Skin Care World

The views expressed below are those of the author, and are not necessarily those of Mölnlycke Health Care.

Perhaps the biggest wrench for the parent or carer of a child with eczema is passing on the care of that child to the ‘big school’. It is something that we all have to endure and this is an attempt to make that transition from home or nursery to school as easy as possible. Due to the very nature of the condition eczema can vary in its severity from a small patch of dry skin to extreme cases that require regular hospital admissions. You are about to pass on the care of your child to a teacher who will have experienced eczema but may not have experienced the level of the condition that your child has.

The only way to build an understanding of this is by talking to the class teacher and the head teacher. You have cared for your child on a one-to-one basis, and the class teacher cannot possibly be expected to maintain that level of care. However, they can be instrumental in making sure that you maintain your child’s skin in the best condition possible and ensure that their skin does not deteriorate unnecessarily.

A STEP-BY-STEP APPROACH

Approach your child’s new class teacher and ask for a meeting/interview/coffee and a chat – depending on the type of person they are. Try to fit in as best you can with their busy schedule – most teachers like to see parents immediately after school, or when (and if) they have a free lesson. You may need to take time off work, but this appointment is as important as any doctor, dentist or hospital appointment you may ever have – it is about your child’s well being as they start school.Make sure that they are aware that you will need about 20 minutes of their time (or longer if necessary) and then right from the start they know there is a lot to cover.

PREPARE FOR THE MEETING

Your class teacher’s experience of eczema may range from an acquaintance’s baby having a bit of eczema, and therefore wondering why you need to speak to them, through to having already dealt with a child with severe eczema.

Your list should include:

• Your child’s normal routine – emphasise how much time you spend at home treating your child as this will give the teacher a perspective on how much time your child ‘loses’ in a day
• Sleeping habits – a child who is up once in the night will be tired in school the following day; a child who has woken every half-hour scratching will be exhausted and may need to come in to school late some days in order to ‘catch up’. This will certainly need consideration when it comes to taking part in tasks, tests or assessments at school
• Medications – it is helpful to take samples in of all the medication that your child is currently using as well as any medications they may need that you have on repeat prescriptions (for example, antibiotic creams for infected eczema). Explain to the teacher how and when they are used and, if your child is wet-wrapped, explain to the teacher what this involves
• Medical history – explain to the teacher when and how (if you know!) the eczema developed, and how often they have visited and need to visit the GP, practice nurse, health visitor, consultant or have been admitted to the dermatology ward. Many teachers (myself included when I was teaching) are unaware that children with eczema are often regular hospital admissions
• Activities – highlight activities that may lead to exacerbations: painting, clay, washing their hands with soap and drying with paper towels, getting too hot doing PE, getting too cold outside, sitting in a sunny window, sitting on the carpet for story time and circle time, sitting on a plastic chair for long periods, cooking with foods that your child is allergic to, tasting foods as part of the National Curriculum, and helping with the school pets

Make friends with the teacher during your meeting. You will probably need to make regular contact with them during the time your child is in their class, so it is important to build a mutually understanding relationship.

Make sure that the time you have picked is appropriate and they have plenty of time for you to explain – this is important and you must not be made to feel rushed.

PARENT/TEACHER INFORMATION

Carefully go through the salient points, at the same time emphasising that there are strategies we can use to overcome most of the difficulties.

The main aim is to make sure that your child is not made to feel different from the other children by ‘missing out’, at the same time ensuring that their eczema is not exacerbated by misunderstandings. Make sure that the teacher points out to the class that eczema is not contagious, and discusses some of the problems the child with eczema may encounter from other pupils. It is crucial that the class understands that a person with eczema is an ordinary person, just like everyone else and that people’s reactions can be a bigger nuisance than the eczema itself.

It is natural for you to worry but essential that your child is unaware of your fears. It will be impossible for your child to receive the one-to-one attention that you have given them until now but, by working as a team with the teacher and classroom assistants, together you should be able to make your child’s time in school a happy time.

EXAMINATIONS AND ASSESSMENTS

As your child progresses, pre-empt possible problems with tests, examinations and assessments. Explain that eczema can be aggravated by stress. Establish what special dispensations may be available to children with medical conditions, for example:

• Up to 25% extra time for pupils with writing difficulties (if they have hand eczema)
• Permission to record answers on a tape;
• Provision of an amanuensis;
• Rearrangement of dates and times;
• Relocation to a hospital ward; or
• A doctor’s note submitted to the exam board if the eczema flares up suddenly and unexpectedly and affects the child’s exam, either through pain or a lack of sleep

In all these cases, application must be made to the appropriate examination boards via the school.

APPROPRIATE SUPPORT

Most children can cope well in mainstream school by paying special attention to their physical comfort and well-being. A child is only regarded as having ‘medical needs’ if their condition limits their access to education. Most children with eczema should not reach this stage. In these cases the Health and Local Education Authorities should work together to ensure that the pupil has effective support.

However, please note that there is no legal or contractual duty on staff to administer medication. There may be a member of the support staff who has specific duties to provide medical assistance as part of their contract, and in some cases the NHS Trust may provide specialist support.

Whatever arrangements you may come to, it is of the utmost importance that the child is considered at all times. The object of the exercise should be to ensure that the child is cared for and happy so that they progress to the best of their ability in the education system.

PRACTICAL GUIDES FOR POSITIVE ACTION

• Pump action dispensers for emollients are easier, more hygienic and less ‘messy’ for use in a classroom
• Seek out small sizes of soap substitutes and emollients for your child to have in their bag
• Teach your child the basics:
• Putting the cream on in the direction of the hair growth
• Clean hands are essential to put cream on
• The difference between steroid and emollient – for example, the emollient can be applied as often as you want to and the steroid is restricted. Colour-code their tubes if necessary – green for go (emollient), amber for think about it (steroid)
• Keep cool, avoiding radiators and sunny windows
• Sit on a chair rather than the carpet
• Wear loose cotton clothes where possible
• Put a cotton cloth or towel over plastic chairs before sitting
• Have a small cotton towel (named) in school with a loop on to hang it up (possibly with their PE bag which is usually in a cloakroom near the washbasins)
• Use non-irritant gloves to protect hands during Art, Pottery, and Food Technology
• Allow the child to watch, rather than handle chemicals, in Science
• Excuse from ‘washing up’ in Technology subjects
• Be aware of the problems caused by temperature changes in PE lessons and allow either long-sleeved kit or being excused in extremes of temperature. Allow plenty of time for the pupil to use emollients after and during showers (if appropriate)
• Arrange for your child to have the occasional ‘lie-in’ after particularly disturbed nights, allowing them to arrive at break having previously telephoned to inform school of their late arrival