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Home | California County Offices of Education | SDCOE

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Tons of health care plans

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Home | California County Offices of Education | SDCOE

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San Diego County Office of Education (SDCOE) serves our county’s most vulnerable students and supports school leaders, teachers, and students across the county.

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Menus, powered by Nutrislice. Nutrislice is the leading provider of digital menus, signage, and ordering software. View menus online or with the Nutrislice app.

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Diabetes Calculation Printout (1/2 unit rounding)

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Diabetes Calculation Printout (1/2 unit rounding)

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"I've had NSO malpractice insurance since graduating from nursing school in 1982. I have always been comforted in the knowledge that NSO was there if I needed them. Though I've never had a single issue, NSO is covering me on or off the job. I am able to work as a nurse and as an educator without worrying that my employers will cover me."

"It's such an emotional time when the care we give our patients is questioned. To have all the red tape just disappear helped more than anything. I felt well taken care of, knowing that NSO was helping me and providing the advice of a lawyer. I cried when they called to tell me my claim was paid promptly and in full."

"Working as a Nurse Practitioner, I was sued by a non-compliant patient. The best thing was having NSO malpractice insurance. From the moment I notified them of my lawsuit I felt protected and supported. You owe it to yourself to have your own coverage. NSO is the only malpractice insurance I will ever have."

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Nursing Malpractice Insurance, Liability Insurance Nurses

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"I've had NSO malpractice insurance since graduating from nursing school in 1982. I have always been comforted in the knowledge that NSO was there if I needed them. Though I've never had a single issue, NSO is covering me on or off the job.

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Group that comes to our schools in October and April

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Big Smiles Dental | offering in-school dental care

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Dental care right outside your classrooms at no cost to your school! Or Call Us 888.833.8441 1 in 7 children (6-12) are suffering from tooth pain right now. Over 51 million school hours are lost each year due to poor dental health. Over 50% of Children on Medicaid don't regularly see a dentist.

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"make a copy" to your drive then you can edit it

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Hancock Place School District Medication Administration Authorization

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Centers for Disease Control and Prevention

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Recommendations for Ages 18 Years or Younger, United States, 2023

To make vaccination recommendations, healthcare providers should:

1. Determine needed vaccines based on age (Table 1)

2. Determine appropriate intervals for catch-up, if needed (Table 2)

3. Assess for medical conditions and other indications (Table 3)

4. Review special situations (Vaccination Notes)

5. Review contraindications and precautions to vaccination (Appendix)

6. See Addendum for new or updated ACIP vaccine recommendations (Addendum)

Administer recommended vaccines if immunization history is incomplete or unknown. Do not restart or add doses to vaccine series for extended intervals between doses. When a vaccine is not administered at the recommended age, administer at a subsequent visit. The use of trade names is for identification purposes only and does not imply endorsement by the ACIP or CDC.

Notes

For vaccination recommendations for persons ages 19 years or older, see the Recommended Adult Immunization Schedule, 2023.

Additional information

Consult relevant ACIP statements for detailed recommendations.

For calculating intervals between doses, 4 weeks = 28 days. Intervals of ≥4 months are determined by calendar months.

Within a number range (e.g., 12-18), a dash (-) should be read as "through."

Vaccine doses administered ≤4 days before the minimum age or interval are considered valid. Doses of any vaccine administered ≥5 days earlier than the minimum age or minimum interval should not be counted as valid and should be repeated as age-appropriate. The repeat dose should be spaced after the invalid dose by the recommended minimum interval. For further details, see Table 3-2, Recommended and minimum ages and intervals between vaccine doses, in General Best Practice Guidelines for Immunization.

Information on travel vaccination requirements and recommendations is available at https://www.cdc.gov/travel/.

For vaccination of persons with immunodeficiencies, see Table 8-1, Vaccination of persons with primary and secondary immunodeficiencies, in General Best Practice Guidelines for Immunization, Immunization in Special Clinical Circumstances (In: Kimberlin DW, Barnett ED, Lynfield Ruth, Sawyer MH, eds. Red Book: 2021-2024 Report of the Committee on Infectious Diseases. 32nd ed. Itasca, IL: American Academy of Pediatrics; 2021:72-86).

For information about vaccination in the setting of a vaccine-preventable disease outbreak, contact your state or local health department.

