Health Services

Contacts

As a health services team, we are working hard to keep ourselves updated on the most current medical advice from the most trusted sources. If you have any questions or need support for your student's medical needs, please don't hesitate to reach out to our Health Services Team listed below.

FES Nursing Staff
Kellie Schimelman RN kschimelman@falmouthschools.org 207-347-3152, fax 207-781-1023
Lindsay Wissink RN lindsay.wissink@falmouthschools.org 207-347-3152, fax 207-181-1023
Visit the FES Health Services page

FMS Nursing Staff
Jean Barbour RN jbarbour@falmouthschools.org 207-781-1020, fax 207-781-1021
Visit the FMS Health Services page

FHS Nursing Staff
Beth Luce RN beth.luce@falmouthschools.org 207-781-1321, fax 207-781-1022
Visit the FHS Health Services page

Falmouth School District Physician
Charles de Sieyes MD

General Illness Guidelines

Students who become ill during the school day will be assessed by the school nurse and receive appropriate care and supervision in the nurse’s office. The school nurse will dismiss the student only after a parent or other designated emergency contact has been informed. In accordance with Maine Department of Health and Human Services guidelines, a child should not attend school if he/she exhibits one or more of the following symptoms or infections:

Fever – fever is defined as having a temperature of 100.4 degrees F or higher.
Diarrhea – watery, foul-smelling, runny and/or bloody stools. Should be free from diarrhea episodes for 24 hours before returning to school.
Vomiting – in the last 24-hour period.
Rash – an unexplained rash with fever or behavioral change. Child can return to school if a physician has determined the illness is not communicable and fever is gone.
Bacterial infections requiring antibiotics. If your child is placed on antibiotics for any kind of infection please consult school nurse for return to school recommendations.

Students with these symptoms cannot comfortably participate in program activities and unnecessarily expose others to their illnesses. Students should be fever-free without the aid of fever-reducing medication, such as acetaminophen or ibuprofen for 24 hours before returning to school.

District Health Policies & Guidelines

Forms

Medications

Medication Administration

It is the Falmouth School Department’s policy that medications are given at home whenever it is medically feasible. In exceptional cases when the child needs the medication in order to be in school, the prescribing physician can order it during school hours. This policy was developed with the safety of your child in mind.

If medication is necessary the following policy must be followed:
1. Medication will be sent in the original bottle.
2. Written instructions with the following information:

Name of child
Name of medication
Reason for medication
Dosage
Time to be administered
Possible side effects
Termination date of medication

3. Parents will provide a signed informed consent.
4. Parents will provide a signed informed consent from the prescribing physician. Download the form for parental and physician signature.
5. Parents must bring controlled substances to the health room.
6. Parents will be responsible for informing the school nurse of any medication change.
7. Medication will be stored in a secure space in the health room.
8. Students cannot carry or self administer any medication at school except for inhalers, epipens, and insulin. In order to carry these medications, the student must first meet with the school nurse to review the administration of the medication in a manner directed by the physician. The student must be able to assess their medical need for the medication and understand any necessary follow up post administration. Download the form for medication self-administration.

This medication policy applies to all prescription and most over-the-counter medications including cough syrups, ointments and inhalers. Acetaminophen and Ibuprofen can be administered with a parent note. Note: All attempts will be made to administer medication within thirty minutes of the scheduled time. Parents will be notified of any deviation to this schedule. If you have any questions, please contact your School Nurse .

Immunizations

Maine School Immunization Laws require that all students produce an acceptable record/certificate of immunization or provide a written medical exemption to immunization. Immunization exemptions must be updated annually. The immunization dosage requirements upon entry into school are as follows:

5 Doses of any DTaP (diphtheria, tetanus, pertussis) containing vaccine, or 4 if the fourth dose is given on or after the 4th birthday.
4 Doses of OPV/IPV (Polio), or 3 if the third dose is given on or after the 4th birthday.
2 Doses of MMR (measles, mumps, rubella), #1 no sooner than 12 months of age, #2 at least 4 weeks after #1.
2 Dose of Varicella (chickenpox) or documented history of the disease by a health care provider or laboratory evidence demonstrating immunity.

In addition:
** 7th graders now require a Tdap booster and MCV4 vaccine (please see information below)
**12th graders now require two doses of MCV4 vaccine.
If the first dose of meningococcal vaccine was administered on or after the 16th birthday, a second dose is not required (please see information below for details).

Non-immunized students shall not be permitted to attend school or school activities unless one of the following conditions is met:

The parents/guardians provide the school written assurance that the child will be immunized within 90 days of enrolling in school or his/her first attendance in classes, whichever date is earlier. This option is available only once to each student during their school career; or
The parents/guardians provide a physician’s written statement each year that immunization against one or more diseases may be medically inadvisable (as defined by law/regulation); download the medical immunization exemption form; or

CDC recommended immunizations

For additional information about vaccines and vaccine safety read the CDC Vaccine Information, the American Academy of Pediatrics, or the Immunization Action Coalition.

