What is a Concussion?

 According to the Centers for Disease Control and Prevention (CDC), a concussion is a type of traumatic brain injury caused by a bump, blow or jolt to the head, or a hit to the body that causes the brain to move or shift in the skull and causes a functional disturbance and chemical changes to brain cells. Concussions typically result in the rapid onset of signs and symptoms, although in some cases symptoms may evolve over minutes to hours.

 Potential Concussion Signs and Symptoms:

• Headache or feeling "pressure in the head"
• Difficulty remembering events just before or after a hit or fall
• Appearing dazed or stunned
• Forgetting an instruction or confusion about an assignment
• Moving clumsily or answering questions slowly
• Concentration or memory problems
• Just not "feeling right" or "feeling down"
• Showing mood, behavior, or personality changes
• Feeling sluggish or foggy
• Nausea or vomiting
• Balance problems or dizziness
• Double or blurry vision
• Bothered by light or noise
• Losing consciousness (even briefly)

Communicating with School After a Concussion:

It is important to notify your child's school nurse following a head injury/concussion diagnosis. Full recovery from a concussion may take several days to several weeks or even months. There are physical and emotional symptoms that may continue during a recovery.

Returning to School:

• Carlisle Public School requires that a student returning to school, post-concussion, submit a re-entry plan from a healthcare provider. You can download the Heads Up: Acute Concussion Evaluation (ACE) Care Plan to give to your healthcare provider.
• CDC Heads Up information

Diabetes Care at School

Carlisle Public School is committed to supporting students with Diabetes so they can safely participate in school, learn, and take part in activities alongside their peers.

Diabetes care at school is individualized. Each student's care is based on their healthcare provider's orders and the student's individual school health plans. The school nurse works with the student, family, healthcare provider, and appropriate school staff to develop a plan that supports the student's health, safety, independence, and participation in school.

This guide provides general information for families. It does not replace a student's healthcare provider orders, Diabetes Medical Management Plan (DMMP), Diabetes Emergency Action Plan (DEAP), Individual Health Care Plan (IHCP), 504, or other applicable educational or medical plan. The student's individualized plans and current healthcare provider orders determine the specific care provided at school.

Getting Started: What Families Need to Know

Families of students with diabetes should contact the school nurse before the school year begins whenever possible, and whenever a student is newly diagnosed or their diabetes management changes.

Working together before the school year begins allows the school team to understand the student's needs and make sure appropriate plans, medications, supplies, and staff support are in place.

The school nurse will work with the family to review:

• The student's Diabetes Medical Management Plan (DMMP)
• The Individual Health Care Plan (IHCP)/Diabetes Emergency Action Plan (DEAP)
• 504 Plan
• Medication and treatment orders
• Blood glucose and/or continuous glucose monitor (CGM) needs
• Insulin administration and/or self-administration
• Meals, snacks, and carbohydrate-counting needs
• Physical education, recess, and sports
• Field trips and special activities
• Before- and after-school activities
• Transportation needs
• Emergency supplies and glucagon, when prescribed
• Appropriate staff training and communication

The school nurse will provide training to all school personnel working with students with diabetes on an annual basis. Education will include an overview of diabetes, signs and symptoms of hypoglycemia & hyperglycemia, emergency procedures and the student’s individualized plan. 

Massachusetts guidance recommends that the school nurse develop the student's IHCP in collaboration with the student, family, healthcare provider, and appropriate school staff. The IHCP may incorporate information from the DMMP, DEAP, 504 and other applicable plans.

What Does My Child Need for School?

Families are responsible for providing the medical information, medications, and supplies necessary to safely manage their child's diabetes at school.

The exact supplies will vary depending on the student's individual treatment plan.

Medical Documentation

Please provide:

• Current Diabetes Medical Management Plan (DMMP)/healthcare provider orders
• Current emergency contact information
• Healthcare provider/endocrinology contact information
• Information regarding the student's ability to self-manage diabetes
• Any applicable 504 Plan or IEP information

 

Diabetes Supplies

As appropriate for your child's individual plan:

• Blood glucose meter
• Test strips
• Lancets
• Batteries/charging equipment
• CGM supplies
• Insulin
• Insulin pen/syringe supplies
• Insulin pump supplies
• Ketone testing supplies
• Fast-acting carbs
• Snacks
• Glucagon/Baqsimi emergency medication
• Other supplies identified by the healthcare provider

Families should check expiration dates regularly and replenish supplies as needed. Please notify the school nurse whenever there is a significant change in your child's diabetes management or health status.

