FEATURE: DIABETES IN CHILDREN

Back to School? Don’t Forget about Mental Health

Written by Allison Dunne BPharm MSc MA. IUHPE accredited health promotion practitioner

At this time of year you may see several articles about how you, as a pharmacy team, can help families preparing to go “back to school”. Common topics include the use of vitamin supplements, prevention of head lice and preparation for in the inevitable cold and flu symptoms. Indeed, these are all important factors for physical health. But what about mental health and wellbeing? This article will consider the mental health impact of the return to school and how pharmacy teams can support families during this exciting, but often challenging, time of year. When we think about mental health we should consider both the positive and negative aspects. Positive mental health, sometimes called mental wellbeing, includes factors such as happiness, life satisfaction and quality of life. Positive mental health can be protective against some mental health conditions and is important for child development (Department of Children and Youth Affairs, 2014). Young children who have positive relationships with their parents, and teenagers who have supportive peer groups, tend to experience good mental wellbeing (Nolan & Smyth, 2021). The quality of relationships with teachers has also been shown to be important for good mental health, especially among adolescents (Nolan & Smyth, 2021). Mental health conditions such as depression and anxiety affect a significant number of children. A recent report notes that 16% of 13 year olds in Ireland are at risk from depression (Department of Children, Equality, Disability, Integration and Youth, 2021) while over 11,700 young people accessed HSE Child and Adolescent Mental Health Services in 2021 (Pollak, 2022). Parents who are concerned that their child has a mental health condition should speak to the pharmacist about whether referral to the GP is appropriate. Going back to school can trigger feelings of worry and anxiety in some children. In the pharmacy you may meet several parents of children who are concerned about their children experiencing stress during this period. Understanding the causes of common worries can help you to support parents and children during this time. Some of the more common concerns are discussed here.

Exam Stress

Worries about exams and school performance are normal (Duvall & Roddy, 2021). While a small amount of stress around exams is common, if the levels of stress are affecting sleep and daily tasks it is time to encourage parents to take action. Schools can offer support to students who are worried about exams. If additional help is needed the GP is the first port of call for children who are experiencing high levels of anxiety. In a small number of cases children can be diagnosed with anxiety disorders requiring medical intervention or counselling.

Bullying

The Irish government framework for the health of children and young people is called Better Outcomes, Brighter Futures (Department of Children and Youth Affairs, 2014). The framework identifies bullying as a common concern for school children. The most recent progress report, using data from 2018 noted that 31% of 11-17 year olds have been bullied in school, with 13% stating that they have acted as a bully (Department of Children, Equality, Disability, Integration and Youth, 2022). Worries about bullying may lead to increased stress in the lead up to return to school. Parents can support their children with regular conversations about school worries and encourage reporting of bullying to the school. Each school should have an anti-bullying policy. Parents can access these (often available online) and should speak to school staff about any concerns.

Sleep

Reduced sleep has been linked to poor concentration and learning during school hours (Hayes & Bainton, 2020). Over the summer holiday it is normal for sleep patterns to be different to during the school term. Bedtimes may be later with the long summer evenings, and a morning lie-in may become a regular occurrence. As the end of the school holiday approaches, bedtimes can be gradually adjusted to match the school routine. Pharmacy staff can remind parents of the importance of good sleep hygiene in the preparation for the return to school. This will make the first few days of term easier to cope with and start the school year with good sleep habits. Primary school children should sleep for between 9 and 12 hours per night, with teenagers aiming for between 8 to 10 hours (Great Ormond Street Hospital, 2020). Some sleep hygiene tips from Great Ormond Street children’s hospital are; • Reduce caffeine intake; watch out for caffeine in fizzy drinks as well as tea and coffee. • Timing of meals; a large meal just before bedtime can disturb sleep. Aim for the main meal to be earlier in the day and give a small snack or warm drink before bedtime.

• Physical activity; sports or a walk in the fresh air during the daytime can help with sleep at night. Avoid vigorous activity just before bedtime. • Technology; bright lights from mobile phones, televisions or other electronic devices can keep the brain alert. Keep the hours before bedtime device-free. Try a book or relaxing music at bedtime instead of an electronic device.

• Routine; going to bed and waking at the same time every day (even at weekends) can help with good sleep (Great Ormond

Street Hospital, 2020).

Social media

While social media can be a good way for young people to keep in touch with friends, parents may find that children are spending long periods of time online during the holidays. As a return to school date gets closer, the pharmacy team can remind parents to try to gradually reduce screen time to make the transition back to school easier. Late night screen time should be minimised to support good sleep.