The National Vaccine Injury Compensation Program (VICP) is a no-fault alternative to the traditional legal system for resolving vaccine injury claims. All vaccines included in the child and adolescent vaccine schedule are covered by VICP except for dengue, PPSV23 and COVID-19 vaccines. COVID-19 vaccines that are authorized or approved by the FDA are covered by the Countermeasures Injury Compensation Program (CICP). For more information, see www.hrsa.gov/vaccinecompensation or www.hrsa.gov/cicp.

Haemophilus influenzae type b vaccination
(minimum age: 6 weeks)

Meningococcal serogroup A, C, W, Y vaccination (minimum age: 2 months [MenACWY-CRM, Menveo], 9 months [MenACWY-D, Menactra], 2 years [MenACWY-TT, MenQuadfi])

Meningococcal serogroup B vaccination
(minimum age: 10 years [MenB-4C, Bexsero®; MenB-FHbp, Trumenba®])

Appendix - Guide to Contraindications and Precautions to Commonly Used Vaccines

Adapted from Table 4-1 in Advisory Committee on Immunization Practices (ACIP) General Best Practice Guidelines for Immunization: Contraindication and Precautions and ACIP's Recommendations for the Prevention and Control of 2022-23 seasonal influenza with Vaccines.

Influenza, cell culture-based inactivated injectable
[(ccIIV4), Flucelvax ® Quadrivalent]

Influenza, cell culture-based inactivated injectable
[(ccIIV4), Flucelvax ® Quadrivalent]

Influenza, live attenuated [LAIV4, Flumist ® Quadrivalent]

Influenza, live attenuated [LAIV4, Flumist ® Quadrivalent]

Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency)

Severe allergic reaction (e.g., anaphylaxis) to any vaccine component³ (excluding egg)

Children age 2 - 4 years with a history of asthma or wheezing

Anatomic or functional asplenia

Immunocompromised due to any cause including medications and HIV infection

Close contacts or caregivers of severely immunosuppressed persons who require a protected environment

Pregnancy

Cochlear implant

Active communication between the cerebrospinal fluid (CSF) and the oropharynx, nasopharynx, nose, ear or any other cranial CSF leak

Children and adolescents receiving aspirin or salicylate-containing medications

Received influenza antiviral medications oseltamivir or zanamivir within the previous 48 hours, peramivir within the previous 5 days, or baloxavir within the previous 17 days

Contraindicated or Not Recommended ¹

Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency)

Severe allergic reaction (e.g., anaphylaxis) to any vaccine component³ (excluding egg)

Children age 2 - 4 years with a history of asthma or wheezing

Anatomic or functional asplenia

Immunocompromised due to any cause including medications and HIV infection

Close contacts or caregivers of severely immunosuppressed persons who require a protected environment

Pregnancy

Cochlear implant

Active communication between the cerebrospinal fluid (CSF) and the oropharynx, nasopharynx, nose, ear or any other cranial CSF leak

Children and adolescents receiving aspirin or salicylate-containing medications

Received influenza antiviral medications oseltamivir or zanamivir within the previous 48 hours, peramivir within the previous 5 days, or baloxavir within the previous 17 days

Measles, mumps, rubella (MMR)
Measles, mumps, rubella, and varicella (MMRV)

Measles, mumps, rubella (MMR)
Measles, mumps, rubella, and varicella (MMRV)

Meningococcal ACWY (MenACWY)
[MenACWY-CRM (Menveo ®); MenACWY-D (Menactra ®); MenACWY-TT (MenQuadfi ®)]

Meningococcal ACWY (MenACWY)
[MenACWY-CRM (Menveo ®); MenACWY-D (Menactra ®); MenACWY-TT (MenQuadfi ®)]

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³

For MenACWY-D and Men ACWY-CRM only: severe allergic reaction to any diphtheria toxoid- or CRM₁₉₇-containing vaccine

For MenACWY-TT only: severe allergic reaction to a tetanus toxoid-containing vaccine

Contraindicated or Not Recommended ¹

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³

For MenACWY-D and Men ACWY-CRM only: severe allergic reaction to any diphtheria toxoid- or CRM₁₉₇-containing vaccine

For MenACWY-TT only: severe allergic reaction to a tetanus toxoid-containing vaccine

Tetanus, diphtheria, and acellular pertussis (Tdap)

Tetanus, diphtheria (Td)

Tetanus, diphtheria, and acellular pertussis (Tdap)

Tetanus, diphtheria (Td)

1. When a contraindication is present, a vaccine should NOT be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.

2. When a precaution is present, vaccination should generally be deferred but might be indicated if the benefit of protection from the vaccine outweighs the risk for an adverse reaction. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.