Massachusetts guidance recommends that families provide the equipment and supplies necessary to implement the student's diabetes management plan, including monitoring supplies, insulin supplies, ketone-testing supplies, snacks, fast-acting glucose, and glucagon when prescribed.

What Happens During the School Day?

Your child's individual health plan will determine how diabetes care is provided during the school day. Depending on the student's age, development, experience, and healthcare provider orders, a student may:

• Visit the Health Office for diabetes care.
• Care may be conducted in the classroom or alternative location (i.e. cafeteria, playground, etc.).
• Monitor blood glucose or CGM readings independently.
• Carry supplies.
• Treat low blood glucose independently.
• Administer insulin independently when authorized.
• Receive assistance or supervision from the school nurse or trained school personnel.
• Have access to supplies and fast-acting glucose as identified in their plan.

The goal is to support students in developing independence while ensuring appropriate adult support is available when needed. Students have access to necessary diabetes supplies and treatment during the school day, including during activities outside the classroom, as provided for in their individual plan.

Meals, Snacks, and Carbohydrate Counting

Students with diabetes need consistent access to meals and snacks according to their individual Diabetes Management Plan.

Families should communicate with the school nurse about:

• Regular meals and snacks
• Carbohydrate counting
• Additional snacks
• Changes to the student's usual eating schedule
• Classroom celebrations or special events
• Foods brought from home
• Dietary changes recommended by the healthcare provider

If carbohydrate information is needed for meals or snacks, families should provide the information requested by the school nurse or student's individual plan. If the student will be consuming food provided by Carlisle Public School, carbohydrate count will be provided to the family and the school nurse. 

Students should have access to food and necessary Diabetes treatment any time and at any location where the child is according to their individual health plan.

Low Blood Sugar (Hypoglycemia)

Low blood sugar can occur when there is too much insulin compared with the amount of glucose available in the body. Hypoglycemia is the greatest immediate danger to the student with diabetes. During hypoglycemic incidents, the student may not be able to self-manage due to impaired cognitive and motor function. A student experiencing hypoglycemia should never be sent anywhere alone, left alone, or escorted by another student. Hypoglycemia requires immediate treatment and communication systems are in place to assist the student. 

Possible signs include:

• Shakiness
• Sweating
• Hunger
• Pale appearance
• Weakness or tiredness
• Dizziness
• Headache
• Irritability or mood changes
• Difficulty concentrating
• Confusion
• Changes in behavior

What will the school do?

School staff will follow the student's DMMP, 504, DEAP, and IHCP.

Treatment may include providing fast-acting glucose or another treatment specifically identified in the student's plan.

If a student is unable to safely swallow, loses consciousness, has a seizure, or experiences another severe emergency, staff will follow the student's emergency plan and activate emergency medical services as appropriate.

Important: Food or drink should never be given by mouth to a student who is unconscious or unable to swallow safely.

High Blood Sugar (Hyperglycemia)

High blood sugar may occur for a variety of reasons, including illness, stress, food intake, or insufficient insulin.

Possible signs include:

• Increased thirst
• Frequent urination
• Fatigue
• Headache
• Difficulty concentrating
• Blurred vision
• Nausea or stomach discomfort

Students with high blood glucose will be managed according to their individual healthcare provider orders and DMMP/DEAP/IHCP/504.

Physical Education, Recess, and Sports

Students with diabetes should be able to participate in physical education, recess, sports, and other activities unless their healthcare provider has specifically identified a restriction.

Diabetes management may require additional planning before, during, or after physical activity.

The student's individual plan may identify:

• Blood glucose/CGM monitoring
• Additional snacks or fast-acting glucose
• Access to diabetes supplies
• Additional supervision or support
• Emergency contact information
• Other precautions recommended by the healthcare provider

Appropriate staff should know how to recognize and respond to symptoms of low blood glucose.

Field Trips and Special Activities

Diabetes care continues when students leave the classroom.

This may include:

• Field trips
• Assemblies
• School celebrations
• Sports
• Clubs
• Dances and special events
• School sponsored before & after school programs
• Other school-sponsored activities

Families should notify the school nurse in advance whenever a student will participate in an activity that may require additional diabetes planning.

The school team will determine what diabetes care, supplies, medications, emergency information, and trained personnel are needed based on the student's individual plan.

Students with diabetes should be supported in participating in school activities with their peers.

