Nursing Through Winona Health

Contact: Jennifer Warner

Early Childhood Screening

The Early Childhood Screening Program, conducted by the Winona School District, is offered annually to all children whose fourth birthday falls on or before September 1. Bluffview Montessori School does require this for kindergarten.

Participation in this program is required by the State of Minnesota for entrance into kindergarten. This screening program gives a careful, simple screen of the child’s developmental growth including vision, hearing, growth, development, and speech. There is also a discussion with a nurse on the dental, nutritional, and immunization status of the child. This program is part of the district’s Child Find process in the identification of children with handicaps.

The goals of the program are to identify health concerns and allow sufficient time to assist parents in obtaining remedial care. Nurses will assist parents in follow-up care where indicated.

Please schedule your child’s screening well before kindergarten. The recommendation is to screen at age 3.

Screening Location: 
Winona Area Learning Center
1299 West Third Street
Winona, MN 55987

Screening Registrations: 
call (507) 494-0900.

Head Lice School Procedure

It is safe to assume that head lice (like strep throat) are usually present in school. Once we are able to see lice, they have probably been present at least a month.

Parents are encouraged to regularly check their children’s heads (every two (2) weeks is recommended). School may or may not know about head lice and it is frequently identified incorrectly.

If a parent reports a case of head lice, we will check heads of siblings at their request and the child who had it before they return to the classroom.
No letters will be sent to classmates or entire school body unless there are 3 or more cases in a classroom in a month. This is a confidential manner, we will not share names of who has lice with other parents.

No whole group screenings will be done at school. Research says it does not help and gives parents a false sense of security.

If live lice are identified by the school nurse, the student will be sent home for treatment at the end of the day.

Parents are urged to follow instructions on the lice shampoo exactly and treat everyone who has live lice. Most will require retreatment in 7 to 10 days.

Classrooms are vacuumed here daily by the cleaning service. No lice sprays will be used in school, they are harmful to many children.

Head Lice Information

Head Lice Info Sheet

  1. Lice do not jump, hop or fly but they can move fast. Head-to-head contact is the usual mode of transmission.
  2. Healthy lice stay close to the head, making it difficult to get lice from hats, combs, brushes and the like.
  3. Head lice prefer clean hair that they can more easily latch on to (it is not a sign of uncleanliness).
  4. Pets do not pass lice to humans.
  5. Head lice do not spread infection or disease.
  6. Signs of head lice: itchy scalp, crawly feeling, red scratch marks especially at nape of neck.
  7. Head lice have usually been around for a month or more before being detected.
  8. Follow directions when treating head lice with over the counter products. Most recommend retreatment in 7 to 10 days. If live lice are not dead after treatment, call your doctor. There have been reports of resistance to some lice shampoos.
  9. Nits (lice eggs) are difficult to remove. A special fine-toothed metal comb is the most effective way of removing nits. They do not wash out.
  10. The most effective screening occurs when parents check their own children on a regular basis. School wide screenings are not recommended by experts. It does not help to prevent the spread of lice but can make parents think they do not need to check at home.
  11. Nit and lice removal is tedious. Some unproven but popular products that may help with loosening the “cement” that nits attach to the hair with are: vinegar, real mayonnaise, vegetable oils and Dawn dish soap. They have not been shown to be an effective treatment for live lice.
  12. Remember, the treatment of head lice is now based on sound research. In the past, companies who profited from “Head Lice Hysteria” encouraged misconceptions concerning lice. Trust your school nurse to give you information that is evidence-based. There is a lot of inaccurate information on the internet. Please do inform us if your child has lice.

Infectious Diseases and the recommendations for exclusion from school.

Chicken Pox
Excuse until all the blisters have dried into scabs and no new blisters or sores have started within the last 24 hours; usually by day 6 after the rash began. Chickenpox is still a common disease. It takes 10-14 days after receiving the vaccine to develop immunity, vaccine failure occasionally occurs, and the incubation period is 10-21 days. Therefore, exclude children who:

** appear to have chickenpox regardless of whether or not they have received varicella vaccine, or
** develop blisters within 10-21 days after vaccination.