Support groups for children and parents

The pharmacy team have an important role in understanding the role of health services and support groups, to enable staff to direct parents and young people to access these services. The HSE provides an up-to-date list of supports for school aged children at https://www2.hse.ie/wellbeing/mentalhealth/supports-for-young-people.html Some of the supports are listed here: Childline provides free listening services to children and young people up to the age of 18. The Childline helpline is open 24 hours every day and can be accessed by Online chat at www.childline.ie, Freephone 1800 666 666 or by texting the word “Talk” to 50101

Jigsaw is a national centre for youth mental health. They use early intervention to support the mental health of young people aged 12 to 25 years of age. Jigsaw has 13 centres across Ireland. They offer a place that young people can visit for free with confidential support from trained mental health professionals. They can also be accessed online at www.jigsaw.ie BeLonG To youth services is the national organisation supporting lesbian, gay, bisexual, transgender, and intersex (LGBTI+) young people between 14 and 23 years in Ireland. Services include support groups for young people and parents. The services are confidential, free-of-charge and welcoming to all young people. www.belongto.org In summary, the end of the summer holidays can bring mixed emotions for children and their parents. The pharmacy team are ideally placed to support families during this period and to signpost to local services where appropriate.

Action points for continuing professional development

After reading this article you could: • Discover more about local and national supports for young people and parents.

Find out where your nearest branch of

Jigsaw is. • Think about your local schools. Is there an anti-bullying policy on the school website? Does the school offer a wellbeing programme? • Read more about child mental health and wellbeing using the references below.

References

Department of Children, Equality, Disability, Integration and Youth (2022). An indicator set for Brighter Outcomes, Better Futures. 2021 update. Department of Children, Equality, Disability, Integration and Youth (2021). Growing Up in Ireland. Social-Emotional and Behavioural Outcomes in Early Adolescence. Department of Children and Youth Affairs (2014). Better Outcomes, Brighter Futures. Duvall, A., & Roddy, C. (2021). Managing anxiety in school settings : creating a survival toolkit for students. London ;: Routledge, Taylor & Francis Group. Great Ormond Street Hospital. (2020). Sleep hygiene in children and young people: information for families. Retrieved on 18th May 2022 from https://media.gosh.nhs.uk/ documents/Sleep_hygiene_F1851_FINAL_ Jun20.pdf Hayes, B., & Bainton, J. (2020). The impact of reduced sleep on school related outcomes for typically developing children aged 11–19: A systematic review. School psychology international, 41(6), 569-594. doi:10.1177/0143034320961130 Nolan, A., & Smyth, E. (2021). Risk and protective factors for mental health and wellbeing in childhood and adolescence. Economic and Social Research Institute. Research series number 120. Pollak, S. (2022). More than 11,700 children and teenagers accessed mental health services last year. Retrieved on 19th May 2022 from https:// www.irishtimes.com/news/health/more-than11-700-children-and-teenagers-accessed-mentalhealth-services-last-year-1.4779390.

Back to School Checklist for Children with Asthma

Asthma is the most common chronic condition among children, affecting one in 10 children and adolescents under 18. Children with the condition miss on average five days of school each year, making it one of the leading causes of absenteeism.

There is a dramatic rise in the number of children admitted to hospital for their asthma in September each year known as the “September spike”. Triggers which are commonly found in schools include:

• Chemical fumes

• Perfumes

• Aerosols

• Chalk dust

In addition, changes in weather, an increase in fungal spores, moulds and in an increase in circulating viruses such as RSV all contribute to an increase in asthma symptoms at this time of year.

Advice for parents:

This checklist should help you control your child’s asthma during September and into the winter months.

• Have your child’s asthma reviewed by your GP in

August/September • Ensure your child has an Asthma

Action Plan and it is up to date • Use the inhaler technique videos on asthma.ie to help your child take their inhaler properly • Make sure your child carries their reliever inhaler (usually blue) at all times • Check that they take their medication every day with a fridge planner • Leave a spare reliever inhaler and spacer in the school, with their name clearly labelled

Written by Ruth Morrow, Respiratory Nurse Specialist, Asthma Society of Ireland

• If your child is participating in

PE or other activities, place a reliever inhaler and spacer in their bag • Never send a sick child to school

• Show them how to wash their hands correctly and explain why this is important • An older child/teenager often require extra supervision and cannot be relied on to selfmedicate independently - put systems in place as they may avoid taking their medication • Visit the school and make sure your child’s teacher is aware that they have asthma • Explain what their triggers are and what to do if your child has an asthma attack

• Check if there is a School

Asthma Policy in place • If your child is starting a new school, speak to teachers about your child’s asthma, even if they are well right now

Asthma Policy for Schools

The Asthma Society of Ireland recommends that all schools have an Asthma Policy in place that is reviewed regularly. As part of their Asthma Policy, it is also recommends that schools create an asthma record sheet for all students with asthma. The Asthma Society is warning teachers to be vigilant for asthma triggers at this dangerous time of year and to talk to parents to ensure you are aware of any students with asthma in your class.

