Laughing, jumping, climbing and romping through the slides, jungle gyms and other inflatable gizmos at Monkey Joe’s recently were hundreds of St. Louis area children. Not an unusual sight at a party/play center except for the fact that most of the children have asthma. They, along with family members, school staff and medical attendants, celebrated a successful school year of managing their respiratory disease through the St. Louis Children’s Hospital Healthy Kids Express Asthma Management Program.
“In the 2007-2008 school year more than 200 children in six St. Louis schools were enrolled in our asthma program which helped them learn about and manage their chronic condition,” said Jackie Ferman of St. Louis Children’s Hospital. “This year-end party celebrates their hard work and encourages more healthy habits over the upcoming summer break.”
Lisa Meadows, a nurse practitioner from Children’s who oversees Healthy Kids Express said school nurses and staff receives training as well as the children and their parents.
“School nurses have standing orders to follow the same protocol as that on the Healthy Kids Express. We’ve supplied them with all the equipment they need to properly manage the children,” Meadows said. “Kids and families get equipment: peak flow meters, aero chambers, medication bags and we teach them how to use all of that.” Although asthma medication is not supplied, Meadows said they provide tools for its proper use and educational meetings for parents during family activities.
Helping the kids learn more about asthma, its triggers and what children can do to help control their disease is a major part of the effort. For example, nurses regularly review with the children how to use a metered-dose inhaler properly. This school year, more than a third of the children have completed the “Open Airways” class by the American Lung Association.
During “Lunch and Learns,” teachers find out more about asthma and what to do if a student has an asthma emergency. Teachers also receive emergency kits supplied by the program and kept by the school nurse to take on field trips just in case the asthmatic student gets into respiratory trouble while away from school.
One St. Louis family had three reasons to celebrate a year of better breathing. Asthma is a constant companion for three little boys in their home. De’Borah Watson’s and Darren Avery’s son, Darren Jr., had asthma since birth.
“At first we thought it was because he was born premature,” Watson said, describing his asthma as the most severe among the boys.
Even with medical support at the party and Darren Jr. being in eyesight and at arms reach from her, his dad or siblings, mom could not help but worry. “I was sort of skeptical about bringing him out. We’ve been battling for about a month, because when I take him to the ER—every time they wind up keeping him.”
Allergies and asthma were not slowing Darren Jr. down this day as he and his siblings played to their hearts content, seemingly without a care in the world—the way it should be for all kids.
“When it’s starting, he’s got this cough—his nose runs, his eyes swell up and his eyes run,” Watson said.
Darren knows what to do at school when there is trouble.
“I ask my teacher if I can go to the nurses. They check my lungs,” he said thoughtfully, before dashing off in stocking feet heading for another inflatable free-for-all.
His brother Dezjuan and their cousin, Damon Fultz have asthma as well. With a house full of asthmatic children who also have allergies and parents who are smokers, some changes had to be made at home.
“You have to stop smoking in the house,” dad Darren Avery said. Mom took it a step further. She hasn’t had a cigarette since January 2007.
“You have to be considerate of him and maintain the air quality,” he explained. I can’t have animals. I love dogs. I had to give that up. At his age, all he wants to do is go-go-go.”
St. Louis schools in the program are Ames, Baden, Clay, Kennard, Mark Twain and Nance Elementary schools.
The Healthy Kids Express, a full -sized charter bus-turned-lung care center, rolls up to each of the schools during regular intervals to assess the children’s asthma. The entire team includes a social worker, two nurse practitioners and three registered nurses. Healthy Kids Express does not replace visits to the child’s primary care provider—the team works in conjunction with the child’s doctor, the school and family members for good asthma management at home and at school.
“We like to be adjunctive service, not taking the place of them,” Meadows said.
Teachers can request appointments if they observe the child’s asthma may not be in control. School attendance is an indicator examined to see if there may be problems.
“We look at their absentee rate in school—five days or more and we’re going to see them,” Meadows said.
If it is determined that a child is in respiratory distress or heading toward an asthma attack during a school visit, a member of the team makes necessary contacts to find out how to proceed.
“After the physician tells me what he wants to do, I’ll call the mom,” Meadows said.
Meadows said in prior school years, the program has reduced absenteeism by 30 percent.
Children’s Hospital works with the Asthma and Allergy Foundation on for families of children who are uninsured. Its Project Concern works with prescription assistance for asthma and allergy meds.
The AAF also provided participants with hypoallergenic pillow and mattress casings. This year, the AAF ranks St. Louis No. 26 out 100 in its 2008 Spring Allergy Capitals list (last year St. Louis was No. 6).
For the school nurses, the American Lung Association offers a bit of summer school with an asthma educator course held each June.
Healthy Kids Express plans to add two additional stops to its road trips next school year to include an elementary school in Normandy and a rural school in Meramec Valley.
For more information about asthma, go to the local chapter of the Asthma and Allergy Foundation of America www.aafastl.org or the American Lung Association at www.lungusa.org.