Riding the Bus

Parents are encouraged to inform the bus company/speak to your child’s bus driver if your child will be riding the school bus. If your child requires special diabetes-related considerations while riding the school bus, please discuss this with the school nurse. The school nurse and family may need to develop emergency medical information and procedures for transportation personnel. 

The school nurse may delay departure from school and request parent pick up if the student is not stable to leave on the bus. Parents will be notified immediately should this be the case. 

Lockdown, Evacuation, and Emergency Preparedness

Students with diabetes should have an emergency kit readily accessible at all times, including during classroom activities, recess, physical education, field trips, lockdowns, evacuations, and other emergency situations. The kit should travel with the student and include supplies identified in the student's individual diabetes care plan, including fast-acting carbohydrates for treatment of low blood glucose and, when prescribed, glucagon/baqsimi and other emergency diabetes supplies. Students may carry this on his/her person and students who are able to independently manage their diabetes should be responsible for carrying these supplies. 

Families are responsible for keeping the kit adequately supplied and replacing expired or used items. The school nurse will work with families to determine the appropriate contents and ensure the kit is incorporated into the student's individualized diabetes care plan. 

Supporting Student Independence

Carlisle Public Schools supports students as they develop independence in managing their diabetes.

The level of independence is individualized and may change as the student grows and develops.

Depending on the student's abilities and individual plan, independence may include:

• Recognizing symptoms of low or high blood glucose
• Monitoring blood glucose or CGM
• Carrying diabetes supplies
• Carrying fast-acting glucose
• Counting carbohydrates
• Administering insulin
• Managing an insulin pump or other diabetes technology
• Recognizing when assistance is needed
• Communicating with adults when they do not feel well

Independence does not mean that a student must manage diabetes alone. The goal is to provide the appropriate balance of independence, supervision, and support.

Communication Is Key

Successful diabetes management at school is a partnership: Student + Family + School Nurse + Healthcare Provider + School Staff.

Open communication helps ensure that your child's diabetes care remains current and that the school team is prepared to support your child throughout the school day and during school-sponsored activities.

Please contact your child's Carlisle Public Schools School Nurse/Health Office whenever you have questions or concerns about diabetes care at school.

Massachusetts Diabetes Resources

Breakthrough T1D: Education & Support

The Massachusetts Guide for Managing Diabetes in Schools
Massachusetts Department of Elementary and Secondary Education and Massachusetts Department of Public Health

View the Massachusetts Guide for Managing Diabetes in Schools

 

Life-Threatening Allergies

Carlisle Public Schools (CPS) recognizes the increasing prevalence and potentially life-threatening nature of allergies among children and adolescents. Allergic reactions can range from mild, localized symptoms to severe, potentially life-threatening anaphylaxis. CPS’s coordinated approach to supporting the health and safety of students with life-threatening allergies aims to reduce the risk of allergen exposure, educate members of the school community about life-threatening allergies, prepare staff to recognize and respond to allergic reactions, and develop individualized plans to address the health, safety, and inclusion needs of affected students. CPS also recognizes that students’ needs change as they grow and develop. Allergy management procedures will be age-appropriate and will support students in assuming increasing responsibility for their health and safety, as developmentally appropriate.

Understanding Allergic Reactions and Anaphylaxis

Allergic reactions vary from person to person and can range from mild local reactions to severe, potentially life-threatening anaphylaxis.

Anaphylaxis is a serious systemic allergic reaction that can affect multiple body systems. The most dangerous symptoms may include difficulty breathing, swelling of the airway, and a significant drop in blood pressure that can lead to shock or loss of consciousness. Anaphylaxis may occur following exposure to an allergen even when a student has previously been exposed to that allergen without experiencing a reaction. Reactions may occur immediately or may develop over a period of time following exposure.

Common causes of anaphylaxis in children include:

• Food: peanuts, tree nuts, milk/dairy, eggs, soy, wheat, fish, and shellfish
• Insect stings: bees, wasps, hornets, and yellow jackets
• Medications
• Latex
• Other allergens identified by the student's healthcare provider

Exposure to an allergen may occur in a variety of ways. For example, a student with a food allergy may experience a reaction after ingesting the food, touching an allergen and then touching their mouth or eyes, or, in highly sensitive individuals, potentially through inhalation of allergen particles. When a serious allergic reaction or anaphylaxis is suspected, prompt action is essential.