Students with Asthma – advice for teachers

When a student with asthma joins your class, there are a number of steps can be taken to ensure they are supported as much as possible which include:

• Familiarise yourself with the school’s Asthma Policy • Always ensure that students with asthma have access to their reliever inhaler including during school trips, sports and

PE. Relievers should never be locked away. • Tell parents when their child has an attack or needs their reliever inhaler in school and encourage older students to tell you or another staff member if they use their reliever.

• Speak to parents about concerns over missed days, tiredness in class due to night-time symptoms or lack of concentration due to asthma.

Students with severe or poorly controlled asthma may require extra support due to missed school days. • Monitor students with asthma to ensure they don’t feel excluded or experience bullying. • Provide opportunities for all students to learn about asthma in class.

• Think about requesting resources from the Asthma

Society of Ireland to ensure the school is well informed about asthma and how to manage the condition.

Once you know what triggers the child’s asthma, you can take practical steps to reduce their impact. • Damp dust chalkboard and classrooms regularly to get rid of dust mites and pollen • Don’t keep furry or feathery pets in the classroom. • Try to avoid fumes in science and art classes.

• Rigorously enforce a non-smoking policy on school grounds. • Make sure the school is cleaned regularly. • Heating and ventilation systems should be well maintained.

• Air classrooms to avoid mould and condensation.

• Avoid plants that give off high amounts of pollen • Use non-latex gloves. • Make sure that play areas and sports fields are free of autumn leaves as they are full of mould and fungal spores. • Avoid mowing sports fields or grassy areas during school hours.

• Make sure changing rooms and bathrooms are well ventilated.

• Avoid opening windows and allow students with pollen allergies to stay indoors when pollen is high, such as during and after thunderstorms.

P.E. and Sports

Exercise improves lung function and is an important part of a healthy lifestyle. Asthma symptoms shouldn’t stop children from taking part in sport and PE, provided that certain precautions are taken.

Asthma Safe Schools in 2021

This programme is run by the Asthma Society of Ireland. 32 schools in total were funded to take part in the Asthma Safe Schools Pre Hospital Care Council (PHECC), approved, and certified training in basic life support and the administration of Salbutamol for emergency treatment of adults and children (< 16 years) with an acute asthma attack. Schools were selected on a first come, first serve basis and each school nominated one teacher/SNA to attend the training day. The training was provided by the Irish Ambulance Training Institute. It involved an Asthma Safe School Webinar, Asthma Safe Schools Training Day and an Asthma safe school Pack. A survey carried out by the Asthma Society on the Asthma Safe Schools Programme 2021 showed that:

• 55.5% of teachers who participated in the programme identified themselves of having gained considerable asthma management knowledge.

• 89% of participating teachers believe that they have been provided with the training and tools to provide a supportive and safe environment to children with asthma.

• 78% of teachers gave a star rating of 4 or more when asked how confident that they would be in the management of another person who is having an acute asthma attack in the out-of-hospital environment until handover to an appropriate person.

• When asked if the Asthma

Safe School’s Programme has increased teachers overall

knowledge of asthma, 45% agreed and a further 46% strongly agreed. • 90% of teachers said that they would recommend this programme to others and it was found that both the webinar and the training day were found to be the most beneficial aspects of the program. • 100% of respondents said that they would use the Asthma

Adviceline (1800 44 54 64) and the WhatsApp Messaging

Service (086 0591032) if they had any asthma related queries. This article has addressed managing asthma in schools at a time of year when asthma can be increasingly problematic. Strategies for children, parents and teachers were discussed.

Pharmacists and technicians can send a message to the WhatsApp service on 086 0590132 if they have questions/queries about asthma/COPD and an asthma nurse will respond.

Back2School Headlice

Getting Ahead of Lice

While several health concerns come to the forefront as students head back to their classrooms, head lice seems to top the list at most pharmacies.

