Focus on Pediatrics: To manage chronic illness, give schools the right info

Help classmates understand

Attending school can be hazardous to a child’s health when he or she suffers from a condition that requires interventions during the day that conflict with the classroom schedule. That’s why Children’s Healthcare of Atlanta created a school nurse liaison program, which helps children with chronic disease and other ailments safely attend school.

The nurses who are part of this program work with schools to make sure that the health care needs of children are adequately addressed in school. They get referrals from the hospital after a child has had surgery or has been diagnosed with a chronic disease such as diabetes, and they also get referrals from school nurses.

When a liaison from the health care system is not available, parents need to be taught how to work with the school, says Alison Ellison, RN, BSN, PNP, NCSN, a school nurse liaison at Children’s Healthcare of Atlanta.

"If something about the child’s illness could go wrong during the day while he or she is in school, then someone at the school needs to know what to look for and what to do," she says. For example, if a child has diabetes, it is important for key people to know the signs and symptoms of low or high blood sugar. Many times, young children or those who are newly diagnosed don’t know the symptoms themselves.

The first step in alerting the school about the special health care needs of a child is to contact the school nurse, says Ellison. "The nurse will understand all the ins and outs of confidentiality and share appropriate information with the appropriate people," she explains.

For example, if a child has food allergies, the nurse could alert cafeteria staff and the classroom teacher. However, if a child were allergic to bee stings, the physical education teacher or recess monitor would need to know. "The nurse can disseminate the information to the appropriate people telling them what they need to know but not too much," says Ellison. In this way, medical confidentiality is kept.

If a school does not have a nurse, then parents will have to make sure the right people are notified. A good place to start is with administration. "Simply telling the classroom teacher is not enough because the information may not get to all the people who need to know," says Ellison.

An individualized health care plan can be written in which the child’s needs are clarified. There are many factors to consider. For example, children with diabetes will have to have their blood sugar monitored and may have to eat snacks at timed intervals. If showing signs and symptoms of low blood sugar, they may need to be escorted to the office for safety reasons by an adult or classmate and not allowed to walk alone.

Children with arthritis might have to have their classes on the first floor so they won’t have to climb stairs. Also, they may need to get an extra set of books to leave at home. In this way, they can avoid carrying a heavy backpack.

The Americans with Disabilities Act does require schools to cooperate with parents on health issues. If parents are having problems, this law provides the legal muscle to make sure the school takes measures to ensure the child is receiving an appropriate education while meeting health care needs.

In addition to working with teachers, administrators, and other appropriate people at the school, parents might consider sharing information with a child’s classmates, says Ellison. This is especially appropriate for elementary-age children through the third grade. "There are many good books that help educate a classroom about why certain things may be different about a student, such as why he has to have snacks at 10 a.m.," she explains.

For example, children should be told why their classmate is coming back to school without any hair after having chemotherapy.


For more information about helping parents work with schools when their child has a health problem, contact:

  • Alison Ellison, RN, BSN, PNP, NCSN, School Nurse Liaison, Children’s Healthcare of Atlanta, 1655 Tullie Circle, Atlanta, GA 30329. Telephone: (404) 929-8631. E-mail: