Eczema and school
Off to school
NES Nurse Adviser Julie Van Onselen has some top tips to help everything go smoothly for primary-aged children. This article was published in Exchange 180, June 2021.
Preparation and forward planning are essential before your child starts school. Eczema is a common condition, so staff at your child’s school will have some awareness of it. However, even if they’ve come across another child with eczema, their experience may differ from your child’s individual eczema needs, as eczema is not a one-size-fits-all condition.
In the term before your child starts school (or if their eczema has changed during lockdown), make sure you contact the school and ask for a specific meeting, before settling-in and early school days, so the class teacher is prepared.
A face-to-face meeting may not be possible but ask for a virtual meeting or phone call with the child’s teacher. This is important so you can work on a plan together. As a parent, you need to build an understanding between you and the school staff and provide individual information about your child and their eczema. This may be pulled together into an individual healthcare plan.
If your child is starting school for the first time, this will be a huge milestone for them – and for you. It may be the first time you have entrusted your child’s skin care to someone else, so you need to feel confident that your child’s school team really understand what triggers their eczema, what this can mean for your child, and what to do about it.
Prepare for independence
As your child develops, they will learn to meet their own personal care needs at school – including for their eczema. Each child is different and needs to take this at their own pace. Even some older children may need more help at school, especially after the disruptions to schooling during Covid-19.
Before your child starts school, try and help them understand their eczema and start to get involved in managing their skin. The sooner they start this learning and self-management, the better equipped they will be to cope at school without you.
At home, include moisturising as a daily life skill alongside brushing their teeth and hair. If they are still at nursery, ask staff if they can help them learn to moisturise their skin, as this will help them prepare for school. Reward charts or verbal praise will help encourage your child to take control of a daily emollient routine. Once they can do it for themselves, it will be very empowering and increase their confidence.
Help your child understand what can make their eczema worse and their personal triggers – not least, as they may need to remind adults at school. If your child has allergies, especially ones that may cause anaphylaxis (for example, nuts or latex), it’s very important that you teach them what to avoid and this will be central in their individual healthcare plan for all the school staff.
Troubleshoot the triggers
PROBLEM: Synthetic fibres and wool can irritate and cause itching. If you have a choice, buy 100% cotton uniform.
SOLUTION: If synthetic uniform is regulation, your child can wear thin cotton layers under the uniform or ask if they can wear a similar cotton uniform with school logos sewn on. Consider buying larger sizes, as loose clothing is more comfortable.
Getting too hot
PROBLEM: Classrooms are often overheated. Children can also get too hot at playtime when they are running around.
SOLUTION: Talk to the teacher about how your child can access a cool place in the classroom, near a window rather than a radiator. Explain that your child may need to cool down and apply emollient in a private area.
Games and PE
PROBLEM: Overheating during sporting activity (including swimming) causes sweating, which can start itching and scratching. Dust can be a problem, too, when the child’s skin is exposed. In the winter, moving from the outside into central heating can also be a trigger, while in the spring, tree pollen can be problematic.
SOLUTION: Ask if your child can wear cotton leggings and long-sleeved T-shirts to reduce dust exposure. Tell the teacher that your child can go swimming, but they may need to apply a layer of emollient before getting in the pool and then have time to shower and apply emollient after swimming. This might mean getting out of the pool early.
Messy play, art and cookery
PROBLEM: Sand, water, paint, clay and some foods can all be irritants. Plants may also be a trigger for eczema.
SOLUTION: Your child could try wearing nitrile gloves with a cotton liner for these activities. Tell the teacher your child will need to wash their hands with an emollient after these activities, rather than soap and water.
Circle or carpet time
PROBLEM: Sitting directly on a carpet can irritate eczema.
SOLUTION: Provide your child with a cotton sitter, so their skin is not touching the carpet – especially in the summer when legs are exposed.
PROBLEM: Some children with eczema are allergic to furry or feathered animals.
SOLUTION: Explain to the teacher that it is best your child does not handle pets. Perhaps they can have a special pet-related role so they don’t feel left out? Definitely don’t volunteer to look after pets at the weekend!
Friendships and peers
PROBLEM: Friendships and learning with peers are central to school life. There may be times when your child feels different, self-conscious or anxious about their eczema. However, primary school aged children are remarkably inclusive and understanding about differences. Sometimes children can be singled out or teased though.
SOLUTION: If your child becomes reluctant to go to school, encourage them to share what is going on. If you think there could be a problem, talk to the teacher first rather than other parents. Classmates will be curious and it can be a good idea for teachers to use age-appropriate stories or activities to help the class understand what eczema is and how it affects your child. (You might want to share books and resources with the teachers).
