Childhood headaches: a school nurse perspective

One hundred eight out of 256 (42%) surveys were completed by registered school nurses (SNs) working in the Connecticut public school system. Of the 108 respondents, 99% were RNs and 1% were LPNs. Each SN spent an average of 19 working days a month at school, in elementary (71%) and/or preschool (40%) settings. Professional experience and educational backgrounds were variable. Over 40% had never received formal instruction regarding childhood headache (CH), and an additional 32% had received less than two hours. School nurses ranked CH behind minor trauma, GI upset, and URI as the fourth of the 13 most common clinical problems encountered at school. An average of 35 children with headaches were seen each month. A brief description of, and inquiry about, other systemic symptoms were nearly always made. Only 62% of the SNs usually asked a child about neurological symptoms. A child's temperature and pulse were measured routinely by 84% of SNs, whereas blood pressure and neurological assessment were obtained routinely only in approximately 12%. Treatment varied; nonetheless, 31% routinely allowed the child to rest or sleep as part of their management plan. Analgesic was administered routinely only by 10%. Approximately one third generally discussed a disposition plan with the child's parents, whereas only 3% usually spoke with the child's physician. Although 51% of the respondents felt they were "constrained by school policy" in their management of CH, half of these individuals (71% of all respondents) did not want more latitude. It is concluded from this survey that despite limited formal instruction about CH, SNs dealt with CH in a reasonable manner.