Diabetes Forecast

11 Tips for Keeping Kids With Diabetes Safe at School

By Benjamin Page , , , ,

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The new school year can trigger a mix of excitement and end-of-summer groans. But for kids with diabetes, back-to-school time can introduce additional worries and preparation. After all, they won’t have Mom or Dad on hand to assist with glucose monitoring or insulin injections.

That’s where Safe at School comes in. The American Diabetes Association (ADA) campaign helps schools meet the needs of students with diabetes by providing guidance and resources to families, schools, and members of the health care team. Diabetes Forecast reached out to the campaign’s working group members—health care providers, legal professionals, and parents who develop and advise on policy to ensure students’ diabetes-related needs are met—to get advice on navigating the new school year. Whether your son is about to take his first steps into kindergarten or your daughter is starting a new high school, these tips will help keep them safe and make sure they are treated fairly. And they’ll give you peace of mind.

1. Make a Diabetes Medical Management Plan

Work with your child’s health care team before the school year starts to create a diabetes medical management plan (DMMP). “This [prescribes and] guides the diabetes care at school and keeps your student safe,” says Leah Wyckoff, MS, BSN, RN, NCSN, faculty/diabetes nurse educator at the Barbara Davis Center for Childhood Diabetes in Denver. What kind of insulin does your child use? What about equipment to monitor blood glucose? What are the student’s usual signs of hypoglycemia? The DMMP lays out these specific needs—and more. Having this information on a single form makes it easy to share with school staff. Download a sample here.

2. Create a 504 Plan or Individualized Education Program

A 504 plan establishes how your child’s medical needs are met at school, determines what adjustments are necessary for your child to thrive, and ensures your child is treated fairly. “These accommodations might include extra time, if necessary, to check glucose levels during testing or access to water and the bathroom at all times,” says Anastasia Albanese-O’Neill, PhD, ARNP, CDE, cochair of the Safe at School Working Group. If your child qualifies for services under the Individuals With Disabilities in Education Act (IDEA)—say, if he or she is struggling academically because of diabetes—you’ll create an individualized education program (IEP) instead, which also specifies academic services for the student. Work with school administrators to iron out these details before the school year starts. Go to here to download a sample 504 plan and here to learn more about IDEA.

3. Contact the School

Meet with administrators, the school nurse, and teachers during the summer, well before the first day of school, suggests Crystal Woodward, the ADA’s director of the Safe at School campaign and parent of a daughter with type 1. Confirm which staff members have received appropriate training from a school nurse or other qualified diabetes health care professional. Go a step further and train staff on needs specific to your child, such as how to operate your child’s diabetes devices. Seeing the school’s layout and meeting your child’s new teachers may also give you peace of mind. You’ll also want to make sure teachers, nurses, and administrators understand their role as set out in your child’s written plans.

4. Work Together

Remember that school staff has to balance the needs of hundreds of students. During the initial meeting and beyond, it helps to be diplomatic. “Parents must educate the district and assert their child’s rights,” says Janel Wright, JD, a hearing officer with the Alaska Workers’ Compensation Division and member of the ADA’s Legal Advocacy Subcommittee. “At the same time, my experience has shown it is best for the child and parents if they can do so without creating enemies of the educators.” Being cordial from the beginning will also make it easier to communicate any future changes in care strategy. Use Safe at School resources to support your request for accommodations in your child’s care plan. If you hit a roadblock and need help, contact the ADA (see below).

5. Be a Resource

As the parent of a kid with diabetes, you’ll likely know more about the disease than school staff. “Be a resource for best practices in general diabetes care,” says Tracy Milligan, assistant director at Northeast Florida Center for Community Initiatives in Jacksonville, Florida. Make yourself available to answer questions administrators have. If you’ve collected training resources from your child’s health care provider, share these with the school nurse—within reason, of course. “Don’t overwhelm the staff with too many materials,” says Milligan.

6. Advocate for Self-Care

The less time your child spends in the nurse’s office, the better. “You need to be in school to learn and not constantly leaving to check blood sugars or treat lows,” says Fran Cogen, MD, CDE, director of the Childhood and Adolescent Diabetes Program at Children’s National Health System in Washington, D.C. If your child is old enough and able to manage his or her diabetes in the classroom, then advocate for that when developing your 504 plan.

7. Prepare for Lunchtime

A kid’s gotta eat! Packing a lunch at home may allow you to better manage carb intake, especially for younger kids. To cover your bases on days when that’s not possible, ask to see a food service menu with detailed nutrition information or check the school’s website. It should list the food available each day of the week, allowing your child and assigned staff to estimate carbohydrate content ahead of time and calculate mealtime insulin doses.

Lunchtime also presents social aspects to consider. “It’s a vital time for interaction,” says Cynthia Muñoz, PhD, MPH, a pediatric psychologist with Children’s Hospital Los Angeles. If the 504 plan calls for your child to eat lunch in the nurse’s office instead of with peers, see if a friend can join.

8. Stock Enough Supplies

“Make sure you have enough diabetes supplies for both at home and at school,” says Sarah Lyons, MD, a pediatric endocrinologist with Texas Children’s Hospital in Houston. This includes insulin, test strips, extra batteries or charging cords for devices, and nonperishable snacks. Provide teachers with glucose tablets to keep in the classroom in case of lows (though your child should carry some, too). If you can’t afford extra supplies, ask your endocrinologist about samples and coupons, or reach out to your insurance company.

9. Encourage Openness

It’s normal to be self-conscious about wearable devices such as insulin pumps or feel singled out when checking blood glucose in class, but remind your child that there’s nothing to be ashamed of. “Rehearse how to handle situations,” suggests Karen Harriman, FNP-BC, MSN, CDE, a certified diabetes educator and family nurse practitioner in Fairfax, Virginia. Other students may ask about sensors or frequent trips to the nurse’s office, and having a response in mind will help your child feel more at ease. Of course, if your kid isn’t comfortable opening up about diabetes, don’t push it. Children should be allowed to disclose information to their classmates as they feel comfortable.

10. Plan for Extracurricular Activities

If your child wants to play sports or participate in other school-sponsored activities, make sure his or her written plans state that the school is responsible for providing a trained staff member to help with diabetes care. Trained staff should also accompany the student on field trips, says Marilyn Clougherty, RN, MSN, CDE, diabetes program coordinator with Children’s Hospital of Pittsburgh. Make sure your contact information and emergency backup are current on your child’s written plans. While the school is responsible for bringing supplies, pack extras in case of unforeseen circumstances, such as the school bus breaking down.

11. Do an End-of-Year Review

The close of one school year is the perfect time to plan for the next. “Be prepared and proactive,” says Henry Rodriguez, MD, cochair of the Safe at School working group, professor of pediatrics at the University of South Florida College of Medicine in Tampa, and an associate editor of Diabetes Forecast. “Schedule a meeting with the school nurse prior to the end of the current school year to review successes and challenges over the past year.” Take what you’ve learned and make any necessary adjustments to your child’s written plans.

Struggling to ensure your child stays safe at school, day care, camp, or recreational programs?

Reach out to the American Diabetes Association at 1-800-DIABETES (800-342-2383) or AskADA@diabetes.org.



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