If your child needs an individual healthcare plan…
…you will have filled in a medical form as a general school admission procedure. If your child has ongoing medical needs, a long-term condition or continuing health needs, they should have an individual healthcare plan (IHP) that is reviewed annually, or sooner if their needs change.
IHPs are relevant for children with moderate-to-severe eczema and any associated allergies. The IHP may be drawn up before your child starts school or if their medical needs change – for example, if their eczema has become more difficult to manage and requires medical intervention during the school day.
The plan should include information from the school, your child’s healthcare professional such as a dermatologist, yourself, and your child. It should clarify how to support your child effectively and what needs to be done, when and by whom. It should include:
- the medical condition, signs, symptoms and treatments
- your child’s resulting needs, medication (including emollients)
- the level of support needed – if your child is self-managing their medication, the IHP needs to state this clearly, with appropriate arrangements for monitoring, including storage of medication (probably emollients)
- who will provide this support and their training needs, including confidentiality of information (limited to essential staff only)
- arrangements for written permission from parents and the headteacher for medication to be administered by a member of staff or self-administered by the pupil during school hours, and privacy for treatment (applying emollients)
- arrangements for school trips (factors that may affect your child’s condition), including special instructions for residential trips
- what to do in the event of an emergency, including who to contact and contingency arrangements.
Keep it positive!
It’s natural to feel worried about your child at school – especially if they are struggling with their eczema. Make sure you get all the support you need from friends and other sources such as the Society’s Eczema Helpline. Then do what you can to help them stay positive about school.
Ultimately, you want them to be happy, make friends and fulfil their educational potential – and eczema doesn’t need to stop that from happening. Your child should be able to join in everything at school, even though they may need some adaptions with activities.
You can help by providing clear, simple information to help school meet your child’s needs so your child can get on with having a great time at school.
Find out more
Allergy UK has a wealth of information on managing allergies in schools, available at: https://www.allergyuk.org/information-and-advice/for-schools
Statutory government guidance on supporting pupils with medical conditions and a downloadable template are available at: https://www.gov.uk/government/publications/supporting-pupils-at-school-with-medical-conditions–3
Eczema at school: tips from a teacher with eczema
Secondary-school teacher Ana-Maria Fernandes explains how her own experience with eczema has informed the way she supports students with eczema today and shares tips for parents. This article was published in Exchange 181, September 2021.
I’ve had eczema from the day I was born. As a child, I was under the care of Great Ormond Street. My transition to adult dermatology was problematic in many ways and it took more than ten years to find a dermatologist who I trusted. I have tried everything, ranging from questionable, eye-wateringly expensive herbal remedies to immunosuppressant treatments.
While I was growing up, I tried to compartmentalise this part of my identity. Looking back, I can see how this made school difficult to navigate. There can be a lack of awareness about the condition, with many still wrongly believing eczema is ‘just a rash’.
This is something I certainly encountered. These memories, combined with my pastoral role within school, have helped me realise how important it is to acknowledge the needs of pupils with eczema and make adjustments for them. These tips may help.
It can be hard to know how much information to share with your child’s school. If your child’s eczema compromises their enjoyment and wellbeing, it’s important to explain this to the school, and their doctor or dermatologist, so a support plan can be put in place.
- Find a trusted adult at school for your child to speak to. This might be their class teacher, form tutor, head of year or school nurse. In secondary schools, a form tutor or head of year can help to share information with other staff.
- Be clear with medical professionals about difficulties your child faces at school. For example, if they say ‘You must apply moisturisers often during the day’ and the reality of school makes this impossible, let them know. Check timings for treatment plans against school demands, especially in examination years such as Year 11 or 13.
- Phototherapy or immunosuppressant treatments can involve frequent medical appointments. If you think this would improve wellbeing, ask for reduced homework or deadline extensions, or see if they can take fewer subjects. Some students find that knowing in advance what content they will miss does help them manage their studies.
- If your child is suffering from a flare-up, let teachers know so they can make temporary adjustments to your child’s workload.
- At its worst, eczema can impact on wellbeing – sometimes leading to anxiety, depression or low self-esteem. If you feel your child is struggling, contact the school mental health lead or wellbeing team (if you’re unsure who this is, ask your child’s teacher). If the school cannot offer support in house, they may be able to signpost you to external agencies and write supporting letters.
School trips are significant social and educational events but you or your child may worry about managing skincare or emollient routines away from home – particularly during overnight stays.
- Ask for the trip itinerary. The excitement and chaos may disrupt those all-important skincare routines. Tell teachers that your child may need to get ready for bed or wake up earlier to apply creams or take their medication. If your child is worried about privacy, find out in advance about access to bathrooms and sleeping arrangements.