3. Vaccination providers should check FDA-approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. See Package inserts for U.S.-licensed vaccines.

4. For information on the pregnancy exposure registries for persons who were inadvertently vaccinated with Heplisav-B or PreHevbrio while pregnant, please visit heplisavbpregnancyregistry.com/ or www.prehevbrio.com/#safety.

Addendum - Child and Adolescent Recommended Immunization Schedule for ages 18 years or younger, United States, 2023

Vaccines in the Child and Adolescent Immunization Schedule*

Combination vaccines (use combination vaccines instead of separate injections when appropriate)

(Use combination vaccines instead of separate injections when appropriate)

DTaP, inactivated poliovirus, and Haemophilus influenzae type B vaccine

DTaP-IPV/Hib

DTaP, inactivated poliovirus, Haemophilus influenzae type b, and hepatitis B vaccine

DTaP-IPV-Hib-HepB

New Vaccines and Other Immunizing Agents added to the Schedule since February 2023 (See Addendum)

Vaccines and other immunizing agents

Abbreviation(s)

Trade name(s)

*Administer recommended vaccines if immunization history is incomplete or unknown. Do not restart or add doses to vaccine series for extended intervals between doses. When a vaccine is not administered at the recommended age, administer at a subsequent visit. The use of trade names is for identification purposes only and does not imply endorsement by the ACIP or CDC.

† COVID-19, Poliovirus, Influenza, and Pneumococcal vaccines have new or updated ACIP recommendations. Please see Addendum for more details.

This schedule is recommended by the Advisory Committee on Immunization Practices ( ACIP) and approved by the Centers for Disease Control and Prevention ( CDC), American Academy of Pediatrics ( AAP), American Academy of Family Physicians ( AAFP), American College of Obstetricians and Gynecologists ( ACOG), American College of Nurse-Midwives ( ACNM), American Academy of Physician Associates ( AAPA), and National Association of Pediatric Nurse Practitioners ( NAPNAP).

The comprehensive summary of the ACIP recommended changes made to the child and adolescent immunization schedule can be found in the February 10, 2023 MMWR.

Report

Suspected cases of reportable vaccine-preventable diseases or outbreaks to your state or local health department

Clinically significant adverse events to the Vaccine Adverse Event Reporting System (VAERS) at www.vaers.hhs.govexternal icon or (800-822-7967)

Questions or comments
Contact www.cdc.gov/cdc-info or 800-CDC-INFO (800-232-4636), in English or Spanish, 8 a.m.-8 p.m. ET, Monday through Friday, excluding holidays.
Helpful information

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View and Print CDC immunization schedules for those ages birth through 18 years.

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Apply today for this classroom kit full of easy-to-use classroom materials, plus Colgate® samples for 25 kindergarteners or first-grade students.

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Healthcare plan for a child with PKU at school

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Gastro-Jejunal (GJ) Tubes

Jejunal (J) Tubes

Common Tests

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Condition List

Swallowing Disorders

Motility Disorders

Other Common Disorders

Calories & Hydration

Formula and Breast Milk

Blended Diets

Navigating Life

Answering Tough Questions

Family and Friends

Siblings

Feeding Tube Dolls and Stuffed Animals

Birthdays and Holidays

Feeding Tube Fun

Feeding Pumps and Sets

Syringes, Extensions, and Other Supplies

Continuous and Overnight Feeding

Bolus, Gravity, and Intermittent Feeds

Tube Feeding in Public

Swimming, Traveling, and Camping

Daycare and Childcare

Feeding at School

Camps

Oral Eating and Aversions

Feeding Therapy

Weaning from Feeding Tubes

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Skin, Site, and Oral Care

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Tube Clogs

Tube Pullouts

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Gastro-Jejunal (GJ) Tubes

Jejunal (J) Tubes

Common Tests

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Motility Disorders

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Feeding at School

Feeding at School admin 2020-03-11T14:40:48+00:00

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This page deals with the practical issues of tube feeding at school. Most children with feeding tubes will also need an IEP or 504 plan to meet their needs in the school environment. Our page on Special Education discusses how these plans work, and which might be right for your child.

