Sending your child off to school on her first day can cause separation anxiety in even the most level-headed of parents. Sending off a child with diabetes can be downright frightening.
Will the school know what to do if your child becomes hypoglycemic? Will other students make fun of your child for having to go to the nurse's office? Will your child eat her snacks and lunch at the right times?
These are all questions parents ask when it's time for a diabetic child to go to school, or when a newly diagnosed son or daughter has to begin coping with the disease in the school.
The need for individualized plans
In many school districts across the country, school health officials have created detailed guidelines designed to serve children with diabetes and other special health needs. In Minnesota, for example, school officials work closely with the parents and personal physicians of their diabetic students in order to develop special care programs tailored to each student. School nurses not only provide emergency care for children with diabetes, but educate teachers and staff about the disease and serve as key players on the student's diabetes management team.
"We develop individualized plans for all of our kids with diabetes," says Gayle Rieland, the health services coordinator for a school district just south of Minneapolis. Parents often provide the school with a one-page instruction sheet that informs teachers and the school nurse exactly what is to be done depending on the student's blood sugar reading. "Other than that, we try not to make the students feel like they're different in any way," says Rieland. (For a sample instruction sheet, see the Children with Diabetes site, www.childrenwithdiabetes.com).
If your child has diabetes and is about to start school for the first time, there are several things you should do before school even begins. You should start by meeting with the principal to find out the school's policies concerning blood testing and emergency sugar. You should also find out who your child's teacher is and make an appointment to see him at least a week before school opens.
Children with Diabetes recommends that you accomplish the following at your meeting with the teacher:
- Tell the teacher your child has diabetes and what that means. Explain that your child has to have midmorning and midafternoon snacks (and what time you expect her to eat them), even if it means eating during a school assembly or outing.
- Find out when lunch is served so you can plan insulin treatments, and describe the symptoms that indicate when your child is in need of insulin.
- Bring the teacher a supply of sugar and extra snacks to keep in his desk (or in the clinic) in case they're needed. Let him know that your child shouldn't be left alone if she's having an insulin reaction.
- Give him your cell phone number, if you have one, so that you can be contacted immediately if tests show that blood sugar levels are abnormal.
- Arrange to meet with other teachers and staff members -- including gym teachers and librarians -- who may be monitoring your child during the school year. Be sure to tell the gym teacher to keep a close watch on your child's glucose levels when she exercises. The 2005 American Diabetes Association Clinical Guidelines recommend blood glucose monitoring before and after exercising and eating extra carbohydrates if blood glucose is low.
Helping your teen deal with peer pressure
For adolescent children, schools and parents need to work equally hard to make sure diabetic students don't feel as though they're any different from the rest of the student body.
Sharon Murr, the nurse at Eagle Ridge Junior High School in Savage, Minnesota, deals with this issue daily. "These are adolescents who are having to make a major adjustment in their lives just when they're facing the most peer pressure to feel 'normal,'" Murr says. "Our goal is to enable them to have a day that's as normal as possible and yet provide them with a safe environment," one in which they can manage their diabetes comfortably.
Rieland and Murr's district does not allow students to self-test their glucose blood levels in the classroom. They must either go to the nurse's office or, in the case of the older students, test themselves when they leave campus for lunch.
Testing in the classroom has been a hot topic for parents of children with diabetes, many of whom believe classroom testing allows their children to miss less class time and lessens the stigma of the disease. Many school districts, citing health concerns for both the diabetic student and other students, do not allow children to self-test in class. Among the reasons, school nurses say, is that other kids like to play with the tiny but sharp blade on the instrument that diabetic children use to do blood testing, and thus might be exposed either to cuts or to blood from another student.
Schools do have the right to bar blood glucose testing in the classroom itself, but parents may be able to demonstrate to the school's satisfaction that these tests will not endanger others. This usually involves making provisions to dispose of the materials at home and not at school. If this is worked out, a school may then agree that the child can test herself in a secure place in the classroom, according to the organization Children with Diabetes.
