Children in Wichita public schools can't take a pain reliever, suck on a cough drop or put on sunscreen without a doctor's written permission.
It's part of a long-held policy intended to protect students' health and safety and guard the district from liability.
But a group pushing to change the rule says the policy is outdated and unrealistic and that it particularly hurts children from poor and working-class families.
"All children... should have the right to reasonable treatment and compassionate care during the school day," said Diane Wahto, a member of the Peace and Social Justice Center of South Central Kansas, which is leading an effort to revise the medication policy.
"We are asking for a more lenient policy that allows parents to consent to their child's treatment with over-the-counter medications."
Superintendent John Allison said he planned to talk to school nurses and others about the policy and bring the issue to school board members in coming months.
The district's policy requires a doctor's written consent and specific instructions before a school nurse or other staff member can administer any medication — prescription or over-the-counter.
That's more restrictive than state law, which requires a doctor's note only for prescription medications. And it means you can't send your child to school with a bottle of Motrin and a note saying, "She just had her braces tightened. Please give one dose after lunch."
Though the policy doesn't name specific types of over-the-counter medication, health officials say the category includes common pain relievers and cold medicines as well as cough drops, antacids, antibiotic ointments and sunscreen.
One reason, officials say, is that even simple medications come with risks. Giving a child acetaminophen for a headache or Neosporin for a playground scrape may sound easy, said Kathy Hubka, Wichita's director of health services. But there can be "significant complications," including allergic reactions and potential overdosing.
"What if a student gets Tylenol in the morning and comes to school, and we're not aware that he received Tylenol?" Hubka said. "How much would it take for him to have a negative consequence because of that medication?"
But Hubka cites another, more philosophical reason for retaining the current policy.
"We are a society that is very quick to say, "You have a headache? Take a pill. You have a stomachache? You don't feel good? Here, take some of this,' " she said.
"We need to ask why the child has a headache: Did he not get enough sleep? Has he eaten breakfast? Did he eat dinner? Is he stressed about something? Did he fall at home and hit his head?
"We want to make sure that we're giving medication for the right reasons." A doctor's note ensures that someone with medical expertise has made that decision, she said.
Some local doctors say the requirement does little but add to their mountain of paperwork.
"Over the years I cannot ever remember declining a request for over-the-counter medication to be administered by school personnel," said Philip Cherven, director of pediatric education and associate director of the Via Christi Family Practice Residency Program.
"It would benefit everyone if USD 259 followed state policy and required physician signatures for prescription medications only."
Another doctor, Jose Sanchez, wrote in a letter to the Wichita school board that the current policy "seems to be a loss of common sense."
"Through the years, I have had to fill out thousands of forms for children to be allowed to be given over-the-counter medications," Sanchez wrote. "I feel this policy is very restrictive, and I hope that this will change."
Other districts' policy
Several Kansas school districts allow students to take some over-the-counter medications with a parent's consent.
In Augusta, a district of about 2,300 students just east of Wichita, parents complete a medical information form during enrollment that notes their doctor's information along with chronic conditions, allergies or medical concerns.
The form includes an option to authorize several common over-the-counter medications, with a waiver certifying that the child "has received the above medications before with no adverse effects." The parent also agrees not to hold the district responsible for possible adverse reactions.
"It works fabulous. I think the parents really appreciate the fact that we have that available," said Monica Guilliams, a nurse at Ewalt and Lincoln elementaries in Augusta.
Each school keeps a supply of over-the-counter medicines and ointments to administer when needed. Families are charged a $1-per-student fee at enrollment to pay for the medications.
"Sometimes kids just have a small headache or a small toothache, and it's not something you want them to miss school for," Guilliams said.
Requiring a doctor's note for over-the-counter medication — or asking parents to drive to school to administer the medication themselves —"seems a little unrealistic," she added.
"I have a child, and I'm not going to take my child to the doctor and pay a $20 co-pay because they have a headache.... With the way people are having issues with jobs and the economy right now, I don't think it's fair to ask a parent to take an hour off work and come down and check out their child when they're fine."
Help for families
Among those who support changing Wichita's policy is a former school nurse who said she was reprimanded several times for administering over-the-counter medications to students at a predominantly low-income elementary school. The registered nurse, who left the district after more than 15 years and now works at a local clinic, asked that her name not be used to protect her current job.
"It's not fair to children in poverty, children who don't have doctors," the nurse said. "It's unfair that these kids are made to suffer unnecessarily."
She said children would often come to her office complaining of simple aches, pains or sore throats. She remembers one boy with "a hole in his molar the size of a small pea" who was awaiting a dentist appointment but did not have pain medication.
"His mother didn't have a car, and asked if I could give him something. These are the kinds of things you come up against," the nurse said.
Hubka, the district's health director, said the doctor's-note requirement may ensure that children in poverty get medical care. If a parent requests over-the-counter medicine for a child who does not have a regular doctor, school nurses or social workers help connect the family to safety-net clinics such as GraceMed and Hunter Health Clinic.
"All children deserve to have a medical home," Hubka said. "Here in Wichita we have a wealth of resources, and school nurses are in a prime position to put families in touch with those resources."
The former nurse agrees with that concept "in theory," she said. But she remembers spending hours one school day trying to find a doctor who would see a child with asthma who was covered under Medicaid.
"It's continuity of care that I was looking for," she said. "Because his condition was chronic, I wanted to find someone who could really follow him and see if he's improving.... But doctors who normally take those kids on are already overloaded."
Cindy Galemore, director of health services for the Olathe school district in suburban Kansas City, said it's important for schools to consider "the whole picture and all its ramifications" when developing or revising medication policies.
Groups such as the National Association of School Nurses and the American Academy of Pediatrics have said requiring a doctor's permission for all medicines is ideal. "But sometimes the reality of the world is different than 'best practice,' " Galemore said.
In Olathe, middle and high school students can carry and administer their own over-the-counter medicines with some stipulations. The medication must be in its original container, for instance, and a student can't give medication to another student. Health rooms also stock bottles of ibuprofen and acetaminophen that students can buy for 25 cents a dose.
In elementary schools, nurses can administer pain relievers with a parent's consent, and only after contacting the parent.
"The reality is that not every child has a physician, a medical home, particularly in challenging economic times," Galemore said. "You balance 'What are the hazards? What are the risks?' with 'Where's our society at in all this?' So it's a very complicated issue."