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Integrating back into the school system during an illness can be a difficult period for a child, but it is essential for socialization, academic progress, and normalization, says Melinda Coughlin, MEd, school program manager at Children’s Hospital of Philadelphia. "It’s important that they are treated as kids first and we aren’t looking at them as an illness," she says. However, due to the illness, there are frequently issues the child, family members, and school officials must deal with when a chronically ill child returns to school.
Some children need to develop coping strategies to manage their pain, such as relaxation techniques. Other children may have personal issues like the need to have frequent access to a restroom.
"It is essential to talk to the child, no matter what their age is developmentally. During the conversation, let the child voice what some of his or her worries or concerns are about returning to school," says Coughlin.
Also rehearse with children what types of questions they may get from their peers and how they might want to answer them. Young school children have all types of questions for their classmates, such as whether the illness is contagious or if they are able to do the same things they did before on the playground and in the classroom. Sometimes it is appropriate for children to say that they don’t want to talk about it.
The Child Life and Education Department at Children’s Hospital of Philadelphia offers an educational program for classmates where a staff member goes with the child to the classroom and does a short presentation on the illness if the family thinks this would be helpful. Usually, this is done when children’s physical appearances are altered from treatment, such as when they have hair loss following chemotherapy or radiation or they have gained lots of weight while taking steroids.
Families need help in determining realistic expectations and identifying options that they can discuss with the school officials so that their child can participate. Often parents have a lot of anxiety, so it’s important to discuss what would make them feel comfortable. Perhaps the school can keep a communication log for the parents so they know how the child does at school or make arrangements for the child to periodically check in with the school nurse, says Coughlin.
Parents also need innovative suggestions that they can approach the schools with that will help their child integrate into the school environment without feeling different. For example, if their child has to use the bathroom frequently, they might talk to the teacher about developing a sign the child can use when he or she needs to leave the classroom.
When working with schools, health care officials must identify what information school officials need and who needs to know, whether it is the school nurse, guidance counselor, or classroom teacher, advises Coughlin. "Most schools, when offered the suggestions, are very open to brainstorming solutions to problems. If the medical profession could try and meet the school officials’ learning needs, then they would be able to help the child meet his or her learning needs," she says.
Also, it’s a good idea to provide a contact person at the clinic, such as the nurse practitioner, so school officials can call for information. A lot of "what ifs" come up during discussion of re-entry, and it is important to point out that in most cases schools would respond just as they would with any child. For example, if the ill child fainted on the playground, they would handle the incident the same as they would any school child.
When children are chronically ill, they lose control of a lot of aspects of their lives. They don’t control their treatments, hospital admissions, or the side effects from treatment options. "The school re-entry piece is an opportunity to give children some control over an important aspect of their life, and that is why it is important to include the child and family in looking at how to make that a reality," says Coughlin.
For more information about education revolving around school re-entry, contact:
• Melinda Coughlin, MEd, School Program Manager, Children’s Hospital of Philadelphia, Child Life and Education Department, 34th and Civic Center Blvd., Philadelphia, PA 19104. Telephone: (215) 590-7512. E-mail: Couglin@email.chop.edu.