Sending a child to school after a diabetes diagnosis can be an anxious time for parents and children. It is important that you work with the school and ensure they understand the condition and how they need to act. Good communication between parents and the school is key.
Below are some tips that will help you get started.
What can parents do to prepare for back to school?
- Talk to the hospital staff if you have concerns, the dietitian will be able to offer helpful advice about suitable school lunches, snack ideas and what to eat around exercise and play time. The nurse will help with tips on when to blood glucose monitor in school, what advice to give to the teacher and what to do if insulin is administered in school.
- Talk to the school principal and class teacher. Remember you are the expert on your own child’s diabetes, the school may never before have had a child with diabetes so there is a lot they will need to know. Arrange time so that you can explain to them what diabetes is and how your child is managed. If they are familiar with diabetes and have dealt with your child’s diabetes before they will still need an update after the summer as things can change. This is especially important if the child is moving on to a new class teacher.
- Talk to your child, make sure that they understand the importance of eating their lunch and snack, make sure they know that they need to eat extra on days of activity, be satisfied that they will inform the teacher if and when they feel unwell and talk to them about how they feel about testing blood glucose and/or giving insulin in school.
- Provide verbal and written information to the school on what to do if your child has a low blood sugar reading (becomes hypoglycaemic ‘hypo’) in school. Provide a pack with food and drink that you use to treat a hypo and written instructions on how much to give.
- Provide contact details for you and other carers in case of emergency.
School Resource Pack
- Ensure the school have a copy of our School Resource Pack. Every school in Ireland was issued with a pack.
- The whole pack containing information on diabetes, asthma, epilepsy and allergies is available to download here – School Resource Pack.
- As part of the pack there is forms and emergency plans to be filled in. These forms are available here – School Resource pack plan & forms
- We also advise your child’s teacher has a copy of Your Student With Diabetes Booklet.
What can schools do to support a child with diabetes?
- Talk to parents, to ensure that you as a teacher/principal understands the diabetes condition and how to manage it in school. In particular, be satisfied that you have all the information you need to recognise and treat a hypo (Agree emergency treatment plan section on resource pack).
- Talk to all staff, it is not only the class teacher that needs to be aware of the needs of a child with diabetes. Teachers on yard supervision, special needs assistants and learning support teachers should all be informed of who the child with diabetes is, what the signs of a low blood glucose are and how to treat it.
- Develop a healthy eating policy in the school. The presence of a healthy eating policy ensures that all children eat well at school and this makes it easier for the child with diabetes to do the same. Healthy Eating and lots of activity should be encouraged for all school children as it prevents the development of childhood obesity and possibly type 2 diabetes in later life.
- Incorporate the management of hypoglycaemia into your Health and Safety Policy, this ensures that everyone knows what to do and when to do it.
- Develop a mechanism of feedback between home and school i.e. a notebook which documents food eaten, activity done, episodes of low blood glucose and how they were treated. This can then also be used at home so that parents can inform school of changes or missed breakfast which might increase the risk of hypoglycaemia in school.
- Inform parents in advance when there are games, PE, sports days on in school as they will need to provide the child with extra food or snacks on these days.
Information for Schools on hypoglycaemia and how to treat it.
Firstly, school staff should know what causes hypoglycaemia.
Some common causes of low blood glucose levels in school include;
- Breakfast only half eaten or skipped altogether
- Unplanned games or activities without extra food to eat
- Snack or lunch not eaten
- Lunch time delayed for some reason
- Excitement or unusual levels of activity
- Too much insulin given.
Remember, prevention is best, when teachers are aware of what might cause a low blood sugar they are more like to check that food is eaten or monitor child’s behaviour after exercise.
Secondly, school staff should know the symptoms of hypoglycaemia.
In particular they should be informed of how each individual child typically behaves when blood glucose levels are low (as this can be different for every child with diabetes). The following are some of the signs but remember all children may not have these signs and sometimes the child themselves might not be aware so it is important that the teacher knows what to look out for:
- Cold, clammy, pale
- Shaking, staggering
- Irritable, poor behaviour
- Lack of concentration, drifting off, sleepy.
Some children may also complain of hunger, headache, tummy ache or nausea.
Treating a hypo in School
Always have suitable items in school to treat a low blood glucose. These items should be kept in the classroom and in the first aid box and should be replaced whenever used.
This low blood glucose is an emergency situation and should be treated the moment it is noticed. It can develop without warning and can progress to a serious stage quite quickly. The good news is that it can be treated simply and effectively by giving some rapidly absorbed carbohydrate to the child.