Head lice are tan to grayishwhite, 6-legged, wingless insects typically measuring 2 mm to 3 mm in length, or about the size of a sesame seed. Because lice crawl and do not jump, head-to-head contact is the primary route of transmission. Once on the scalp, lice attach eggs to the base of hair shafts a few millimeters from the scalp surface. Once laid, eggs hatch within 9 to 12 days, and the resulting nymph matures into an adult louse over the subsequent 9 to 12 days, for a full reproductive cycle of approximately 3 weeks’ duration. Typical signs of head lice are usually itchiness on the scalp, around the ears and the back of the neck. However, some people may experience no symptoms at all. Because lice eggs are located on hair shafts approximately 4 mm from the scalp, it is often easier to identify eggs by searching at the back of the hairline, where they are most visible. Research suggests that wetting hair before combing improves diagnostic reliability. There are several methods that can be recommended for managing a head lice infestation. Pharmacy teams should help customers choose the most appropriate product for their child because not all treatments will be suitable for everyone. Understanding a person’s preference, medical and drug history, the product’s active ingredient, how the active ingredient works, how the product should be used and if anything has been tried previously will allow pharmacists and pharmacy staff to recommend and help parents choose the right head lice product. Mechanical removal involves systematically combing the whole head of wet hair with a detection comb to remove the lice. The comb must be cleaned after each pass through the hair to remove lice and eggs, which is best done by wiping it on clean white paper or cloth.

The process must be repeated every few days for two weeks. Products containing dimeticone or isopropyl myristate kill the lice through physical action. Dimeticone coats the surfaces of head lice and suffocates them, while isopropyl myristate dehydrates head lice by dissolving their external wax coating. The advantages of these products are that they are easy to apply, they have few side-effects, are odourless or have only a faint perfume, and the head lice are unlikely to become resistant to them.

Instructions must be followed exactly otherwise the treatment won’t work. Some of these products don’t kill louse eggs either, so it is vital that the treatment is repeated after a week to kill any lice that have hatched since the first application. Many parents are looking for allnatural remedies, so it would be wise for pharmacies to stock up on both traditional and alternative choices. It’s also important to alert parents to this topic, as they need to be inspecting their children for ticks and lice and so whilst stocking up on head lice products, education shouldn’t be missed.

Make sure head lice products are prominently displayed, along with educational brochures. Remind parents that their children should not share hats and also point out places where lice can be contracted.

Pharmacy Role in Sexuality Education

Tips from Relationship & Sexuality Educators, to Pharmacists

Written by John Halloran and Shauna Monaghan, Education Facilitators, Sexual Health West

We get asked a lot of questions in our line of work, and often we have to pause for thought. Dealing with young people, they can often blindside you with a question. So, take a breath and remember at the root of every question is an unknown. Here are 5 qualities we try to lean into in our workshops.

1. Time

Although hard to come by when working in a pharmacy, it is important that the time you can give is dedicated to this person.

In this case quality of the time, matters just as much as quantity.

This person may be in an anxious state asking about STI’s, because they feel they are at risk and a pharmacist is easier to access than their family GP.

(If is a more serious issue- i.e. sexual violence, then each pharmacy should have a protocol to follow in contacting the Gardaí and the SATU).

2. Patience

Routine questions are only routine to the professionals.

A young person may not understand what questions they are being asked- what to ask the pharmacist- or how to ease their own concerns or anxieties.

Honour their enquiry and understand that the question may be rooted in a concern much deeper.

3. Support

Listen and try to understand the root of their concerns. Their knowledge of sex and sexual acts may be limited, and sometimes, they might have the complete wrong information.

Myths, gossip and tall tales from school can always influence people’s thoughts, and mixed with the shame and stigma that can be held around sex in Ireland, it can lead them to believe they have done something wrong.

As long as it was freely consenting sex, by in large, there should be no guilt associated with it.

4. Guidance

Part of your role is to give options, give appropriate information and allow them to make an educated decision.

Through patience, time and support you can explain how sexual health checks are carried out, what happens next, what if they are positive? / How do they access treatment?

In this moment, try and place yourself in their shoes, think about the myths and untruths you held as fact when you were young. Understand this young person needs; clear language, a supportive yet not dismissive attitude, a realistic approach (yes, some STI’s are lifelong, yes some require treatment, yes you might have to have difficult conversations), they need you to speak in a way they can understand.

As medical professionals, often the comfort zone of patient interactions can be to drift into the medicine and the science of things, but, in this instance, if you can remove those blocks and speak person to person your interaction will be helpful, impactful and affirming for the person seeking care

5. Openness

How are we asking questions?

So! We’ve given them time, we’ve possibly had a private area to speak, we are in a situation where we are actively listening and using empathy to guide us.

However, we need to ask a question and we are unsure how to do so.

As a health professional, you probably handle this in a day-to-day setting.

How can we get the information we need, without offending the person?

Asking, plainly, in a respectful tone and supporting your statement with qualifying information can help this person get the correct treatment/ support they need.

This is important when it comes to things like, a person’s gender identity and expression, and who they are sexually active with.