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CDC- How's our school health program doing?? 

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CDC- How's our school health program doing?? 

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An online self-assessment and planning tool for schools

The School Health Index (SHI) Self-Assessment and Planning Guide is an online self-evaluation and planning tool for schools. The SHI is built on CDC's research-based guidelines for school health programs that identify the policies and practices most likely to be effective in reducing youth health risk behaviors. The SHI is easy to use and is completely confidential.

The SHI (and related materials) is available as an interactive, customizable online tool or downloadable, printable version. The SHI aligns with the Whole School, Whole Community, Whole Child (WSCC) model.

CDC developed the SHI in partnership with school administrators and staff, school health experts, parents, and national nongovernmental health and education agencies to:

Enable schools to identify strengths and weaknesses of health and safety policies and programs.

Enable schools to develop an action plan for improving student health that can be incorporated into the School Improvement Plan.

Engage teachers, parents, students, and the community in promoting health-enhancing behaviors and better health.

Your Guide to Using the School Health Index (SHI) pdf icon [PDF - 13 MB] includes information and resources for district and school staff who are familiar with the SHI and who are charged with completing the assessment. Included in this Guide are information, materials, and resources on how to implement the SHI in schools, as well as a Facilitating Groups section for conducting trainings, workshops, or presentations on the SHI.

This course introduces you to CDC's School Health Index: Self-Assessment and Planning Guide. After this course, you will be ready to conduct or participate in a self-assessment and create a plan to improve the health of students in your school or district.

Page last reviewed:

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An online self-assessment and planning tool for schools The School Health Index (SHI) Self-Assessment and Planning Guide is an online self-evaluation and planning tool for schools. The SHI is built on CDC's research-based guidelines for school health programs that identify the policies and practices most likely to be effective in reducing youth health risk behaviors.

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Dear Teachers and Staff,

I have had several students come to the nurse's office since school started with loose teeth. I cannot do anything about loose teeth and it is a natural process that happens approximately 20 times in every child's young life. Students are missing valuable learning time to come to the nurse's office (often accompanied by another student who is also losing valuable learning time) to tell me about a loose tooth. Play-time, lunch, exercise, music and art are also valuable to student's learning. And most importantly, student's who visit the nurse's office are exposed to viruses and bacteria that cause illness.

Unless they are bleeding from the mouth, please do not send students to the nurse's office with loose teeth. I am happy to provide teachers with containers for lost teeth for those happy moments when the teeth actually do fall out.

School Nurse

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Thank you for visiting the Missouri Child Abuse and Neglect Mandated Reporter Training website. If this is your first time visiting and will be taking courses with us, please register below or using the header button. If you are a returning visitor, please login to access your profile and courses.

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Health Education grade level expectations

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Health Education grade level expectations

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Main Office

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Jefferson City, MO 65101
Map

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P.O. Box 480
Jefferson City, MO
65102-0480

Contact Us
Main Line: 573-751-4212
Educator Certification: 573-751-0051

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Welcome to dese.mo.gov. We hope you enjoy the site, and we welcome your feedback.

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St. Louis Suburban School Nurses' Association is a local district of the Missouri Association of School Nurses (state level), which is an affiliate of the National Association of School Nurses (national level). We all work in collaboration for the goal of optimizing student health and learning. State and national organizations have useful information for school nurses. Visit their websites by clicking on their logo.

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st louis suburban school nurses association

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Home - St. Louis Suburban School Nurse Association

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St. Louis Suburban School Nurses' Association is a local district of the Missouri Association of School Nurses (state level), which is an affiliate of the National Association of School Nurses (national level). We all work in collaboration for the goal of optimizing student health and learning.

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to provide leadership and promote professional growth to advance the practice of school nursing.

Who We Are

The Missouri Association of School Nurses is an affiliate of the National Association of School Nurses. We have over 400 active members from all areas of the state. Our state organization is divided into eleven districts. We host several educational events every year, including our annual Spring Conference which is hosted on a rotating basis throughout our various districts.

