Parenting Children with PI

11 Common School Issues

Download and Print 11 Common School Issues Related to PI

Issue #1: Lack of knowledge and understanding about PI

School staff and community may lack awareness of primary immunodeficiency diseases.

Recommended Parent and Teacher Response:

Learn about PI and share as much as possible with school personnel.
Discuss school-related issues with a nurse at the student’s immunologist’s office.

Issue #2: Handling school absences

Children may miss school due to illness and IgG infusions.

Recommended Parent and Teacher Response:

Develop a plan up front so that the student, parents, and teachers understand what is expected.
Take homework home for the child and, if necessary, locate a tutor.
If the student is in a children’s hospital, they may have a teacher on staff.

Issue #3: Change in child’s medical condition

It’s important to maintain ongoing communication, since children’s symptoms and treatment for their primary immunodeficiency disease may change over time.

Recommended Parent and Teacher Response:

Parents and teachers should meet at least annually to document immunization status, current treatment, emergency contacts, and activity limitations.

Issue #4: Misunderstanding and fear that PI is HIV

Educating the school community about primary immunodeficiency can prevent misconceptions, including the fear that the disease may be contagious.

Recommended Parent and Teacher Response:

The child and parents will need to decide if they would like to disclose the illness.
They should also be allowed to decide if they’d like to participate in teaching others about PI.

Issue #5: Preventing infection

Because children with PI have weakened immune systems, they are likely to acquire infections when exposed to sick children.

Recommended Parent and Teacher Response:

Insure that all children wash their hands after using the restroom, sneezing, or coughing.
Encourage parents to keep sick children home.
Inform parents of children with PI when infectious diseases are prevalent in the class.
Ask the parents of the child with PI if there are other precautions the class should observe.

Issue #6: Side effects that may impact academics

Immunoglobulin (IgG) infusions have side effects (headache, chills, rigors, hives, nausea, vomiting, myalgia)¹ that may impact the child’s energy level, concentration, comfort, and academic performance. These side effects may last 2-3 days after infusion. Medication may be needed to alleviate them.

Recommended Parent and Teacher Response:

Notify the student’s parents and school nurse of any side effects or changes in the child’s behavior. Be aware of any medications the child needs to take at school.

Issue #7: Immunizations

People with PI should not receive live vaccines such as MMR, oral polio, rotavirus, and varicella (chicken pox) because of the risk of contracting the disease.² Antibodies in IgG products may interfere with patient responses to live vaccine, such as those for measles, mumps, rubella, oral polio, rotavirus and varicella.^2,3

Recommended Parent and Teacher Response:

The child’s physician can provide documentation if vaccinations must be restricted.
Parents will need to update school records to reflect changes in immunization status.

Issue #8: Handling medication use in school

Children with primary immunodeficiency disease may need medication or treatments, such as an inhaler or nebulizer, during the school day.

Recommended Parent and Teacher Response:

Become familiar with the child’s medication(s), dosage and administration requirements.
Provide a private place to administer medications to avoid embarrassment at being singled out.

Issue #9: Classroom accommodations

Children may require modifications to the classroom environment and/or extra time for tutoring and missed schoolwork.

Recommended Parent and Teacher Response:

Talk with the child and parents about options for missed schoolwork.
Follow your school procedures for identifying children with learning problems.

Issue #10: Preventing emergency situations

This is the most common issue school officials face related to children with chronic illness.

Recommended Parent and Teacher Response:

Make sure you have an emergency plan in place for the student.
Notify parents if the child is exposed to contagious diseases or experiences symptoms, such as high fever or difficulty breathing.

Issue #11: Supporting good social relationships and self-esteem

Your student with PI may be rejected by peers or develop low self-esteem.

Recommended Parent and Teacher Response:

Support the child by not tolerating teasing by other students.
Provide necessary accommodations, but emphasize similarities between children.
Be respectful of your student's right to privacy about his/her condition.

Baxter would like to thank Rainbow Babies and Children’s Hospital for sharing this list of 11 Common School Issues, originally published as part of their School Outreach Program for Primary Immune Deficiency, with generous grant support from Caremark, Coram Healthcare, and Schubert Center for Child Development.

Reprinted with permission of Kimberly Duff, RN, BSN, Baxter Senior Clinical Consultant, and Tonya Palermo, PhD.