- If you support your child with their routine at home, help them become independent with this before they leave so they can confidently maintain their skin while they are away.
- Find out who will be responsible for carrying and storing the medication.
- Prepare a written copy of your child’s skincare routine and perhaps a photocopy of prescriptions to help busy teachers be clear about what your child needs.
People with eczema often become experts in covering up and wearing fabrics that minimise irritation, but the restrictive nature of uniforms can cause discomfort for some children. I recall my own experiences of weighing up whether to overheat in a scratchy school jumper or reveal my badly marked arms.
- Speak to your child’s head of year to ask if your child can wear a light natural-fibre undergarment under their uniform.
- Ask if your school can offer reasonable adjustments to the PE kits – for example, a long sleeved T-shirt and leggings or tracksuit bottoms in school colours, rather than Lycra – although your child might not want to look different to their friends.
- White shirts are very unforgiving of cream, ointment and blood stains, while dark jumpers and blazers show dry, flaked skin. If your child keeps a spare shirt or jumper in their locker, or with a trusted teacher, this can minimise their feelings of self-consciousness.
Tiredness caused by disrupted sleep patterns, missed lessons due to hospital treatments and temperature changes in classrooms are just some factors that may affect your child’s happiness and confidence in school.
- Chat to your child about where they sit in class. Ask the teacher if they can sit away from radiators and near an open door or window, as this may help. Don’t worry about drawing attention to your child. Teachers are skilled at making quick, discreet changes to seating plans.
- Discuss an exit strategy in case your child needs to leave class. Sometimes they may need a few minutes out of lessons to compose themselves and ‘check for damage’ if they are particularly itchy or uncomfortable.
- Materials used in subjects such as DT and art can trigger contact dermatitis, so it’s a good idea to check what is being used that term, to avoid issues.
- Eczema, especially if combined with allergies, can make aspects of school difficult. For example, grass, tree and pollen allergies can make outdoor PE or sports days unhappy experiences. Children can feel embarrassed about making a fuss but it’s important to make sure teachers are aware of the severity of the allergies, eczema and triggers.
- If your child has difficulty maintaining focus or gets tired, they may need extra time and/or rest breaks in assessments. Ask your school’s SENCO or head of year for advice. You will need robust medical evidence for this arrangement in public examinations, so keep professionals informed about the impact your child’s eczema has on their education.
Seeing pupils struggle does take me back to my childhood, including:
The horrible: The physics teacher who refused to believe that the nausea and side effects from my twice-weekly hospital trips for PUVA treatment was a valid reason for not completing homework
The helpful: The English teacher who suggested I sit away from a scalding hot radiator
The absurd: Not being able to bend my legs when seated because of icthopaste bandages strategically concealed under winter tights.
I do notice pupils’ discomfort but I’m careful not to tell them to stop scratching. The last thing anyone with eczema wants is someone stating the obvious. If it feels appropriate, I will ask what their triggers are, though, and help them think through how they might make their life easier. Supporting pupils is rewarding – especially when adjustments make an improvement to their wellbeing.
A couple of years ago, I observed a lesson and noticed a pupil clearly struggling with their skin, so I gently suggested we chat. This discussion was worthwhile for both of us and led to many of the suggestions in this article. Eczema is a tricky condition to manage, and there aren’t always answers, but in my experience, good communication with the people around you always helps.
About the author: Ana-Maria Fernandes teaches religious studies at a mixed comprehensive secondary school in Hertfordshire, where she has worked for nearly ten years. For the past three, she has been head of year. A considerable part of this role is supporting pupils with various medical and wellbeing needs.
School Information Pack
Starting school or moving to a new school is an exciting yet anxious time for any parent and child. Families of children with eczema may have additional concerns about this new phase of life.
A child with eczema will, over time, need to learn how to be responsible for their own skin care during the school day. This is often a challenge and all school staff have an important role to play in supporting the child with aspects of their eczema which may affect their wellbeing at school, and in accommodating the child’s complex needs (especially when the eczema is moderate to severe).
We recognise that managing eczema at school can be daunting for everyone involved – children, parents/carers and school staff – and that’s why we’ve produced our School Information Pack.
Our School Information Pack is aimed at parents of primary-aged children, and primary school staff. It contains:
- Information about eczema, eczema triggers in a school context and eczema treatments
- Advice for supporting children with eczema at school
- A parent/carer – teacher meeting checklist to inform a discussion about a child’s eczema
- An eczema-planning checklist for a teacher/teaching assistant who has a child with eczema in their class
- Eczema-related lesson plans for different age groups covering ages 3 to 11, for teaching children about eczema
The School Information Pack can be downloaded below. If you would like a hard copy or copies, please email us at firstname.lastname@example.org