Emergency response will follow the student's healthcare provider's orders and individualized plan. When indicated, epinephrine should be administered promptly. Epinephrine is the first line treatment of anaphylaxis.

Emergency procedures may include:

1. Recognize signs and symptoms of a serious allergic reaction.
2. Administer epinephrine according to the student's medical order. 
3. Call 911 as indicated if epinephrine has been administered.
4. Notify the school nurse and appropriate school personnel.
5. Remain with and monitor the student.
6. Notify the student's parent/guardian.
7. Document the incident and complete appropriate follow-up.

Staff should not delay emergency treatment while waiting for symptoms to become more severe when anaphylaxis is suspected.

Individualized Allergy Management

For a student with a life-threatening allergy, the school nurse, in collaboration with the student's parent/guardian, healthcare provider, school physician, principal, and/or other appropriate school personnel, will address the student's health and safety needs at school. Plans should be reviewed at the start of each school year and as needed and when there is a significant change in the student's allergy, medical orders, treatment plan, or school needs.

Allergy Awareness and Risk Reduction

CPS recognizes that it is not possible to guarantee an allergen-free environment. The goal is to create an Allergy Aware school community in which students, staff, and families understand that individuals within the school community may have life-threatening allergies. All members of the school community are encouraged to take reasonable steps to reduce the risk of accidental exposure.

CPS will:

• Provide staff education regarding recognition of allergic reactions and anaphylaxis and appropriate emergency response.
  • The school nurse, in accordance with DPH guidelines, will serve as a primary resource for staff regarding the management of students with life-threatening allergies.
• Educate appropriate staff about individual students with life-threatening allergies and their emergency plans.
• Encourage appropriate handwashing, particularly before and after eating.
• Encourage students not to share or trade food, drinks, utensils, or food containers.
• Consider allergy-related needs when planning classroom activities, celebrations, field trips, transportation, and school-sponsored events.
• Encourage the use of non-food items for classroom celebrations, activities, and fundraising whenever possible.
• Work with families and staff to identify reasonable strategies for reducing exposure to known allergens.
• With the exception of medical conditions requiring access to food, i.e. Diabetes, and in consultation with the school nurse, eating is not permitted on the school bus. 

Parents/guardians are encouraged to communicate with the school nurse regarding their child's specific allergies and to provide updated medical information and emergency medication as required.

Cafeteria and Food Services

CPS recognizes that students may choose to purchase meals or snacks through the school food service program. Families of students with food allergies should review available menu choices with their child and determine which foods are appropriate based on the child's individual allergies and healthcare provider recommendations. Because ingredients and food preparation practices may vary, families who have questions about potential allergens in a menu item should contact the Director of Food Services directly for guidance. 

While the kitchen itself is peanut/nut free, the cafeteria is not. Students are permitted to bring such foods as peanuts/nuts in their lunch from home. Parents may request that their child sit at an Allergy Aware table in the cafeteria during their scheduled lunch period. These tables are peanut/nut free, but students may have other items, such as dairy products. 

Field Trips, Transportation, and School-Sponsored Activities

Allergy management plans should be considered whenever a student participates in activities outside the regular classroom or school setting. This includes access to emergency medication, staff education related to allergen prevention and emergency plan, reasonable accommodations and how to address additional health and safety needs for the duration of the field trip, after school activity or other school sponsored activity. 

School Nurse Responsibilities

The school nurse will coordinate the school-based management of students with life-threatening allergies and will:

• Maintain current allergy and emergency health information.
• Review healthcare provider orders and allergy action plans.
• Develop or update individualized health and emergency plans as appropriate.
• Coordinate communication with parents/guardians and appropriate school personnel.
• Provide or coordinate staff education regarding allergy awareness and emergency response.
• Establish procedures for the storage, accessibility, and monitoring of emergency medication.
• Provide guidance regarding reasonable accommodations and risk-reduction strategies.
• Respond to and document allergic reactions and emergencies.
• Review allergy management procedures with the student's educational team as appropriate.

Family and Student Responsibilities

Families and students play an important role in managing life-threatening allergies and promoting safety at school. Parents/guardians should inform the school nurse of any known or newly diagnosed allergies, provide current healthcare provider documentation, allergy/emergency action plans, and prescribed medications, and notify the school of any changes to the student's allergy or treatment plan. Parents should notify their bus driver of any allergies or medical considerations at the start of each school year.

