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A Medical Perspective

Before a child with a life-threatening illness enters your classroom, it is essential that you do your homework. Preplanning is necessary so that you feel knowledgeable and capable of handling this unique situation.

It is important for you to learn as much as you can about the specific cancer or other serious disease the child is living with and the treatments used and possible side effects that could impact your classroom. If possible, it would be very beneficial to talk to the child's doctor, nurse, or social worker to get the medical information you need. Perhaps you could even visit the hospital where your student has been a patient to have a firsthand experience of the realities of a hospital stay.

Many hospitals offer a school reentry program in which a nurse and a child life specialist come to the classroom prior to the child's reentry. The purpose of this visit is to educate the chidren and you about the nature of the at-risk child's illness, possible side effects, etc., and to answer any questions. This valuable resource helps everyone concerned better understand the medical, psychological, and educational needs of the child.

Be aware that any typical childhood disease can be devastating to the health of this seriously ill child. Because the child's immune system is compromised, it is more difficult for the child to recover from even a common cold. It is critical to contact the child's parents immediately if any other child in your classroom becomes sick with chicken pox or the measles. These two illnesses are very serious for the special needs child and it is possible that this child will need to be schooled at home during the time the classmates are sick with these diseases.

In addition to the specific medical aspects of the child's condition, there are many other areas of concern to consider. A meeting involving yourself, your school administration, the school nurse, the child's parents, and the child if he/she feels comfortable with attending should be scheduled prior to school attendance. Special area teachers (music, art, physical education, media specialist), other classroom teachers, the school secretary, cafeteria staff, the bus driver, and recess supervisors should also be advised of the issues that pertain to their specific areas.

This meeting is critical to the successful entry or reentry of this child into your classroom. Below are some specific areas to consider and corresponding strategies to accomodate these special needs.

Areas for Consideration

1. Does the seriously ill child have a special friend in the classroom?
2. What should you do in case of a medical emergency?
3. Can the child walk with the other children, or does the child need extra time to make the route or even access to an elevator? Is the child in a wheelchair?
4. What about emergency procedures for fire, tornado, or earthquake drills?
5. Are there diet restrictions for this child?
6. Is the child stable enough to carry the cafeteria tray?
7. Will a snack be needed during the day?
8. Is medication taken during the school day? Who will administer it?
9. Will there be any special needs in regard to use of the bathroom?
10. Can the child participate in physical education class? If there are limitations, what are they?
11. Can the child go outside for recess? If not, what are the alternatives?
12. Are there conditions of the illness that might be disruptive to the other children?
13. Can the child manipulate writing tools or use a computer?
14. Can the child communicate verbally?
15. How much information does the child with the serious illness want shared with other classmates?
16. How do you handle discipline problems that may arise with this child?
17. What concerns do the child's parents have?

Possible Strategies

1. Look at your classroom list to see who is or might be a special friend to the ill child. If possible, manipulate your seating arrangement so that the child entering or reentering your classroom will feel safe and comfortable with a friend nearby. Finding a buddy for this child is an important first step.

Note: An at-risk child's special friend or buddy may at times feel overwhelmed by responsibilities he/she may have toward the ill friend. You may want to assign a different budy each week.

2. During the course of the school day, the child may progress to a state of medical emergency. If each room in your school has a call button to contact the office, set up a code, (for example three short beeps), to indicate the help is needed immediately. If no such technology is available, arrange with the child's buddy to run a prearranged 911 message with your school's address and room number to an adult in the office. If the buddy is absent, make sure that you have an alternative helper apprised of the situation and the required action in the event of a medical emergency. Be sure to keep an updated record of the phone or beeper numbers where the parents can be reached during the school day.

3. Knowing the physical capabilities of the special child is important when movement throughout the classroom and school building is required. If the child can walk, but moves slowly or a bit unsteady, send the child and his/her buddy early to get to the appropriate place on time and without hindrance. This strategfy also works for a child using a wheelchair or on crutches. If the child needs to use the elevator, a key is often needed for operation. Keep the key in a special container on your desk so that the child or the buddy can get it without drawing attention to themselves or interrupting the lesson. The child's physical abilities may improve or worsen off and on during the course of the illness or in response to treatment. Expect the best; be prepared for the worst.

4. Most emergency drills are planned in advance. Ask the child administration to let you know ahead of time so you can get the at-risk child and his/her budddy to the designated safe place before the rest of the student population is notified.

5. If diet restrictions are an issue, arrange specail menus with the cafeteria staff. The child might be encouraged to bring a lunch, if these are too limited for school lunch preparation.

6. Helping the at-risk child carry his/her cafeteria tray could be a handle in many ways. A child could be asked to help, you could carry the tray, or a lunchroom supervisor could help. Planned in advance, this procedure could be done with minimum fuss and embarassment to the child.