Usually no exclusion. Call your healthcare provider if the student has a fever or other symptoms (e.g., pus, eye pain, or eyelid redness). Once antibiotic treatment is started, the student may return to school unless they are unable to keep their hands away from their eyes and pose a risk to other students.

Diarrhea (Infectious)
Exclusion not usually necessary. However, A student that is not feeling well and/or needs to use the bathroom at frequent intervals should not be in school. Exclusion may be necessary during outbreaks or in other circumstances.

E. Coli 0157 H7 Infection
Exclusion not usually necessary. However, students that are not feeling well and/or need to use the bathroom at frequent intervals should not be in school. Exclusion may be necessary during outbreaks or in other circumstances.

Fifth Disease
No exclusion, if other rash-causing illnesses are ruled out by the healthcare provider, since students with fifth disease are no longer infectious once the rash begins.

Hand, Foot, & Mouth Disease
Exclude until fever is gone and the student is well enough to participate in routine activities (sores or rash may still be present).

Head Lice
Exclude until first treatment is completed and no live lice are seen. (Nits are NOT considered live lice.)

Hepatitis A
Exclusion usually not recommended. Consult with your local or state health department. Each situation must be looked at to decide if the student with hepatitis A can spread the virus to others.

Hepatitis B
No exclusion. A student who is infected with hepatitis B virus may attend school. If they have unusually aggressive behavior (e.g., biting), a behavior plan may need to be made. A team of medical experts should assess oozing sores that cannot be covered or bleeding problems on a case-by-case basis to determine whether exclusion from some activities is necessary. Exclusion from school will rarely be necessary as more students become vaccinated against hepatitis B.

Hepatitis C
No exclusion. A student who is infected with hepatitis C virus may attend school. A team of medical experts should assess oozing sores that cannot be covered or bleeding problems on a case-by-case basis to determine whether exclusion from some activities is necessary.

Herpes, Oral infection
No exclusion

Herpes Gladiatorum
Exclude from contact sports until all sores are dry and scabbed. Treatment with oral (by mouth) medication may shorten exclusion time. National Collegiate Athletic Association (NCAA) guidelines recommend exclusion of wrestlers for 5 full days after treatment with oral antiviral medication has begun before they can return to competition.

Exclude until treated with antibiotics for 24 hours and sores are drying or improving.

Exclude until fever is gone at least 24 hours without the use of fever-reducing drugs; and the student is well enough to participate in classroom activities.

Lyme Disease
No exclusion

Exclude for 4 days after the rash appears. A student with measles should NOT attend any activities during this time period.

Meningococcal Disease
Exclude until the student has been on appropriate antibiotics for at least 24 hours.

Methicillin-Resistant Staphylococcus aureus (MRSA)
Colonization and Infection- Exclude if draining sores are present that cannot be covered or contained.

Mononucleosis (infectious)
No exclusion.

Exclude until 9 days after swelling begins.

Pertussis (Whopping Cough)
Exclude until 5 days after appropriate antibiotic treatment begins. During this time the student with pertussis should NOT participate in any school or community activities.

Exclude until 24 hours after treatment has been started. After this period participants of contact sports (such as wrestling) may return if lesions can be covered. If lesions cannot be covered participants should be excluded for 5 days.

Rubella (German Measles)
Exclude until 7 days after the rash appears.

Exclude until 24 hours after treatment begins.

Exclusion not usually necessary. However, a student that is not feeling well and/or needs to use the bathroom at frequent intervals should not be in school. Exclusion may be necesary during outbreaks or other circumstances.

Shingles (Zoster)
No exclusion, if blisters can be covered by clothing or a bandage. If blisters cannot be covered, the student should be excluded until the blisters have crusted. A Student with severe, disseminated shingles should be excluded regardless of whether the lesions can be covered.

Staph Skin Infection
Exclude if draining sores are present that cannot be covered or contained.

Streptococcal Infection (Sore Throat/Scarlet Fever)
Exclude until 12 hours after antibiotic treatment begins and the student is without fever for 24 hours.

