KENNEBUNK — Like a herd of buffalo, five children charge into the school nurse’s office after lunch. Fidgeting and darting around the room, they yell and fight to be the center of attention.
Nurse Florine LaPointe is used to this wiggly bunch, and the 18 other children who visit at lunch time.
She calmly hands out tiny paper cups filled with water. In unison, each child gulps down a pill, tosses the cups and rushes outside to recess.
These students at the Sea Road Elementary School don’t see LaPointe for Band-Aids, aspirin or a sick call home to Mom. Everyday at noon, they need their Ritalin.
Prescribed to help children who suffer from attention deficit disorder or attention deficit hyperactivity disorder, Ritalin is changing the role of the school nurse.
The drug, which helps children calm down and concentrate, wears out after a few hours. “In another hour, they’d all be off the wall,” LaPointe says. To keep up the dosage, children all over the country crowd school nurses’ offices at lunch to get their pills, turning many of the nurses into case managers for dozens of children.
“The nurses are definitely the case managers. The paperwork is very tedious and time-consuming, but it is also very rewarding when students do achieve and do well,” said Maureen Glendon, a nurse at the Archbishop Ryan High School in Philadelphia.
While Ritalin has created more work for nurses, it also has given them a credibility boost and newfound respect.
“Everyone is trying to change the image from a Band-Aid nurse to a well-educated person who is a case manager. When the faculty looks for your input, that’s a turning point,” said Glendon, a nurse for 20 years.
School nurses are consumed by the increase in students’ medication, forcing them to curtail or reschedule other programs such as vision and hearing screening or faculty flu shots.
When there is concern about a child’s behavior, LaPointe sends student evaluations to teachers. She talks at length with parents. And she is notified if a student may be having health problems.
“Work is so intense. I have to prioritize constantly. I feel like a triage nurse,” LaPointe said after a boy came in searching for his inhaler for asthma and two diabetic students checked their blood-sugar levels.
Melissa Cash, a nurse at the Academy at Robinson in Akron, Ohio, said she handed out medicine to only a handful of children when she started her job seven years ago. Now she has to make sure almost 35 students receive their prescription drugs daily, mostly for asthma inhalers and Ritalin.
At LaPointe’s elementary school, 23 of the 450 students take Ritalin. Others take psychotropic drugs such as Prozac and Zoloft to control depression or obsessive compulsive disorders, LaPointe said.
“We have a lot of kids on heavy-duty medication,” she said. “I hope it slows down. I don’t like the quick fix.”
ADHD, a neurobehavioral disorder, affects about 3 to 5 percent of American children. A 1996 study published in Pediatrics found that doctors use about 2 1/2 times more Ritalin for hyperactive and inattentive children now than in 1990. About 1.5 million young people between ages 5 and 18 take the drug, the study found.
The National Association of School Nurses, based in Scarborough, says the number is more like 3 million.
“This really is a very common problem in American schools affecting a lot of children. Almost every teacher in the world has a child in his or her classroom with this problem,” said Doris H. Luckenbill, the association president.
Ritalin is so commonly prescribed to schoolchildren that the nurses association recently sent information packages about the drug to 11,000 members.
The information folders describe how to recognize symptoms of ADD-ADHD; how to store Ritalin safely — it has a street value; and how to administer the pills safely and properly.
In a recent survey, school nurses said that besides asthma, ADD-ADHD is the health problem with which they have the most concerns and need more information.
“The reason that the nurses want more information is because it’s being seen more and more in school. People are becoming more and more aware,” said Luckenbill.
Years ago, there was never a label for ADD or ADHD, Luckenbill said. “But everyone has memories of people who couldn’t sit still in class, who were impulsive and couldn’t give the answer, who were not good in social situations.”
Glendon and LaPointe agree some that some children need Ritalin, but as case managers on the front line, they worry about medicating those who may not require it.
“When kids have issues, the quick fix is a pill. We want them to learn lifetime skills,” LaPointe said. “We’re giving them a message by medicating them. They know they can feel better with drugs.”
LaPointe then handed an 11-year-old boy a cup of water and he swallowed his little pill.