7. Sometimes medications can cause increased appetite. If the child needs a snack during the school day, one way to incorporate this into your routine is to allow the whole class to bring a healthy snack to school also. Snack time could be arranged to coincide with silent sustained reading, study time, or while you read to the class so a minimum of classroom time would be taken. If this idea does not work in your school day, the child could have his/her snack in the nurse's office, library, or administrative offices.

8. Be aware of any medications that are needed during the school day. The school nurse or administration should store and dispense any drug prescribed. If possible, you might schedule the child to take his/her medicine before or after recess along with other children in your room who might take Ritalin, for example.

9. Use of the bathroom is a delicate subject to approach with the specail needs child. It can be very embarassing to discuss for everyone concerned. Tread carefully! If the child can use the bathroom with no help, his/her buddy might be sent along just to make sure the child does not fall or need help. As a teacher, you cannot leave your classroom unattended to facilitate any special bathroom needs. The school nurse should be utilized if the child needs help getting onto or off of the toilet or with wiping or clothes adjustment. If a catheter is utilized, the school nurse would be responsible for that as well. If the office or nurse's area has a private bathroom, that facility should be used to avoid the embarrassment of having other kids witnessing the special needs of the ill child. If your school does not have a school nurse on stafff all of the time, another support person needs to handle this situation.

10. Know in advance what limitations this child may have in gym class. Work with the physical education teacher to design alternative activities and safety precautions for this child.

11. Make plans for outdoor recess. There may be no restrictions on the child's physical activity. If, however, the child is only allowed to go outside under certain provisions, discuss with the child's parents what equipment and games are appropriate for their child to use. A walking tour of the playground lets the child know that you are aware of what is allowed and discourage the child from trying to do more than is acceptable. Be sure to communicate this information to the other recess supervisors. If the child may not go outside, plan alternative actvities such as: helping in the office or library, using the computer in the library, and reading or working with a class in a lower grade. If you are planning to be in your room during this prep time, let the child help you out once in a while. A weekly schedule offers a great way to organize this child's recess time.

12. As a result of the illness, the child may exhibit behaviors such as uncontrollable body movements or noises that may be disruptive to the rest of the class. Explore ways to minimize the impact of this on your classroom. Discuss with the children the reason for the disruptive behavior and the need to ignore it in order to stay focused on their work. Isolating a child for behavior that is out of his/her control is not a viable option.

13. It is essential to understand what the child's capabilities are in regards to completing school work. If the child cannot manipulate a pencil or computer keyboard, a tape recorder may be necessary. It's possible that the child will be able to point to the correct responses and classroom volunteers or aides could be extremely helpful in providing the appropriate feedback for the child.

14. Slurred speech or the inability to speak are real concerns for a classroom teacher. If the child can write, a small blackboard could be used. The child could simply hold up his/her response. Computers can certainly bridge this gap beautifully as can simple communication boards. Ask for help from your corporation's special needs department.

15. It is important to listen to the child who is dealing with a life-threatening illness; it is also important to respect the child's right to privacy. Talk with the child about what he/she want the rest of the class to know about his/her illness. Let the child set the agenda and the timetable for sharing information. Some children want everyone to know every detail right away, others prefer to share very little. Walk through a typical day with the child, and invite the child's input regarding any special accomodations needed. A written schedule for the week would be helpful for the child to have in hand on the first day he/she attends. Try to anticipate other children's reactions and prepare the child for them. Discuss ways to handle excessive staring or bullying behavior. Describe some of the positive aspects of your classroom such as projects you are planning, special events, caring children in the class, etc. Most importantly, let the child know that you are glad to have him/her in your classroom and that it's going to be a great experience. Reassure the child that you are available to help and listen--whatever the child needs. Allow time to answer any questions the child may have. Remember, the child will follow your lead, if you feel good about the situation, the child will too.

16. Disciplining a child who is seriously ill is difficult to do. Many small disturbances can be overlooked, but at some point you may have to intervene. Often, that at-risk child may just be testing you. In a strange way, this child may equate a loss of recess time for inappropriate behavior, for example, with being normal. Your actions may help that child feel like a "regular kid" and may facilitate his/her acceptance by the other children. Resentment from the other children may result if the at-risk child is allowed repeatedly to disregard the rules with no consequences. If the problem continues, a parent conference may be needed.

17. Parents often find sending their child back to school to be a very emotional and difficult choice, especially if the child is very ill. Their need to spend as much time as possible with their child weights heavily. Talk with the parents about their expectations for their child's school experience. Listen to truly understand the situation from the parent's perspective. Be sure to let the parents know the best time to contact you, if possible, at home as well as at school. A weekly communication from you goes a long way toward reassuring the parents and helps keep them apprised of the situation at school. Encourage the parents to communicate with you on a weekly basis as well.

Note: Your discussion with parents may need to occur without the child present. A tour of the school and classroom would be a good activity for the child to be involved with to allow for the privacy necessary. The meeting is over. You have tried to anticipate and overcome any obstacles in a way of the successful entry or reentry of the at-risk child into your classroom. Still, there may be questions yet unanswered.

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