For further questions, please contact the Maine Immunization Program at 207-287-3746 or 800-867-4775 or by email at ImmunizeME.DHHS@maine.gov

Health Related Issues

Influenza

As we strive to keep everyone healthy this school year, it it important that students and adults who are sick not go to school, work, or social activities. The following checklist can help determine if someone has influenza-like illness (ILI)

Flu Symptom Checklist for Families
Does your child have a fever of 100 degrees of more?
Does your child have a cough?
Does your child have a sore throat?

Should I keep my child home?
If you answered yes to:
Fever of 100 degrees or more
and
A cough or a sore throat
then your child has an influenza-like illness. Keep your child home for 24 hours after the fever resolves without the use of medication.

If you checked yes to only one of the questions above, or if your child is ill with other symptoms, keep your child at home at least one day to observe for additional symptoms. If additional symptoms develop, use the checklist questions again to decide whether to continue to keep the child home.

When should my child go to the doctor?
Call your doctor or seek medical care if your child has trouble breathing or has behavior changes including changes in eating or drinking habits. Call your health care provider if your child is ill enough that you would normally seek health care advice.
For more information please visit www.maineflu.gov.

Head Lice

Identification: Head lice are tiny wingless insects that attach to a person's hair, where it feeds on extremely small amounts of blood from the scalp. Signs and symptoms include severe itching of the scalp and the presence of nits or lice. To determine if your child has head lice you need to check their hair and scalp in good light. Use of a comb or applicator sticks to separate the hair is also helpful. Nits (Eggs) may look like dandruff but they do not brush or flake off since they are cemented to the hair. They are tiny oval specks of grey or yellow-white attached to the hair shaft. Often you will find them behind the ear and at the nape of the neck. The louse is harder to detect. They are only 1-3 mm long, are grayish-white to reddish-brown and can move quickly in the hair. They do not fly, hop or jump. They do not live on animals, just humans. Lice are not dangerous and do not spread disease.

Treatment: Permethrin 1% (Nix) is currently the recommended treatment of choice by the American Academy of Pediatricians (AAP) for newly diagnosed cases of head lice. After treatment, remove the nits with a comb (see next paragraph). Wash bedding and clothing in hot water and dry in a hot dryer. Vacuum carpets and upholstered furniture. Those items that cannot be laundered (including stuffed animals) should be sealed in a plastic bag for 10 days. Continue checking your child’s head daily for a few weeks.
Although eliminating lice from your home is essential, the most important thing a parent can do is comb the hair after treatment. A special metal comb designed specifically to help remove lice and nits from the hair shaft is essential. Plastic combs are too flimsy and often break. Metal combs come into contact with nits and lice that are so tiny you may not be able to see them. The most highly recommended lice combs are the Licemeister, the Terminator and the Dual sided lice comb. Daily combing of the hair will allow you to greatly reduce the risk of reinfestation. The Robi Comb is another type of comb. It is an electronic comb used to detect and kill head lice. Robi Comb destroys lice on contact simply by combing it through dry hair. When the electronic Robi Comb touches lice, they get zapped, die and are combed out of the hair.

Other treatment: Occasionally head lice are resistant to Nix or other pediculicides. If some live lice are still found 8-12 hours after treatment but are moving more slowly than before, do not retreat. Comb dead and remaining live lice out of the hair. The medicine sometimes takes longer to kill the lice. If no dead lice are found 8-12 hours after treatment and lice seem as active as before, the medicine may not be working. Contact your healthcare provider for a different medication and follow their treatment instructions. Over the last few years, new treatments such as Sklice, and Natroba have become available. They all have different compounds and mechanisms which will lead to what's called redundant killing, where if one compound doesn't do the job, the other compound will. In addition, the new drugs typically are easier to apply, only needing one application instead of repeated doses and no nit combing. All are prescription drugs, so insurance coverage will vary depending on the insurance plan.

There are some “natural” methods to try to suffocate head lice that pediatricians recommend. One method is to coat the hair with Cetaphil skin cleanser. Complete directions and more information are found on this Cetaphil link. Another method is to coat the hair with a mixture of mayonnaise, and olive oil, cover the head with a shower cap and leave this on overnight. Wash this oily emulsion out with green Dawn dish detergent and vinegar. Use this treatment 4 nights in a row. After treatment, remove the nits with a comb or your fingernails. A third method is daily combing: Buy a cheap cream rinse and coat the hair from roots to end. Use a Licemeister or similar metal lice comb with 1 and 1/2 inch metal tines to comb out lice and nits thoroughly. Take one section of the hair at a time, pin up the rest and spend a fair amount of time on each section on the first comb-through. (It can take a couple of hours- plug in a DVD.) The lice and eggs will get trapped in the gobs of cream rinse each time the comb goes through the hair- wipe them off and throw into the trash. When finished, wash hair as usual with shampoo. You need to continue to do this daily until you do not find lice or eggs (up to 6 weeks).

Prevention: Avoid head to head contact, do not share combs, brushes, hats, etc. Head lice are frequently spread through sleepovers or sharing of headgear via sports teams. Check your child's head frequently when outbreaks of head lice have been reported.