We also co-sponsor the annual "Health Office Orientation" every summer with MODHSS and MARE. Please explore our website and see how we work to support our students' academic success!

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to provide leadership and promote professional growth to advance the practice of school nursing. The Missouri Association of School Nurses is an affiliate of the National Association of School Nurses. We have over 400 active members from all areas of the state. Our state organization is divided into eleven districts.

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Home - National Association of School Nurses

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All schools should be prepared to effectively manage students with food allergies.

Keeping Students Safe and Included

Food Allergies: Keeping Students Safe and Included is an online training course designed to help school staff and administrators become better prepared to manage students with food allergies and respond to food allergy emergencies. Take this course to learn more about managing food allergies in schools and how to best protect and keep students included.

Course Objectives

Improve understanding of food allergies and allergic reactions.

Identify ways that schools can create a safer and more inclusive environment for students with food allergies.

Learn how school staff can enact a food allergy management plan or policy.

The information presented in this coursealigns with the recommended plans, practices, and procedures found in the Centers for Disease Control and Prevention (CDC)'s Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs.

Take the Course

This course is now available through the Food Allergy Academy, FARE's new learning management system. Click below for the registration page for the Food Allergy Academy platform, and then once you have registered you can search for the training course or content you are looking for.

Please note: If you were referred here from AllergyReady.com, you cannot use your old login credentials on FARE's learning system. You will need to register as a new user.

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All schools should be prepared to effectively manage students with food allergies. Food Allergies: Keeping Students Safe and Included is an online training course designed to help school staff and administrators become better prepared to manage students with food allergies and respond to food allergy emergencies.

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Search

Search the database for the Phe content of foods, including all foods in the Low-Protein Food List for PKU and National PKU News' Baby Food list.

Find Related Values

Get Phe, Exchanges, Protein and Calories for the foods you find.

Calculate

Enter your own quantities in weight, phe, protein, or exchanges, and convert to get the related values.

Track

Track your goals, phe/protein/exchange intake, blood levels, and more. Easily export records for yourself or your clinic.

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Search the database for the Phe content of foods, including all foods in the Low-Protein Food List for PKU and National PKU News' Baby Food list. Get Phe, Exchanges, Protein and Calories for the foods you find. Enter your own quantities in weight, phe, protein, or exchanges, and convert to get the related values.

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Some of the procedures developed for the School Nurse Procedure website were funded in part by the Healthier Wisconsin Partnership Program, a component of the Advancing a Healthier Wisconsin endowment at the Medical College of Wisconsin.

The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same. The information is not intended to substitute for, supplement or replace clinical judgment. If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual's healthcare provider. The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.

Success! You're on the list.

© 2022 School Health Associates, LLC

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Some of the procedures developed for the School Nurse Procedure website were funded in part by the Healthier Wisconsin Partnership Program, a component of the Advancing a Healthier Wisconsin endowment at the Medical College of Wisconsin. The information and materials presented in this Website are intended for informational purposes only and are not designed to...

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Milk Substitutions for Children with Medical or Special Dietary Needs - SP-02-2016

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Welcome to dese.mo.gov. We hope you enjoy the site, and we welcome your feedback.

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When I was in grade school (150 years ago) there was this friend of mine...a foreign exchange student...who could fold both of his legs behind his head in a very "impressive" nature. I remember how "freaky" he looked all folded up like that. There he was standing at 4 ½ feet and could twist himself down to about 2 ¼

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Go See The Nurse - It'd be Worse without the School Nurse!

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When I was in grade school (150 years ago) there was this friend of mine...a foreign exchange student...who could fold both of his legs behind his head in a very "impressive" nature. I remember how "freaky" he looked all folded up like that.

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Years ago I was a phlebotomist. Yep. I was in nursing school back in 1994 and picked up a job at the local hospital for $4.50 per hour. I was green, as green as they come…my son would refer to me a “noob” if phlebotomist were video gamers. My job was to gather urines from the floors (having been collected by the night shift nurse) and draw the morning labs from the patients on the floors. There I was, feeling all “medical” in my scrubs, lab coat, little white cart with all my sharps, and Vacutainers (and my hidden stash of butterfly needles), running all about the hospital gathering bodily fluids from hospitalized strangers for four-and-a-half bucks an hour. I was on top of the world!

