AbstractObjectiveMany children who take medication require it during school time, and their participation in school activities could depend on it. The aim of this study was to identify whether schools have guidelines for medication management and to explore teachers’ perceptions about medication administration practices and the characteristics affecting these practices using Bronfenbrenner’s ecological systems theory as the framework.MethodsA cross-sectional postal survey was conducted in Finland in 2010 covering a representative sample of comprehensive school teachers (n = 1700). The survey included sections on guidelines and practices for medication administration, beliefs about medicines, and background information on the respondent and the respondent’s school. Quantitative and qualitative methods of analysis were used.Key findingsThe response rate was 56% (928/1664). At the national level (macrosystem), teachers reported uncertainty about existing laws and guidelines, while at the local level (exosystem), most of the teachers reported having medication management guidelines (73% primary; 76% lower secondary school). However, a majority described guidelines instructing them not to administer medicines to pupils. Medication management practices were found to differ depending on the province and size of school. At the personal level (microsystem), practices were also affected by teachers’ experience of, and views about, medicines.ConclusionNo consistent medication administration guidelines exist in Finnish schools. Challenges were identified at all system levels of ecological theory. To ensure proper medication management, school staff need clear and consistent guidance developed in co-operation between different professions, and exploring ways to involve pharmacists in this task.