Every year around this time, three words that kids hate—and parents love—to hear make their way into television commercials and print ads:

"Back to school!"

Yes, just about the time kids are actually starting to enjoy their summer break, we hear about "back-to-school" this and "back-to-school" that. However, for kids with diabetes and their parents, "back to school" isn't simply about stocking up on new pencils and Pee-Chee folders. It's also about considering how diabetes care will be affected and accounted for in the school setting.

Writing a commentary in the Spring 2002 issue of Clinical Diabetes, Francine Ratner Kaufman, MD, head of the division of endocrinology and metabolism at Children's Hospital in Los Angeles, discusses what the parents and healthcare team of a child with diabetes need to know about federal disability law.

Achieving Good Diabetes Management During the School Day

"Children with diabetes spend an enormous amount of time in school and must be able to achieve the same level of diabetes management in school that they do during the rest of the day," Kaufman writes.

To do this, she says, "they need access to the tools for diabetes management," which include blood-glucose testing equipment, insulin delivery systems, fast-acting carbohydrates and glucagon.

Support Not Up to Par in Some Schools and Day Care

Kaufman admits that the level of support for diabetes management provided by some schools and day care centers is unacceptable.

"In these settings, school personnel seem convinced that the easiest (and legally safest) way to respond to children with diabetes is to just say ‘no.’"

For example, families are sometimes told that school personnel cannot help younger children with testing blood glucose or administering insulin. In other cases, older children are not allowed to test their own blood-glucose levels in the classroom. In addition, Kaufman cites instances in which schools contend that nonmedical personnel cannot administer glucagon or that children with diabetes cannot participate in sports or other extracurricular activities.

"Schools need to be educated about diabetes so that they understand how easily they can facilitate good diabetes care for their students with diabetes," writes Kaufman. "For some schools, providing information about diabetes is enough. Other schools are not so easily convinced that they can or should allow diabetes management at school."

Knowledge of Legal Rights and Responsibilities

Dr. Francine Kaufman advises families of children with diabetes and their healthcare teams to "understand children's legal rights in school" and urges schools "to understand and meet their legal responsibilities." In her Clinical Diabetes commentary, Kaufman outlines three federal laws that provide protection to children with diabetes at school.

Section 504

"Section 504 is a civil rights law that prohibits recipients of federal funds from discriminating against people on the basis of disability," Kaufman explains. "It applies to all public schools and to any private schools that receive federal money."

Americans With Disabilities Act (ADA)

"The Americans With Disabilities Act is another civil rights law that protects students with disabilities. In addition to public school students, this law protects all students in private schools, unless the school is run by a religious entity." Courts have found that children with diabetes are covered by the ADA as well as by Section 504.

Individuals With Disabilities Education Act (IDEA)

"The IDEA is the federal law that funds special education services for children with disabilities." In order to qualify under the IDEA, Kaufman says, "a student's diabetes must impair his or her ability to learn so that the student requires special education."

Kaufman cites as an example a child who "frequently experiences hypoglycemia or hyperglycemia at school that significantly affects the student's ability to concentrate." She adds, however, that although some children with diabetes are covered by the IDEA, others are not, according to court rulings.

Developing Written Plans

Kaufman observes that the "best first step is to make sure that the student with diabetes, the child's family, school staff and the child's healthcare team know what is expected of them." She adds that these expectations should be committed to writing in the form of two signed documents:

• A healthcare plan that explains what medical procedures should take place at school
• A 504 Plan, Individualized Education Program (IEP) or other care plan that explains in what ways the usual school routine needs to be altered for that particular student

Kaufman suggests finalizing these documents before the school year begins or as soon as possible after diagnosis.

The healthcare plan, in particular, should set out "the basic medical needs that the child has at school and how those needs will be met."

The plan should include specific information for that child with regard to the following:

• Monitoring blood glucose
• Insulin
• Meals and snacks
• Treatment of hypoglycemia and hyperglycemia
• Exercise and sports

Fear of alienating school officials or of having their child labeled as "disabled" can make some parents reluctant to initiate action under these federal laws. However, Kaufman argues that it is important to take advantage of the legal protections.

"Schools that approach assisting students with diabetes in a more positive way will welcome written plans so that everyone understands what is supposed to happen and can act in the best interests of these students."