Before I left the lab on my morning runs, I would call the nursery to ask the nurses if they would wrap one of the little feet of the newborns on my roster to have blood drawn for phenylketonuria (PKU) by using the Guthrie Test. I had no idea what it was called at the time. The nurses would wet a diaper with warm water and wrap up one of the baby’s feet and they would let the child sleep until my arrival…they were sleeping when I showed up, but screaming bloody murder when I left. We were to take our “sheep’s foot*” lancet device, apply it to the warmed heal of the baby, “trigger” the device to make a little, very shallow “slice” in the heel of the baby’s foot, gather the blood from the heel using a glass pipette, and apply the blood from the pipette to one of a few circles on the “card” that we brought with us from the laboratory. This was my last stop of the morning.

Before I became a nurse, I had no idea what test I was collecting that blood for. All I knew was how to collect it, how to apply it to the circles on the card, and where deliver the sample when I was done. Now, as a nurse, I know exactly what they were screening for: a congenital birth abnormality in which toxic levels of the amino acid phenylalanine builds up in the blood: phenylketonuria (PKU).

Phenylketonuria (PKU) is a rare metabolic disorder that could lead to developmental delays and mental and emotional issues…serious issues. In the USA, there are about 16,500 people living with PKU and approximately 350 babies are born with it each year. And, with the 4 million babies born in the USA each year, the chances of your having a child with PKU in your school is rare.

But, what does this have to do with us school nurses?

By the time the child comes into your care, they will have been screened and diagnosed with PKU…more than likely. And, more than likely, we’ll know what we are dealing with. But what do we school nurses need to do?

Seizures!

The mechanisms by which Phe affects the brain are poorly understood.  It is known that anywhere from 25% to 50% of patients with PKU experience generalized or partial seizures. So, following the PKU diet is very, very important. How do we school nurse know that the PKU diet is not being followed? It’s not outside the realm of possibility that children with PKU will be any different than children with Diabetes Type 1? I am not saying that children with PKU aren’t going to follow the prescribed diet all the time; I am saying that they may take a liberty now and then (cupcakes and cookies have flour protein and eggs as a binder…just sayin’). And, depending on the age / maturity of the child, they may end up making choices they had believed were good choices.

The child with PKU may not be feeling well. They may seem more hyperactive than normal and present to your office with a “musty or mousy odor (due to phenylacetic acid in the sweat).” They may also show other symptoms such as a rash that appears to be Eczematous. There are other symptoms of PKU that will have presented themselves initially upon the child entering into their school-aged years due to not following the PKU diet. These findings are:

Neurological problems

Fair skin and blue eyes, because phenylalanine can’t transform into melanin — the pigment responsible for hair and skin tone

Abnormally small head (microcephaly)

Intellectual disability

Delayed development

Behavioral, emotional and social problems

Psychiatric disorders
https://www.mayoclinic.org/diseases-conditions/phenylketonuria/symptoms-causes/syc-20376302

Definitions

Phenylketonuria (PKU) is a rare genetic condition that causes an amino acid called phenylalanine to build up in the body.

Phenylalanine is an amino acid, a “building block” of protein.

There are three forms (some sources say two) of phenylalanine: L-phenylalanine and D-phenylalanine and also DL-phenylalanine (synthetic phenylalanine). It is said that the role of D-phenylalanine, a form synthesized in a laboratory, is not fully understood, and it is not an essential amino acid.

Major dietary sources of L-phenylalanine (one of three forms of phenylalanine) include meat, fish, eggs, cheese, and milk…all the good stuff! NOTE: Phenylalanine is found in all proteins and some artificial sweeteners. THIS IS A BIG FYI!

Tyrosine is used by the body to make a bunch of cool hormones and even melanin.

How does phenylketonuria (PKU) affect the child?

When the child (when we humans) eat meat, fish, eggs, cheese, and milk, we get our essential amino acids (some or all) including the L-form of phenylalanine. This helps the child (us humans) build our own proteins. We have a gene that provides the blueprint…instructions…for making an enzyme in our body called phenylalanine hydroxylase. Phenylalanine hydroxylase is the enzyme that our body uses to breakdown and convert phenylalanine into tyrosine.

