child is eating meals provided by the school; or, make sure your child takes to school allergy-friendly lunches and snacks.
“If your child has a history of a severe allergic reaction to a food, the teacher or parent should never hesitate to immediately administer epinephrine as soon as this food is eaten,” Pacheco emphasizes. “It can be very dangerous to wait and see what happens. Antihistamines are not life saving and must not be used instead of epinephrine.”

Attention Deficit Hyperactivity Disorder (ADHD)

“Students with Attention Deficit Hyperactivity Disorder (ADHD) need all their support in place at the start of the school year,” explains W. Daniel Williamson, M.D., professor of pediatrics and developmental pediatrician with the Dan L. Duncan Children’s Neurodevelopmental Clinic at the Children’s Learning Institute at McGovern Medical School.

“When a parent meets with school administrators at the end of the previous school year, they should discuss what the child needs,” he says. “Parents hesitate to have this conversation because they don’t want to be considered pushy. In our experience, teachers want to know how to help each child succeed.”

Williamson says the following tips may help a child with ADHD:

Suggest a quieter place for your child to sit in the classroom.
Transition to a school sleep routine two weeks before school starts.
Encourage your child often (to eliminate your child’s fear or anxiety).
Create a predictable schedule at school and at home.
“If a student needs accommodations, I encourage parents to formalize this information with the 504 Plan,” Williamson explains. “There is a misconception by parents that it is not good to track this information, but that is not the case. One year a teacher may not need a written plan and the next year a teacher needs the information in writing. If there is no paper trail a student may not easily get accommodations in middle school or high school.”

If a child uses medicine for ADHD, a parent may think that because the child did well in the spring semester, that it is OK to start a new school year without medicine. “My advice is to continue the medicine in the fall and then revisit the issue later. We want to give these students every advantage when they start a new school year, whether that involves having accommodations or medicine. These students need a safety net.”

What to Do When Fall Allergies Blow In

Some pollens and mold spike in late summer or early fall, just in time for school.

Parents can take precautions to eliminate or lessen triggers:

Check pollen levels,
Use a dehumidifier,
Remove dust and mold from your home,
Take a shower after spending time outside,
Change air conditioners once a month,
Wash your hands often,
Keep pets out of bedrooms and off furniture (can be challenging), and
Avoid overexposure to leaves and hay.

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