Consult with the local or state health department. Each situation must be evaluated individually to determine whether the student is infectious and poses a risk to other students.

Viral Meningitis
No exclusion.

No exclusion.

For more information, contact your healthcare provider.

Medication at School

Medication Policy/Procedures
Please stop in the Health office and ask me to help you if you need to set up medication at school. We follow these guidelines to keep your children safe but not to make it hard for you. I am happy to help with the paperwork!

Medications may be given at school when necessary. Several conditions must be met in order for medications to be given safely:

  1. All medications require a physician’s order and written parental permission. (Obtaining a physician order does not require an extra visit; the order may be faxed to school 452-6869.) This includes all prescription medications as well as Tylenol, Advil, Aspirin and all other over the counter medications including vitamins and supplements.
  2. All medications must be in the original labeled container. Local pharmacies will provide a second labeled container at no charge.
  3. An adult must bring all medications to school.
  4. Medications (other than inhalers) must be administered by the School Nurse or designated staff member.
  5. Medication orders/permissions are good for the current school year only.
  6. When students go on field trips sponsored by school, physician orders and parent permission are still necessary. (Keep in mind all medications usually taken at home that will need to go on overnight field trips.)

Unused Medications – When use of a medication has ceased, or is no longer needed by the student, it is the parent/guardian’s responsibility to retrieve unused medications from the school. Any unused medications will be disposed of by the school upon the written request of the parent/guardian or at the end of the school year. Bluffview staff will not administer expired medications.

In 2001, the MN legislature passed a law that allows for students in public schools to carry their own inhalers that are prescription medications for asthma. BMS believes that it is in the best interest of students with asthma to move toward independent management of asthma during their school years. It is critical, however, that inhaled medications be self-administered safely, carefully and accurately. BMS allows students to self-carry medication following the criteria listed below.

  1. The inhaler must be properly labeled for the student (name, name of medication, dosage, time, route).
  2. Written authorization from the parent permitting self-administration and possession of an inhaler.
  3. Written order from the physician prescribing the medication.
  4. Assessment of student’s knowledge and skills to safely use and possess an inhaler at school by the school nurse. This includes keeping a written record of use at school.

In May 2004 a new law was enacted that affects the access of students to EpiPens. The new provisions allow for the following things:

  1. Students will be allowed to carry or have immediate access to their EpiPens at all times as deemed appropriate by their parents and the medical professional who prescribed the EpiPens.
  2. Staff must be trained to recognize and manage anaphylaxis including to administration of EpiPens.
  3. Students needing EpiPens must have an individualized health plan that designates school staff responsible for implementing the plan and for recognizing anaphylaxis and administering EpiPens.
  4. Parents and prescribing medical professional must annually inform the school in writing that the pupil may possess EpiPens and/or if the student is unable to possess the EpiPens, they will provide properly labeled EpiPens to the school for the pupil and the EpiPens will be in close proximity to the student at all times.
  5. Back up EpiPens are to be kept in the nurses’ office in an unlocked container.

Immunization Requirements

Immunization Laws for Kindergarten-8th grade

Changes to Minnesota’s Immunization laws have been in affect since September 1, 2014. For complete information please see the Minnesota Health Departments’ web site about the changes.

The new vaccines that will require documentation of immunization or a legal exemption include:

  • Hepatitis B – For all children over 2 months old enrolled or enrolling in child care or an early childhood program.
  • Hepatitis A – For all children over 12 months old enrolled or enrolling in child care or an early childhood program.
  • Tdap – For all students entering seventh grade. Students in eighth through 12th grade must show documentation if the school requests it. This replaces the Td immunization requirement.
  • Meningitis (meningococcal) – For all students entering seventh grade. Students entering eighth through 12th grade must show documentation if the school requests it.

Immunization Requirements for Children’s House

New to Minnesota’s Immunization Law are early childhood programs which include programs that provide instructional or other services to support children’s learning and development and:

  • Serve children from birth to kindergarten.
  • Meet at least once a week for at least six weeks or more during the year.

Children enrolled or enrolling in these types of programs must provide proof of immunizations or have a legal exemption for:

  • DTaP
  • Varicella
  • Polio
  • Pneumococcal (2-24 months)
  • MMR
  • Hepatitis A
  • Hib
  • Hepatitis B

Changes to Previous Vaccine Requirements

  • Varicella – Must have received varicella vaccine by 15 months of age to enroll in child care or early childhood programs. This applies to children turning 15 months old on Sept. 1, 2014 or after. Additionally, the law clarifies that if a child had varicella disease:
    • Before 2010, the parent or guardian needs to provide the month/year of the disease and their signature. A provider’s signature is not required.
    • After 2010, a provider’s signature is required.
  • Polio and DTaP – Starting Sept. 1, 2014, children enrolled or enrolling in child care, early childhood programs, and kindergarten through 12th grade and are completing their polio or DTaP series must have had their final:
    • Polio dose (usually fourth dose) on or after their fourth birthday.
    • DTaP dose (usually fifth dose) vaccine on or after their fourth birthday.Remember, this change takes effect on September 1, 2014, so incoming kindergartners for the 2014-2015 school year who have completed their polio and DTaP series are exempt. This change will have a bigger impact on incoming kindergartners for the 2015-16 school year. Note: This change doesn’t apply to children in upper grades, in other words, a review of records for children in first through 12th grade isn’t necessary.
  • Kindergarten through 12th grade – The immunization law now specifies that students in all grades have documentation for all required vaccines. If the school requests immunization records for any student (K-12), parents must comply by providing the immunization dates or a legal exemption. The requirement for schools to report compliance at kindergarten and seventh grade to MDH remains unchanged.

Please call me at school if you have questions, I will be happy to help you.

Immunization Records

For proof of immunizations, we accept either a print out of immunizations from the clinic you use, or a completed Immunization Form.

Special Diet Statement

Bluffview Montessori School follows the regulations in the National School Lunch Program Act for accommodating special diets. If your child needs special diet accommodations:

Disability Definition:
The Americans with Disabilities Act (ADA) Amendments Act of 2008 made important changes to the term disability to include any person with a physical or mental impairment that substantially limits one or more major life activities, including major bodily functions.
•  Major life activities include, but are not limited to: caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, bending, speaking, breathing, learning, reading, and concentrating.
•  Major bodily functions include but are not limited to: functions of the immune system, digestive, bowel, bladder, neurological, brain, respiratory, circulatory, endocrine, and reproductive functions.
The changes demonstrated Congress’s intent to restore the broad scope of the ADA by making it easier for an individual to establish that he or she has a disability. After the passage of the ADA Amendments Act, most physical and mental impairments constitute a disability.
For the sake of simplicity, we will hereby refer to requests due to a disability as those due to a medical need.

Dietary Preferences:
These are not considered medical conditions or disabilities and, thus, do not need to be accommodated.
These could include:
•  Lifestyle choices, such as vegan, vegetarian, or organic
•  Religious choices, such as eliminating pork
•  General health concerns, such as a preference that a child eat a gluten-free diet because a parent believes it is better for the child
If a sponsor or provider chooses to accommodate a request due to a dietary preference, then they must ensure all meal pattern requirements are met in order for the meal to be eligible for reimbursement.

Required documentation:  Special Diet Statement

A special diet statement is required if the special diet request results in a meal or snack that does not fully meet meal pattern requirements.
A special diet statement must
• Contain the following information in order to be considered complete:
o Food or allergen to be avoided
o Explanation of how exposure would affect the participant
o Foods to be substituted
• Be completed and signed by one of the following state licensed medical authorities:
o Physician
o Physician Assistant
o Advanced Practice Care Nurse, such as a Nurse Practitioner
A Special Diet Statement template is available below and is from  the Minnesota Department of Education (MDE) website. Other documentation, such as a doctor’s prescription, may be accepted if it contains all the required information noted above.

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g., braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:
(1)mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410
(2)fax: (202) 690-7442; or
This institution is an equal opportunity provider.

Special Dietary Request Form