Diabetes and the Back to School Survival Guide
Ah... early August, the dog-days of summer, little traffic in the Washington, DC, region and back-to-school sales!" The Washington Post Magazine featured its Back-to-School guide this week, so I thought I would discuss school survival tactics as well, but in relation to diabetes. On Tuesday, August 9, I will be discussing optimal diabetes care for school-aged children with the school nurses in the District of Columbia, all of whom have a relationship to Children's National Medical Center. I plan to discuss many thorny issues that relate first to safety (of course), independence, and the legal and ethical rights of the child with diabetes in relation to public schools. Public schools are covered under the Americans with Disabilities Act; thus students in attendance at these schools are provided with certain rights and privileges by law. However, problems may arise in terms of staffing such that not every school may have a nurse in full-time attendance. (Unfortunately, private schools may issue rules that do not necessary follow the same protocol as discussed below. However, it has been my experience that many private schools are very liberal in this regard and will be willing to work with the family and child to make the educational experience more productive.)
How do you work with your school to make your child with diabetes feel safe, comfortable, and receptive to learning?
1. Start early:
a. If you have not already met with school representatives (preferably the nurse/health personnel), do so now. In this way, you can give the school a head's up about your child and plan ahead.
b. Ensure that your diabetes team has provided you with a school form applicable to your state. Be aware that different states (even counties) may have different school forms. It is the practice at Children's National to start providing appropriate school forms to families as early as May or June in anticipation of the school year. We hope that eventually we will be able to use a "universal school form" for all students, like the one utilized in the state of Virginia. Crystal Jackson, a dynamic school advocate is the guru in terms of all things school including forms, 504 plans, etc. Check her out.
2. Obtain necessary refills. Don't wait till the last minute when you need to provide test strips, glucagon, and insulin to the school, in addition to what you need at home. We recommend that glucagon be available at school for emergencies.
3. Provide a disaster plan and have supplies available in school should the school go on lock-down. Indeed, our school forms do require that this information be available. You do not want to be worrying about your child's diabetes management in addition to his//her overall safety during an emergency.
4. During your meeting with school officials, find out the school's rules about insulin administration, blood glucose monitoring, bathroom privileges, treating lows (in class or out), examinations, etc. Your requests should be based on your child's independence level and ability to perform diabetes self-care skills. If your child can perform blood glucose monitoring and give injections (pump boluses, etc.) on his own, determine if he must go to the health room to do so. Most diabetes teams support the abilities of their child with diabetes and strongly recommend enabling them to stay in the classroom as much as possible without having to run to the health room if they feel a bit low to test. Likewise, we would recommend that the child be able to check blood sugars and bolus insulin if they are on the pump or using multiple daily injections in the lunchroom instead of having to trek to the health room and miss half of lunch. On the other hand, if your child is experiencing a severe hypoglycemic episode, someone needs to ensure that he/she arrives in the health room and is treated appropriately.
5. Make certain that teachers, coaches, and extracurricular advisers know that your child has diabetes and to allow for blood glucose monitoring, insulin administration, and treatment of lows. Keep in mind that discrimination of your child is against the law.
6. Be clear about the rules in regard to field trips. I am often scuffling with school staff insisting that a parent must attend a field trip if the child with diabetes is to participate. In my opinion, no parent should have to leave work/home to accompany a child.
7. Make certain that your star athlete has her diabetes related supplies with her at all times. It is not acceptable to have their blood glucose meter in the locker during sports practice.
8. Keep in mind that many schools are unable to have a nurse due to staffing limitations. However, just as your family has been trained to manage all diabetes care related skills, so can a reliable office staff member or an administrative assistant. It is my belief that the caregiver need not always be a healthcare professional as long as one has trained them.
9. If the school won't cooperate after you have tried all the appropriate negotiating tactics, it is time to obtain a 504 plan that will enable you to delineate your needs by law. Your family and all the appropriate school personnel will need to meet and craft a plan meeting your child's needs and expectations. An example of a 504 plan is on the ADA website under school related concerns.
Once again, keep in mind that Crystal Jackson of Virginia is not only the mother of a child with diabetes, but has been directly responsible for the American Diabetes Association "Safe at School Initiative." Check out the website on ADA.