Then, in turn, the body uses tyrosine to make several important substances like dopamine, adrenaline, thyroid hormones, and melanin, to name a few. Additionally, tyrosine has a stimulating effect and can be broken down by the body to boost energy.

PKU affects the child’s dietary potential…in a big way.

A target range for blood phenylalanine levels needs to be between 120-360µmol/l (that’s about 13.8156mg/L to 41.4468mg/L. What does that mean? In order to attempt to maintain this range, the diet needs to be limited to about 200-500mg of phenylalanine per day. Still, what does this mean?? To limit the diet to 200-500mg of phenylalanine per day would be to limit the body to about 4-10 grams of protein per day. I eat 3-4 grams each meal (not including snacking as I am cooking). If you think avoiding meat, fish, eggs, cheese, and milk will keep things completely safe, consider the tomato.

There is 0.03g of phenylalanine in 1 medium whole tomato. If a child eats a tomato (0.9g of protein…yes…protein in a tomato), they have consumed 30mg of phenylalanine of their 200-500mg daily limit. That’s not a lot, per se’, but it does add up.

Imagine having to modify the child’s diet to where they are getting sufficient nutrition and yet limiting protein…and growing children need protein.

The parent will be your go-to source for information. Trust me on this. You may have been introduced to PKU in nursing school, or you may have cared for a patient with PKU. But, by the time this child is under your care at your school, the parents will have been dealing with this condition for the past 5-18 years; they KNOW PKU intimately and especially how their child responds to this condition. They should be given an honorary PhD in PKU by the time the child is school-aged.

Medications

KUVAN® (sapropterin dihydrochloride) will probably be prescribed for the child. And, it is less than likely that you (the school nurse) will be giving the child this medication. The parents will most likely be giving this medication to the child each day. Kuvan ain’t cheap. No siree! Kuvan costs about $57,000 a year on average. In a smaller, younger kinder, maybe less; in a larger senior, maybe more. Can you imagine having to maintain a drug that costs more than 4.5x the average home mortgage payment in the USA?
If you have a child that is on Kuvan, watch for signs of hyperactivity, including fidgeting, moving around, or talking too much. Let the parents know if you see any of these symptoms. Also, watch for symptoms of inflammation of the lining of the stomach (gastritis) such as those frequent stomach aches (and other obvious symptoms such as reports of bloody, sticky stool or even vomiting blood)

They may be taking a dietary supplement called PKU Formula or Formula For Life. A low-protein diet alone is not a fix-all solution. We humans NEED our essential amino acids. And with that, you can see the dilemma these children and their parents are facing.
Sugar-free is good, RIGHT?

Absolutely not. The artificial sweetener called aspartame may release phenylalanine when consumed and will raise the blood level of phenylalanine in the child’s blood. Aspartame is made from two amino acids: phenylalanine and aspartic acid.

As the school nurse, I will list “sugar-free products” as an allergy to alert the faculty at my school with that allowing the child to come into contact with “sugar-free” foods is a no-no. This is a paradoxical paradigm (fancy words). Most folks are “programmed” to think sugar-free is good. But, is it?

Consider a Diet Coke. A can of Diet Coke contains 184mg aspartame (APM), which turns out to be over 100mg of phenylalanine. Remember the 200-500mg dietary limits these children have to follow. (A boiled egg has about 630mg of phenylalanine).

Finally

Though PKU cannot be prevented (it’s a genetic condition), the outlook is very good. As long as the PKU diet plan is followed very closely since birth (and at school), the child can perform very well in school and live a long and prosperous life.

Other Resources

https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=160&contentid=58

https://www.webmd.com/vitamins/ai/ingredientmono-653/phenylalanine

https://www.winchesterhospital.org/health-library/article?id=21664

https://www.pku.com/about-pku/phe-in-the-brain
https://www.babycenter.com/0_surprising-facts-about-birth-in-the-united-states_1372273.bc

https://embryo.asu.edu/pages/guthrie-test-early-diagnosis-phenylketonuria

https://kidshealth.org/en/parents/phenylketonuria.html

http://www.nspku.org/information/whatispku

https://www.mun.ca/biology/scarr/PKU_diagnosis_&_treatment.html

https://www.mayoclinic.org/diseases-conditions/phenylketonuria/symptoms-causes/syc-20376302

