If it takes a village to raise a child, it takes a team to manage type 1 diabetes at school. That team will likely be made up of you, your child, and any school personnel who interact with him or her throughout the day. "It should include -- but is not limited to -- teachers, nurses, guidance counselors and physical education instructors," says Colleen Shamberger, a nurse at Maple Avenue Middle School in Saratoga Springs, N.Y. Typically, a school nurse will train staff members to recognize basic signs and symptoms of low and high blood sugar, and what to do in an emergency.
Of course, you can't have great teamwork without great communication. "Parents are the best resource for a child's individual needs," says Beth Anderson, a nurse who covers four elementary schools in San Diego County, Calif. Sharing behavioral information about your child is particularly important because the signs of low blood sugar can vary greatly among kids with type 1 diabetes. "Some children may get a little goofy, while others may get cranky," explains Anderson. Once a nurse knows a child's symptoms, she can include them in the care plan that is shared with the school staff.
"It's extremely important to get off to a good start, even before the school year begins if possible," stresses Janice Tate, a registered nurse and certified diabetes educator based in Missoula, Mont, who frequently educates staff at schools in her area. "Communicate, communicate, communicate. Be very specific about what you need -- if your son needs a snack at 10 a.m., then put it in writing."
What else should you share with the staff at your child's school -- and how? We asked a panel of school personnel -- teachers, nurses, and administrators -- to share the most useful nuggets they've received from moms.
The best defense is being really open.
Many parents try to keep private about their child's type 1 diabetes for fear of stigmatization. "But that only tends to make a child feel alienated," says Megan Firth, a fourth grade teacher in a Seattle suburb who has taught seven kids with type 1 diabetes in the past decade. "Parents who teach kids to 'own' their diabetes do them a tremendous service. Being open and natural is the best way to get the other students to accept that there's nothing shameful about the condition." Shamberger agrees: "When a child and family are open with their friends about diabetes, most kids want to learn, support and help their fellow peer."
The ultimate goal is partnership.
"Three years ago, our school hadn't had any experience with type 1 diabetes," says Shelly Turner, a second grade teacher at a small school in a rural community outside of Houston, Texas. "A new student's mother asked for a 504 Plan and came in with copies of the JDRF's School Advisory Toolkit, which was tremendously helpful." A 504 Plan is a legal document that formalizes how a child's diabetes will be managed in school. "I loved her collaborative approach," says Turner of that mom. "She helped us all become better educated, and we worked together to develop a protocol for what happens with field trips, substitute teachers, standardized testing, and every other situation."
Nine going on 19 is still a kid.
"By fourth grade, kids are often becoming more independent in managing their diabetes," says Firth. "But even the most responsible child can occasionally forget to check in with the nurse or drink enough water after P.E. class. One year I taught an extremely mature young lady whose mom used to send in notes when her daughter was preoccupied with other things, like getting a puppy or having a sick grandfather. That way, I knew to keep an extra close eye on her. I really appreciated those little reminders that she was still just a little girl."
Older kids can make excellent advocates.
By middle school, many kids are ready to step it up a notch. Kelly Wickham, an assistant principal at a magnet middle school for technology in Springfield, Ill, marvels about the mom who encouraged her child to help write his own 504 Plan. "In our team meeting, her son opened up with a PowerPoint® presentation -- yes, I know! -- about his diabetes: when he learned he had it, how he manages it, and what we were to look for in his behaviors that should cause us concern. That mother really raised her son to be his own advocate. He let people know why he might be eating a snack in class, what his water bottle was for and that we should always know where he is, even when he leaves the classroom to use the bathroom."
Being proactive isn't being pushy.
Each of our panelists noted how much they admire parents who are open and engaged. Tate, the nurse educator, recalls a mother who wrote out her son's schedule from the time he woke up to the time he went to bed. "She wanted to show his teacher what a typical day looked like -- how often he needed a snack, how often he needed to check his levels. She wanted his teacher to really understand his life."
So when in doubt about over-sharing? Do it, advises Wickham. "I want parents to be proactive and set up a meeting with the new teachers who need to be made aware of the serious health risks involved for unmanaged diabetes," she says. "Call the school and ask for that meeting and invite as many people as possible."
Disclaimer: The experiences and suggestions recounted in these articles are not intended as medical advice, and they are not necessarily the "typical" experiences of families with a child who has type 1 diabetes. These situations are unique to the families depicted. Families should check with their healthcare professionals regarding the treatment of type 1 diabetes and the frequency of blood glucose monitoring.
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