Please contact the school nurse if you would like further information or guidance regarding head lice treatment. Anyone can get head lice. An infestation does not indicate poor hygiene and is nothing to be ashamed of.
Further Information can be found at:
CDC Head Lice information
Healthy Children resources

Lyme Disease Information

Deer ticks carry the bacteria that cause Lyme disease. They cling to vegetation in brushy, wooded, or grassy areas and transmit Lyme disease by biting. Both immature ticks (nymphs) and adult ticks can transmit Lyme disease. It is believed that the tick needs to remain attached for at least 24 hours for infection to occur. The immature tick is very small and may not be immediately noticeable on the skin. Not all ticks carry Lyme disease; in fact the common dog tick has not been shown to do so. Even a bite by a deer tick does not mean that Lyme disease will occur.

One symptom of Lyme disease is a red, circular skin rash that occurs at the site of the bite but may spread to other areas. It begins about 7 to 10 days after the bite and gradually enlarges, often with partial clearing in the center so that it resembles a donut. Hives, swelling of the face, redness of the eyes, and flu like symptoms (fever, headache, stiff neck, muscle and joint aches, and fatigue) may also occur.

The only known way to get Lyme disease is from the bite of an infected tick. Avoiding areas where ticks are found and promptly removing attached ticks are the most important preventive measures. People living in or visiting areas where Lyme disease is known to occur should take the following preventive measures:

Don’t walk bare legged in tall grass, woods or dunes where ticks may be found. If you do walk in such areas, wear a long-sleeved shirt, long pants, high socks (with pants tucked into the socks), and sneakers. Light colors will help you spot ticks on clothing. Apply a commercial tick repellent on clothing, shoes and socks, after reading the label instructions carefully. Avoid applying high concentrations to the skin, particularly of children. Family pets may bring ticks into your house and it is important to discuss tick control for pets with your veterinarian.

Daily tick checks reduce your risk of contracting Lyme disease. Because of their small (poppy seed) size, nymph ticks present the greatest threat. You need to check yourself, your pets, and especially small children DAILY after outdoor activity. When showering or bathing, do a full body inspection for a rash or attached ticks. Remember that the nymph tick is about the size of the head of a straight pin. Pay special attention to checking favorite tick spots, such as backs of knees, groin, waist, armpits, and the scalp. You may be able to feel the tick even if it is too small to see.

To remove an embedded tick, use tweezers to grip its body as close to the skin as possible and pull gently but firmly until the tick lets go. Local pet stores sell a tool called Ticked Off. This simple to use tick remover is very effective at removing ticks safely. For further information visit I have a tick bite, what to do now or Maine CDC page on Lyme Disease. Contact your physician if you have concerns about a tick bite.

Chronic Daily Headaches (CDH)

Headache specialists define CDH as at least 15 days of headache per month, with pain lasting longer than 3 to 4 hours daily, and a total headache duration of more than 3 months.

Internalized emotional stress can produce very real headache. A death of a loved one, abuse (verbal, physical, or sexual), change in school, or family discord can adversely affect a teen's life; when he or she is unable to recognize or cope with the stress, this may manifest as CDH. Students who are high achievers in scholastics or sports may be under immense stress to perform at their best and can develop CDH as a result.

What is your daily routine, and how do you sleep? Generalized stresses on the body can not only alter mood and energy but also trigger headaches. Hunger, dehydration, and lack of sleep are causes of headache that can be prevented. Having teenagers eat 3 balanced meals per day and take adequate hydration is a critical component of headache management. Monitoring caffeine intake is also essential; teenagers, like adults, are prone to caffeine withdrawal or overuse headaches from coffee or soft drinks.

Do you take any medications for your headache? How much and how often? Assessing medication use is the most important step in recognizing underlying causes of primary headache. Worldwide, medication overuse, usually with analgesics, is the most common cause of CDH in adolescents. Using analgesics (eg, ibuprofen, acetaminophen, aspirin) or abortive headache medications (eg, sumatriptan, ergots) more than 3 times per week predisposes individuals to medication-overuse headache. Unless these medications are discontinued with a 2- to 4-week washout period, a primary cause of headache cannot be evaluated.

Although these nonpharmacologic approaches might not be the prescription the teen is expecting, failure to implement these interventions is almost a guarantee for continued CDH.

Exercise has a 2-fold benefit: weight reduction in obese patients and improved mood-related symptoms in depressed patients. Learn to work through headache pain. High-impact aerobic activity can exacerbate headache pain; therefore use less rigorous exercises at first, such as walking, yoga, or swimming, which are relaxing and can be adjusted for all levels of physical capabilities.

Treating mood and stress issues. Depression and mood disorders are common problems in this population, and appropriate management with antidepressants or cognitive-based therapies should be employed. Both pharmacologic and nonpharmacologic treatments can be helpful in patients with CDH who also have mood disorders. Referral to a counselor, psychologist, or psychiatrist should be considered if indicated.

Just say no to most drugs! All abortive drugs should be stopped. No exceptions. Medication overuse is seen in up to 50% of children with CDH and may play a causative role in some cases. Once there has been a washout period for analgesic and rescue medications, allowing the patient to use over-the-counter medications such as ibuprofen and acetaminophen 2 times per week is permissible.

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