*Sheep’s Foot Lancet Device: Isn’t it funny how we nick-name stuff? The Tenderfoot heel incision device is what we used, but for some reason the lady who introduced me to the device and trained me on how to use it called it a “sheep’s foot.” Not sure why. But, what’d I know? I just went with it and have been calling it that for the past 25 years. Here’s a video on what we did (video from the manufacturer):

With envelope pilgrims hat isolated with the cartoon vector illustration

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Phenylketonuria (PKU) – The School Nurse Guide – Go See The Nurse

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Years ago I was a phlebotomist. Yep. I was in nursing school back in 1994 and picked up a job at the local hospital for $4.50 per hour. I was green, as green as they come…my son would refer to me a “noob” if phlebotomist were video gamers. My job was to gather urines from the floors (having been col…

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How Much Did You Eat?

CONCEPT: Calculating Phe

BRIEF SUMMARY

Read a story about the importance of weighing and measuring foods to know how much phe we are eating. Practice the skills with a hands-on activity and a worksheet.

OBJECTIVES

After completing this activity, children will be able to:

choose the correct tool for measuring it

use the measuring tool correctly

obtain the correct measurement

METHODS

Read the story How Much Did You Eat? together.

Lead a discussion , with questions such as:

Why is it important to weigh and measure the foods we eat? ( to be able to know/calculate the amount of phe we eat)

How do you weigh foods?

How do you measure foods?

What tools do you use to weigh and measure foods? (show them the scale, measuring cups, and measuring spoons; demonstrate how to use them)

Why is it important to measure foods accurately?

Practice Measuring
With the measuring tools and foods provided, help the children to practice their measuring technique.

Give them prompts, such as:
"I would like a 1/2 cup of dry cereal." or
"I would like a 1/4 cup of corn." or
"I would like 60 gm of cereal."

Activity Sheets
While some children are practicing their measuring technique, others can be working on the activity sheets. They rotate through the measuring station as the other children finish. Make sure all children are able to practice measuring.

When everyone is finished with the activity sheet, review the answers together.

MATERIALS

HOME ACTIVITIES

Involve your child in simple recipe preparation and measuring of food at home.

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university of washington seattle pku clinic phenylketonuria phenylalanine pediatric inherited inborn metabolic disorders management curriculum primary school

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PKU Clinic - University of Washington, Seattle

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BRIEF SUMMARY Read a story about the importance of weighing and measuring foods to know how much phe we are eating. Practice the skills with a hands-on activity and a worksheet. OBJECTIVES After completing this activity, children will be able to: choose the correct tool for measuring it use the measuring tool correctly obtain the correct measurement METHODS Read the story How Much Did You Eat?

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Urgent Care & Walk-In Clinic | Oakville, MO | Total Access Urgent Care

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Total Access Urgent Care in Oakville, MO: Our urgent care clinic in Oakville provides cost-effective, immediate health services for local patients.

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In an effort to care for our patients' urgent orthopedic injuries and needs, Mercy Clinic Orthopedics is providing same-day appointments for specific injuries. Please call our office to make an in-person or virtual visit appointment during our normal hours of operation. To ensure the safety of our patients, providers and coworkers, we aren't currently offering walk-in visits.

The specific injuries we will be able to see are:

Acute injuries from slips or falls

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Fractures

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For any other orthopedic injuries not on this list, please contact your doctor.

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Sunset Hills, MO | Mercy Clinic Orthopedics - Sunset Hills | Mercy

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In an effort to care for our patients' urgent orthopedic injuries and needs, Mercy Clinic Orthopedics is providing same-day appointments for specific injuries. Please call our office to make an in-person or virtual visit appointment during our normal hours of operation. To ensure the safety of our patients, providers and coworkers, we aren't currently offering walk-in visits.

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Orthopedic Injury Clinic 12-6

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Get instant access to Sports Medicine Specialists at the Washington University and Barnes-Jewish Orthopedic Center in Chesterfield.

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To help people pay past-due rent and utilities, St. Louis City has received $7.5 million in federalWELCOME TO THE START HERE ST. LOUIS AREA RESOURCE DIRECTORY. This website provides general information, street addresses, phone numbers and websites for dozens of agencies, shelters, employment resources, food pantries and other organizations throughout the St.