Parents/guardians should work with their child, as developmentally appropriate, to understand their specific allergen(s), identify foods or situations to avoid, recognize symptoms of an allergic reaction, and develop self-advocacy and self-management skills. Students should be encouraged to take increasing responsibility for their health and safety based on their age, developmental level, maturity, and healthcare provider recommendations.

Food of any kind should not be shared or traded at school or on the school bus. Students with food allergies should be encouraged to avoid accepting food from others, ask questions about unfamiliar foods, recognize and immediately report symptoms or possible allergen exposure to a trusted adult, and participate in managing their allergy as appropriate for their age and abilities.

Families are encouraged to partner with CPS to identify reasonable accommodations and strategies that support the student's safety, independence, inclusion, and participation in the school environment.

Collaboration and Communication

Effective allergy management requires collaboration among students, families, the school nurse, healthcare providers, and appropriate school staff. CPS will work with students and families to promote safety, inclusion, and increasing student independence while providing appropriate accommodations and support. Allergy-related information will be shared with staff who need to know to safely support the student, while maintaining confidentiality. CPS will also consider the social and emotional needs of students with life-threatening allergies and strive to support their full participation in the school community.

 

What Are Head Lice?

Head lice (Pediculosis capitis) are a common condition caused by tiny parasitic insects that live on the scalp and feed on small amounts of blood. Although they can be bothersome, head lice are not known to spread disease and do not cause serious or long-term health problems.

What Do Head Lice Look Like?

• Adult lice are small, grayish insects about the size of a sesame seed (2–3 mm). They move quickly through the hair and can be difficult to see.
• Nits (eggs) are tiny white or tan oval eggs firmly attached to the hair shaft close to the scalp. Unlike dandruff, nits cannot be brushed or shaken off.

Signs and Symptoms

The most common symptoms include:

• Itching of the scalp
• Frequent scratching
• A tickling sensation of something moving in the hair
• Small red bumps or irritation on the scalp
• Nits or live lice, especially behind the ears and at the nape of the neck

Itching occurs because of a reaction to the saliva lice inject while feeding.

How Do Head Lice Spread?

Head lice spread primarily through direct head-to-head contact with someone who has live lice. Less commonly, they can spread by sharing personal items such as:

• Hats
• Hair brushes or combs
• Hair accessories
• Helmets
• Pillows or bedding

Head lice cannot jump or fly—they crawl.

Anyone can get head lice regardless of age, cleanliness, or hair-washing habits.

A female louse can lay up to 8 eggs each day, and eggs typically hatch within 7–10 days. Away from the human scalp, lice usually survive for only 24–48 hours.

School Attendance and Treatment

If You Find Live Lice at Home

If your child has live lice:

• Notify the Carlisle Public School nurse.
• Contact your child's healthcare provider or pharmacist for treatment recommendations.
• Begin treatment as soon as possible and follow the product directions carefully.

If Lice Are Found at School

If live lice are identified during the school day:

• A parent or guardian will be notified.
• Prompt treatment is encouraged. Families may be asked to pick up their child for treatment.

Students may return to school after appropriate treatment has been completed. The school nurse is happy to recheck your child after treatment and provide additional education or support as needed.

Carlisle Public School follows recommendations from the American Academy of Pediatrics (AAP) and the National Association of School Nurses (NASN), which no longer support "no-nit" policies.

Research has shown that:

• Nits found more than ¼ inch from the scalp are unlikely to hatch or may already be empty egg casings.
• Nits are firmly attached to hair shafts and are unlikely to spread to others.
• Excluding students from school because of nits alone results in unnecessary missed instructional time and places an unnecessary burden on families.

For these reasons, students are not excluded from school solely because nits are present.

When Should I Contact My Child's Healthcare Provider?

Contact your child's healthcare provider if:

• You need guidance on choosing a treatment.
• Your child develops sores, a rash, or signs of skin infection.
• Itching continues after treatment.
• Live lice return despite following treatment instructions.
• You have any additional questions or concerns.

Helping Prevent the Spread of Head Lice

Families can help reduce the spread of lice by encouraging children to:

• Avoid head-to-head contact during play and group activities.
• Avoid sharing hats, helmets, hair accessories, brushes, or combs.
• Perform regular head checks if a household member has lice.
• Complete treatment exactly as directed if lice are found.

Treatment Locations

Lice Centers of New England

Lice Aunties

Lice Clinics of America

Resources

Head Lice: What Parents Need to Know

Head Lice Management in Schools (NASN)

This information is intended to educate families and support prompt, effective treatment while minimizing unnecessary absences from school.