Once the low blood glucose has been corrected the child should then eat their snack or lunch to prevent it from happening again.
Inform parents and try to establish why it might have happened, to prevent re-occurrence.
You should provide your child’s school with:
- Information about your child’s diabetes
- Supplies (Lucozade) in case your child’s blood glucose goes low (hypoglycaemia or ‘hypo’)
- Information about your child’s meal or snack schedule – which you should organise to fit with school timetable.
- Permission for your child to take part in all the same activities as their classmates, unless there is unplanned vigorous physical activity when there should be something else for your child to do.
- Details about who the school should contact and what they should do if your child is unwell or there is an emergency.
The school should provide your child with:
- Immediate access to treatment of a low blood glucose when needed – you should explain to the school at the beginning of the year when this might necessary.
- Some place in school where your child can have privacy when testing their blood glucose or administering insulin, and where they can store their diabetes equipment.
- A named person to remind young children to have a snack, a drink, or a visit to the bathroom, without repercussions.
- Permission for your child to miss school, without consequences, for medical appointments.
- Details on their policy for handling an emergency in relation to your child’s diabetes.
Remember the best way to ensure that school is a happy and safe place for the child with diabetes is by talking to the relevant parties and preventing problems before they arise. The more people know and understand about the condition, the less likely it is that fear will prevent the right response and misunderstandings are less likely if there is regular communication between school and home.
Tips for top control
- Enlist the help of teachers to supervise younger children.
- Stress the importance of eating starchy carbohydrates – it’s difficult when all most children want to do is run out and play.
- Discourage swapping foods with other children until your child is able to make a sensible swap.
- Most children will need a snack when they come in from school or an early dinner.
Quantities will depend on the age of the child and their activity levels but as for all children a healthy sandwich with varied fillings (meat, chicken, tuna) and salad and fruit and yogurt make for a healthy lunch box idea.
Milk or water are always the best choice for a drink and all children including those with diabetes should be discouraged from fizzy drinks or high sugar drinks in school. Fruit and yogurt are good ideas for extras and try to avoid biscuits and crisps for the school lunch box. These foods should be treat foods and kept for home where quantity can be monitored and they can be timed around activity. These basic habits for school lunch are good for all children, not just the child with diabetes
Ideas for school lunches
Children with diabetes, like all other children, need a good, healthy, well-balanced and appetising lunch to get them through the day. Lunch should provide approximately one third of your child’s daily food requirements.
A healthy lunch should include an item from each of the following groups:
Bread, cereals and potato group
These carbohydrates should take up most of the lunch box space (for example, bread, crackers, rolls, baps, pitta bread, rice and pasta.
Fruit and vegetables group
These foods provide a rich source of vitamins and minerals (for example, fresh fruit, tomatoes, lettuce, cucumber, mini boxes of raisins or dried fruit, small tin of fruit in fruit juice.
Milk, cheese and yogurt group
This group contains calcium-rich foods, important for healthy bones and teeth, for example, cheese slices, triangles and strings and yogurt – check with your dietitian. Also include a carton of milk.
Meat, fish and alternatives
This group contains protein rich foods important for growth, for example, tinned tuna, sliced ham or beef, chicken, corned beef, eggs, cheese, and peanut butter.
One week menu plan
Here are some suggestions for including a variety of tasty and nutritious foods from Monday to Friday, including foods that could be taken as mid-morning or afternoon snacks.
- Monday: Wholemeal bap with sliced ham, one nectarine, one yogurt, one sugar free juice, and a packet of popcorn.
- Tuesday: Pitta pocket with sliced chicken and lettuce, a little salad cream, two satsumas, two digestive biscuits, one triangle cheese, one sugar-free juice.
- Wednesday: Wholemeal bread with Tuna and sweetcorn, a little mayonnaise, one apple, one slice fruit brack, a small carton milk.
- Thursday: Brown roll with sliced beef or pate and tomato, one yogurt, one banana, one packet of crisps, one bottle of water.
- Friday: Sandwiches (one brown and one white bread slice), cheese and pickle, one melon slice or small bunch of grapes, one mini chocolate bar and one sugar-free juice.
Remember: If your child takes part in a lot of activities or sports after school, remember to include an extra sandwich or snack on those days. You may need to discuss this further with your dietitian.
You will also need to make sure they have some quick-acting carbohydrate to hand in case of a hypo. It is also a good idea to leave an emergency pack with the teacher such as glucose tablets or a full sugar drink.
With all these ideas and variety your child will be asking for a packed lunch at the weekend too!