Blaese RM, ed. IDF Guide for Nurses on Immune Globulin Therapy for Primary Immunodeficiency Diseases. 2nd ed. Towson, MD: Immune Deficiency Foundation; 2007:16.
National Institutes of Child Health and Human Development. National Institutes of Health. When the Body’s Defenses are Missing: Primary Immunodeficiency. NIH Pub No. 99-4149: p17.
GAMMAGARD LIQUID [Immune Globulin Intravenous (Human)] 10% [package insert]. Westlake Village, CA. Baxter International Inc.; December 2010.

GAMMAGARD LIQUID [Immune Globulin Infusion (Human)] 10%

Indications

GAMMAGARD LIQUID is used to treat patients with primary immunodeficiency diseases (PI). There are many forms of PI. The most common types of PI result in an inability to make a very important type of protein called antibodies, which help the body fight off infections from bacteria or viruses. GAMMAGARD LIQUID is made from human plasma that is donated by healthy people. GAMMAGARD LIQUID contains antibodies collected from these healthy people that replace the missing antibodies in PI patients.

Detailed Important Risk Information for Patients

Tell your healthcare provider about any side effect that bothers you or that does not go away.

GAMMAGARD LIQUID can cause the following serious reactions:

Severe allergic reactions causing difficulty in breathing or skin rashes
Decreased kidney function or kidney failure
Blood clots in the heart, brain, lungs or elsewhere in the body
Severe headache, drowsiness, fever, painful eye movements, or nausea and vomiting
Dark colored urine, swelling, fatigue, or difficulty breathing

Tell your healthcare provider if you have a history of poor kidney function or kidney failure. If so, GAMMAGARD LIQUID should be administered at the slowest intravenous infusion rate as determined by your healthcare provider.

Contact your healthcare provider or call emergency services immediately if you have reduced urination, sudden weight gain, or swelling in your legs. These could be signs of a kidney problem.

Do not use GAMMAGARD LIQUID if you have a known history of a severe allergic reaction to immune globulin or other blood products. If you have such a history, discuss this with your healthcare provider to determine if GAMMAGARD LIQUID can be given to you. Tell your healthcare provider if you have a condition called selective (or severe) immunoglobulin A (IgA) deficiency.

If any of the following problems occur after starting treatment with GAMMAGARD LIQUID, stop the infusion immediately and contact your healthcare provider or call emergency services. These could be signs of a serious problem.

Hives, swelling in the mouth or throat, itching, trouble breathing, wheezing, fainting or dizziness. These could be signs of a serious allergic reaction.
Bad headache with nausea, vomiting, stiff neck, fever, and sensitivity to light. These could be signs of irritation of the lining around your brain.
Reduced urination, sudden weight gain, or swelling in your legs. These could be signs of a kidney problem.
Pain, swelling, warmth, redness, or a lump in your legs or arms. These could be signs of a blood clot.
Brown or red urine, fast heart rate, yellow skin or eyes. These could be signs of a liver problem or a blood problem.
Chest pain or trouble breathing, blue lips or extremities. These could be signs of a serious heart or lung problem.
Fever over 100°F. This could be a sign of an infection.

These are not all of the possible side effects with GAMMAGARD LIQUID. You can ask your healthcare provider for physician’s information leaflet.

GAMMAGARD LIQUID is made from human plasma. It may carry a risk of transmitting viruses.

The following one or more possible reactions may occur at the site of infusion. These generally go away within a few hours, and are less likely after the first few infusions.

Mild or moderate pain
Swelling
Itching

Redness
Bruising
Warmth

During the infusion of GAMMAGARD LIQUID, look out for the first signs of the following common side effects:

Headache
Migraine
Fever
Fatigue
Itching
Rash/Hives
Cough

Chills/Shaking chills
Dizziness
Nausea/Vomiting
Faster Heart Rate
Upper Abdominal Pain
Increased Blood Pressure

Whenever giving yourself treatments at home, you should have another responsible person present to help treat side effects or get help should a serious adverse reaction occur. Ask your healthcare provider whether you should have rescue medications, such as antihistamines or epinephrine.

Please see the Full Prescribing Information for GAMMAGARD LIQUID [Immune Globulin Infusion (Human)] 10% for full prescribing details.