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Updated on August 24, 2023
Asthma is one of the most common chronic (long-term) health conditions among children in the United States. It affects nearly 4.7 million kids—or about 1 in 15—under the age of 18. Allergies, meanwhile, affect nearly 1 out of 4 children in the U.S., and as many as 80 percent of kids with asthma also have allergies.
Asthma is one of the top reasons kids miss school, accounting for one-third of all absences. Even when children are well enough to be in school, asthma and allergy symptoms can make learning a challenge for several reasons:
- Symptoms can interfere with kids’ ability to concentrate on assignments and join in activities.
- Itchiness or discomfort can lead to changes in thinking, behavior, or mood.
- Swelling, watery eyes, and shortness of breath from outdoor allergens (like pollen) can make participating in recess and sports frustrating or even impossible.
In turn, these barriers to learning and play can contribute to low grades and low self-esteem. At school, kids often need to navigate allergy and asthma challenges on their own. Because these conditions can be subtle or invisible to others, it can make it difficult for kids to get the help they need.
Here are steps you can take—at the beginning of the school year and all the way until summer—to help children with allergies and asthma stay safe, healthy, and ready to learn.
Build your child’s asthma and allergy team
Kids, caregivers, healthcare providers (HCPs), and school staff need to be partners in protecting kids from allergies and asthma at school. Friends and classmates can also be powerful advocates when they are equipped with the right knowledge.
While many people will play a role in keeping your child safe at school, it can help to have one main point of contact for health concerns. The ideal person will depend on your child’s age, health needs, and the way your school is organized.
For example, younger children might have one teacher who oversees all their learning and activities. This teacher might be best positioned to speak for your child’s needs throughout the day. Older kids might have a different teacher or classroom for each subject. In that case, it might make sense to ask a school nurse or guidance counselor to serve as their advocate.
If major asthma risks (like mold in the classroom) need to be discussed with school leadership, it may be appropriate to ask the principal for a meeting. When it comes to efforts that seem out of reach for one parent to achieve—like making changes to the school’s policies or budget—your school’s Parent-Teacher Association (PTA) can be a powerful ally. PTAs can lead change by raising awareness, “making noise” when necessary, and gathering community support.
Start with a school visit
Often, your child is the only person who can draw attention to their asthma or allergy symptoms. And yet, kids’ reports about factors that bring on symptoms (like overexertion in gym class) and requests for accommodations (like needing exercise breaks) are sometimes brushed aside by the grownups who need to listen most.
“Coaches and teachers are accountable for your child’s health when they’re in their care,” says Abby Mutic, PhD, MSN, CNM, Principal Investigator of the Southeast Pediatric Environmental Health Specialty Unit (PEHSU) at Emory University in Atlanta, Georgia. “But to really be accountable, they need to fully understand your child’s condition and all the unique needs that come with it.”
These needs may vary and evolve as your child ages. “Toddlers and teenagers are going to be very different in terms of who’s preparing their school bags (and what they’re packing), who’s giving their medication, and how involved they are in their own care,” notes Mutic. That’s why it’s important to check in with the school every year.
Before the school year starts or as early in the year as possible, schedule a visit and bring your child. As you walk through the school, check for possible sources of exposure, such as dust or pollen on windowsills, old carpeting, signs of water damage or mold, and dirt or dust surrounding air vents. Point out places your child should avoid and follow up with your point of contact to ask about cleaning or repairs.
Know the right questions to ask
Speak with your child ahead of time and write down the questions that are important to both of you. Consider asking about the following during your visit or in a follow-up conversation with the school:
The ride to school
What type of fuel does the school bus use? Are buses allowed to idle outside when kids are nearby?
Diesel fumes contain at least 40 toxic chemicals that can hurt kids’ health. Replacing buses might sound expensive or beyond your ability to accomplish, but your child’s school may already be working on it. In fact, the federal government has offered incentives for switching to electric. In the meantime, "no-idling” policies can reduce the chemicals children breathe.
Classroom cleaning
What cleaning products does the school use? If they’re not on the Safer Choice List from the U.S. Environmental Protection Agency (EPA), ask school staff about switching products for the health and safety of all.
