504s and Other Long-Term Plans
Once you've settled in and bonded with the school nurse, it's time to think long term. You'll want to find a way not only for your child to settle in, but for you and your child (and your school) to be on the same page and not have to worry constantly about what comes next.
Your child will need a written set of rules and plans for his school day, usually in the form of a 504 plan. A 504 plan, named for the section it falls under in the Education Rehabilitation Act of 1974, is a plan for students who have special medical or educational needs in the school environment. Your child's diabetes means that, under federal law, you can set up certain things for her to ensure her safety and equal education each school day.
What do parents like to include in 504s? Obviously, you will include the basics. First, your child can take as many bathroom or water breaks, or visit the nurse as needed each day. Also, she can carry and eat snacks at any time. Many parents push for, and get, more. Some ask that a child be allowed to carry a meter in school and to check wherever he'd like.
Additions to the 504
The 504 plan can allow a child more absences than schools normally allow; it can also include how long a child has to make up work and provide for tutoring if a child misses many days. Aggressive plans can call for anything from carrying a cell phone in school (to call parents with blood sugar readings), to holding off on testing if blood sugar readings taken just prior to the exam are too low or too high, and, in one case, to providing a full-time aide trained in insulin-pump management to be placed in the classroom with a young child.
Set up your 504 meeting for a time that works for you, the teachers, the nurse, the principal, and the school psychologist. If possible, ask one of your medical team to draft a letter explaining your expectations and goals. When discussing your requests, always point out that you are asking the advice of your child's “medical team.” In most cases, schools want to help a child come up with a plan that will mean academic success and social happiness.
What about testing, beyond what's laid out in the 504? It's a good idea to have a frank discussion with your child's teachers about low and high blood sugars and how they can impair cognitive reasoning. Most teachers have no idea that children with diabetes often experience huge blood sugar swings. Explain that this, sadly, is not out of the norm for a child with diabetes. Download some facts on lows, highs, and testing and share them with the teacher. In most cases, teachers truly care and will take that into account if an unusual low grade pops up in a student's portfolio. Some teachers even take the time to call a parent if a good student struggles on a test to make sure it was not a low or high blood sugar day. Sharing such concepts and making plans can only help your child.
What you don't need to worry about, for the most part, is that your child will use lows and highs as an excuse. Most children with diabetes do not want to consider themselves hampered by the disease. Most will never use it as an excuse. Let your teachers know that if your child says he's struggling with a blood sugar, he most likely is.