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School nurses caught up in dispensing medications

Like a small herd of buffalo, the five children charged into the office of school nurse Florine LaPointe, fussing and fidgeting, vying to be the center of attention.

LaPointe, used to this wiggly bunch, calmly hands out cups of water and each child gulps down a pill, tosses the cup and rushes out to recess.The students at the Sea Road Elementary School don't come to LaPointe for Band-Aids, aspirin or a sick call home to mom. Every day at noon, they need their Ritalin.

The scene is the same in schools across the country. Ritalin, prescribed to help children with attention and hyperactivity disorders, has turned many nurses into case managers.

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 35 students receive their prescription drugs daily, mostly for asthma inhalers and Ritalin.

At Sea Road, 23 of the 450 students take Ritalin. Others take psychotropic drugs like Prozac and Zoloft to control depression or obsessive compulsive disorders.

"We have a lot of kids on heavy duty medication," LaPointe said. "I hope it slows down. I don't like the quick fix."

Although critics have suggested that Ritalin is overprescribed for children, a study last December found that doctors use about 21/2 times more Ritalin for hyperactive and inattentive children than in 1990 - a much smaller increase than feared.

The research, reported in the December issue of Pediatrics, said some 1.5 million young people ages 5 through 18, or 2.8 percent of the nation's school-age children, take the drug.

The National Association of School Nurses, based in Scarborough, Maine, said the number is more like 3 million.

"This really is a very common problem in American schools affecting a lot of children," said Doris Luckenbill, the association president. "Almost every teacher in the world has a child in his or her classroom with this problem."

Ritalin is so commonly prescribed to schoolchildren that the association recently sent information packages about the drug to 11,000 members. It includes tips on how to recognize symptoms and how to store the drug.

Whatever the numbers, school nurses say they are swamped by the increase in students' medication, forced to curtail or reschedule other programs such as vision and hearing screening or faculty flu shots.

"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.