Children With Epilepsy Need an Emergency Plan for School

                   Lara C. Pullen, PhD Medscape Medical News

Children with epilepsy should have a plan in place at school for how best to respond to medical emergencies. The American Academy of Pediatrics (AAP) has released guidance suggesting prescribing providers, families, and schools collaborate develop such plans detailing the use of seizure rescue medications.

Adam L. Hartman, MD, from Johns Hopkins Hospital, Baltimore, Maryland, and colleagues published their recommendations online December 28 in Pediatrics. "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," coauthor Cynthia Di Laura Devore, MD, a pediatrician in Fairport, New York, told Medscape Medical News.

The plan is particularly important for children with prescriptions for seizure rescue medications. The individualized actions plan should ideally include the least restrictive medication choice (ie, buccal or nasal) that will keep the child safe in the environment. The plan should also include details of when to activate emergency medical services.

"More options are now available in terms of treating these episodes, which leads to further consideration of how we can improve students' educational opportunities," explained Dr Hartman. Ideally, pediatricians and neurologists will work together to design individualized plans. The authors note that having rescue medication available at school can prevent the child from requiring more invasive and costly treatment in an emergency department setting, and enable the child to continue his or her school routine.

"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. 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," Dr Devore explained.

Prescribing professionals should familiarize themselves with local and state regulations as well as local school resources for treating students with seizures. "[N]eurologists will be surprised by the variability between school districts with respect to the issues that we raised in this report," Dr Hartman elaborated.

Although the Individuals with Disabilities Education Act and the Rehabilitation Act have been in place for many years now, there is still a lack of uniformity of laws and practices among states and school districts. For example, not all schools have a school nurse who can implement medical plans from a medical home. Instead, some schools may rely on the pediatrician to assist in training unlicensed staff.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online December 28, 2015.