Schools and parents are a long way from reaching consensus on the issue. In an informal poll taken on the Children with Diabetes Web site, 54 percent of parents responded that their child tested in the classroom, 35 percent said they tested in the clinic or nurse's office, 2 percent reported testing in another office because there was no nurse's office, and 1 percent responded that their children were not allowed to test in school.
Legal rights of the diabetic child
The American Diabetes Association takes the position that children with diabetes should be allowed to make blood sugar checks at school. As legal precedent, they cite the Americans with Disabilities Act, the Individuals with Disabilities Education Act of 1973 (IDEA), and Section 504 of the Rehabilitation Act of 1973, which prohibit discrimination in all schools and daycare centers -- except religious schools and facilities -- against children with disabilities, including diabetes. Any schools that accept federal funding must follow IDEA and Section 504 laws. The association encourages parents to use the laws to ensure that their kids can participate in all school activities while caring for their medical needs.
Parents of children who are barred from glucose testing at school can contact the local American Diabetes Association (ADA) affiliate for help at http://www.diabetes.org/for-parents-and-kids/diabetes-and-the-law/know-your-rights.jsp.
Parents of a student with diabetes also have a right to set up an individualized plan for their child with school officials. This plan, called a Section 504 or an IEP (Individualized Education Program) plan, can be created in a special meeting with parents and school officials. The plan sets out your child's health needs, designates the accommodations the school shall provide for your child, and protects your child against discrimination or exclusion from activities he or she can perform. (For more information about the school's responsibilities and your child's legal rights at school, visit the ADA site or Children with Diabetes site .)
Children with Diabetes suggests that it's the responsibility of the parents or student to let the school know he or she has diabetes, to provide documentation to that effect, to make a written request for accommodations, and to request a meeting to discuss a 504 plan or IEP. The American Diabetes Association recommends that your written plan include medication procedures, blood glucose testing procedures, and the following agreements on the part of the school:
The school will have staff members trained in testing blood glucose levels, recognizing, and treating hypoglycemia and hyperglycemia, and administering insulin and glucagon.
Your child will be allowed to give himself blood glucose tests in the classroom and/or in other locations, and promptly treat hypoglycemia and hyperglycemia.
Your child may have full participation in all sports, extracurricular activities, and field trips, with the necessary assistance or supervision, and may have lunch at an appropriate hour with enough time to finish eating.
Diabetic students will be permitted extra trips to the bathroom or water fountain.
Extra absences for medical appointments and sick days will be excused when necessary. (See http://www.diabetes.org/advocacy-and-legalresources/discrimination/school/ada_schoolmaterials.jsp for more details.)
In most cases, school officials are happy to work with you to provide the best and healthiest learning environment for your child with diabetes. Sure, it's still hard to drop your kids off at the school doors for the day. But with a little education and advocacy work, your child should feel comfortable with the condition both in and out of school.
Children with Diabetes(http://www.chidrenwithdiabetes.com ) offers loads of information and tips for parents on such topics as how to talk to children about diabetes, how to administer shots, and what your child's legal rights are at school. It also offers chat rooms and bulletin boards concerning diabetes and school issues, including parents' rights and responsibilities.
American Diabetes Association Legal Advocacy Program
By calling the ADA at 800/DIABETES, you can obtain a free Employment and Education Discrimination Kit, which contains the association's position statement as well as fact sheets about discrimination against diabetics and what you can do about it. The packets also contain the phone number of an ADA member in your community who can counsel you about any discrimination you or your child may experience.
National Guideline Clearinghouse. Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association. http://www.guideline.gov/
Diabetes Care Tasks at School: What Key Personnel Need to Know. American Diabetes Association, 2014. http://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/school-staff-trainings/diabetes-care-tasks.html
American Diabetes Association. Know Your Rights! http://www.diabetes.org/for-parents-and-kids/diabetes-and-the-law/know-your-rights.jsp
Children with Diabetes. Where does your child perform blood tests while at school? http://www.childrenwithdiabetes.com/poll/poll20070909.htm