“There’s this idea that classrooms should ‘smell clean,’” says Mutic. “That’s not right—you shouldn’t smell anything. Clean means the absence of odor. It shouldn’t smell like poop, but it shouldn’t smell like roses, either. If a cleaning substance has a pleasant odor, there’s a good chance it’s releasing chemicals that are bad for your child’s health.”
Ask your child’s teachers to consider natural solutions like vinegar for everyday surface cleaning and to reserve stronger substances like diluted bleach or products from the EPA’s Safer Choice List for messes that need disinfecting (like blood or bodily fluids). The PTA can also be an ally in consulting with the school’s janitorial staff or purchasing board in case teachers don’t make decisions about product purchases.
Classroom air
Does your school take measures to keep indoor air clean?
“Schools tend to use one of three things to help clean the air: an HVAC (or Heating, Ventilation, and Air Conditioning) system, an HVAC with air filtration, or portable air filters. Or they may use nothing at all,” says Mutic. What’s in your child’s classroom?
If the classroom has no air purifier—and the school can’t afford to install one—ask the teacher if they would be willing to build a homemade air purifier with you.
A homemade device still requires supplies that can cost money (like a box fan and high-quality filters), but the supplies are more affordable than a retail portable air purifier. The parts may cost about $30 to $40, depending on where you purchase them and if you already have items like a box fan. Just remember that you will need to replace the filters as often or more often than you would with a commercial air purifier.
Follow these tips from the Centers for Disease Control and Prevention (CDC) for building your own air purifier.
Outdoor play
Is your school mindful of outdoor air quality?
“There’s been a lot of attention paid to if and when schools should open windows, especially if they’re in a high-pollution area,” explains Mutic. “But we can’t really make blanket statements about school policies because what you do should depend on real-time pollution levels in the area.”
Tools are becoming available to help make decisions about whether it’s appropriate to open windows, when it’s okay to play outside, and more. Air quality monitors can now be found in many drug stores or online, with prices starting around $49. The EPA’s AirNow website and app are free, but it’s important to remember that their insights are provided at the zip-code level, rather than for your precise location.
Many schools are adopting safe air flag programs, where they raise different-colored flags to indicate air quality levels. On “red” days, for example, everyone stays indoors.
Mealtime
Do all class parents, caregivers, and cafeteria workers have a list of allergens to avoid? Do they have EpiPens or anaphylaxis kits on-hand for accidental exposures? Do they know how to use them?
Cafeteria staff should have a copy of your child’s asthma/allergy action plan and know which foods to avoid when preparing their meals. You can ask your child’s teacher to send notes to the class list asking other parents and caregivers to avoid allergens in shared foods, as well.
Many classes have “no nuts” policies for birthday cakes, bake sales, and other shared foods. Likewise, some cafeterias may set aside allergy “safe zones” for preparing and serving food, such as sections of the kitchen where the most common allergens are never used.
Accommodations
If your child needs accommodations for learning, sports, or play as a result of their asthma, are the teachers and staff aware? You (and school staff) may not realize it, but children with asthma are entitled to protection under the Americans with Disabilities Act (ADA), which provides “reasonable accommodations” for U.S. students.
A reasonable accommodation is one that adjusts the learning environment so that kids with a health condition have the same opportunities to learn as other kids. An accommodation is considered reasonable if it doesn’t threaten or harm others.
You may want to complete a 504 Plan with the school, as well. A 504 Plan is a contract between you and the school that legally protects accommodations for your child under the ADA. If the school receives any federal funding, they have to follow 504 Plans. The Asthma and Allergy Foundation of America has a guide on how to know if your child needs a 504 Plan for their asthma and how to create one.
Medications
Who will store and give your child’s medications—the teacher, nurse, or your child? In the U.S., children can legally carry and self-administer asthma meds. If you have a child who’s new to using an inhaler, work with your school nurse or your HCP to ensure your child is ready to self-administer.
The American Lung Association (ALA) offers an assessment tool to help determine when kids are ready. Since children might have different levels of readiness at different ages, the ALA’s tool can help you, your child, and their HCP assess their readiness year-to-year.
Create an action plan for emergencies
Does your school know what to do for your child in case of an asthma or allergy emergency?
An action plan for asthma or allergies is a document that you and your child create with their HCP. It should detail what actions to take in different scenarios, from their everyday routine to an emergency. The ALA has created a printable action plan form for easy use.
A new plan should be made every year. Print the action plan and give it to any adults who care for your child. Those adults need to know what to do in an emergency and how to do it, as well. They should be able to find and administer emergency meds, like an EpiPen or albuterol inhaler, in seconds if needed.
In addition to your child’s action plan, many schools require that you fill out specific asthma or allergy forms each year. These may include medication permissions, dietary requests, and others. If you’re not certain what’s required, write or call your child’s teacher or the school nurse or bring it up at back-to-school night or at your next parent-teacher conference.
Understand the impact of environmental injustice
The systems designed to support children and families—like education and health care—don’t always work equitably for everyone. For example, research shows that children with asthma and allergies have different health outcomes based on their race, their neighborhood, their parents’ income level, and many other factors.
Of the nearly 4.7 million American children with asthma, nearly a quarter are Black (1.06 million) and another quarter are Latinx or Hispanic (1.1 million), figures that are out of proportion with the number of people in the U.S. who are Black (nearly 14 percent) or Latinx/Hispanic (19 percent). What’s more, in 2020, Black children had a death rate from asthma that was 7.6 times greater than that of white children. Overall, Black, Latinx, and Native American or Indigenous children are most likely to miss school, be hospitalized, or die due to asthma.
“It's not correct to simply say children from any one race are more likely to get sick,” says Mutic. What we should consider instead, she says, are the policies and systems that shape children’s environments and the environmental risks that are found in the places where they live, learn, and play, which can make them sick as a result.
The fact that children of color are more likely to experience severe asthma and less likely to receive proper care is an example of environmental racism. Simply put, environmental racism is the way in which a person’s lived environment can be impacted by systems that are biased against people of color.
There’s no one simple reason or solution for environmental racism, says Mutic. It’s the result of countless factors—including history, economics, and how resources are divided and shared throughout society—that come together to hurt some communities more than others.
“It’s things like kids having to spend all their time indoors because there’s no safe outdoor areas to play,” Mutic explains. “It’s the materials in their homes and the toxins that building companies have been allowed to use. It’s the laws and policies that say how close factories and dump sites can be built to family homes. It’s schools’ ability or inability to access air filtration systems—and whether air quality is even a priority compared to things like lead in the drinking water. It’s what’s in the air when the teacher opens the window, including ozone and diesel exhaust, and so much more.”
How to help
The issues contributing to environmental racism can feel too big to fix. But there are real steps everyone can take to help protect people and communities.
To start, you can visit the Pediatric Environmental Health Specialty Unit (PEHSU) website to learn about environmental health efforts underway in your region. Each region of the U.S. has its own PEHSU. These government-sponsored networks bring together families, physicians, nurses, scientists, and advocates to promote environmental health.
“The PEHSU isn’t just made up of healthcare providers,” says Mutic. “These units are effective because they’re healthcare providers and communities working together to address environmental issues based on the unique ways those threats affect people's lives.”
If you want to take part in environmental justice efforts at the community level, she says, reach out to the PEHSU near you. The PEHSU website also offers information, resources, and ways to connect with healthcare providers who specialize in environmental health.
“On the other hand, your local department of health can help with environmental threats in the home, like mold or lead,” says Mutic. “If you’re concerned about long-term exposure to substances like lead and you want to get tested, you can make an appointment with a primary care provider. If you or your child is exposed to a poisonous substance—like if they swallow a cleaning chemical—contact Poison Control (at 800-222-1222) right away.”
If there are active or ongoing threats facing your home or community—such as an untreated chemical spill or dangerous factory emissions—consider also reaching out to your elected representative. They may be able to work with your community to address the issue through policy actions or state or local funding decisions.
This article has been written in collaboration with the Center for Children’s Health Assessment, Research Translation, and Combating Environmental Racism (CHARTER) at Emory University. CHARTER works to develop strategies to translate research findings on children’s environmental health for stakeholders in the community, academia, and health care with the goal of improving children’s health.
