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Form from: Alwoodley Primary |
This form has been archived
Child's name
Date of birth
Address
Parent/Carer name
Telephone - home
Telephone - work
Telephone - mobile
Parent/Carer responsibility - Please ensure all medication is in date, review the form at least once a year and also notify your child's school if their treatment or contacts change during the year.
Reliever treatment when needed
For wheeze, cough, shortness of breath or sudden tightness in the chest, give/allow my child to take the medicines below. After treatment and as soon as they feel better they can return to normal activity.
Medical Condition
Type of Medicine eg Salbutamol
Can your child administer this alone
Expiry date
What are your child's triggers? (things that make their asthma worse)
What signs can indicate that your child is having an asthma attack?
Any Additional Information
What to do in an asthma attack
1. Make sure the child takes 1 or 2 puffs of their reliever inhaler (usually blue) preferably through a spacer.
2. Sit the child up and encourage them to take slow steady breaths.
3. If no immediate improvement, make sure the child takes 2 puffs of reliever inhaler (1 puff at a time) every 2 minutes. They can take up to 10 puffs.
4. If the child does not feel any better after taking their inhaler as above, call 999 for an ambulance. If an ambulance does not arrive within 10 minutes repeat step 3.
5. I give permission for a school inhaler to be used in an emergency.
Please sign below
please use your mouse or finger sign above
Date: