Safe at School (Daycare)

Unsafe at Pre-school?

Even with US Federal Law protecting their rights, American children with diabetes still face discrimination:

"Children in the school and day care setting still face discrimination. For example, some day care centers may refuse admission to children with diabetes, and children in the classroom may not be provided the assistance necessary to monitor blood glucose and administer insulin and may be prohibited from eating needed snacks." (Source: Diabetes Care in the School and Day Care Setting Diabetes Care January 2010 vol. 33 no. Supplement 1 S70-S74 )

Without any Federal legislation or national standards, how can we expect Canadian children to be safe at school and pre-school, or even meet the most basic ADA guidelines (in the absence of CDA guidelines):

  1. The school or day care provider should provide the following:

    1. Opportunities for the appropriate level of ongoing training and diabetes education for the school nurse.

    2. Training for school personnel as follows: level 1 training for all school staff members, which includes a basic overview of diabetes, typical needs of a student with diabetes, recognition of hypoglycemia and hyperglycemia, and who to contact for help; level 2 training for school staff members who have responsibility for a student or students with diabetes, which includes all content from level 1 plus recognition and treatment of hypoglycemia and hyperglycemia and required accommodations for those students; and level 3 training for a small group of school staff members who will perform student-specific routine and emergency care tasks such as blood glucose monitoring, insulin administration, and glucagon administration when a school nurse is not available to perform these tasks and which will include level 1 and 2 training as well.

    3. Immediate accessibility to the treatment of hypoglycemia by a knowledgeable adult. The student should remain supervised until appropriate treatment has been administered, and the treatment should be available as close to where the student is as possible.

    4. Accessibility to scheduled insulin at times set out in the student's DMMP as well as immediate accessibility to treatment for hyperglycemia including insulin administration as set out by the student's DMMP.

    5. A location in the school that provides privacy during blood glucose monitoring and insulin administration, if desired by the student and family, or permission for the student to check his or her blood glucose level and take appropriate action to treat hypoglycemia in the classroom or anywhere the student is in conjunction with a school activity, if indicated in the student's DMMP.

    6. School nurse and back-up trained school personnel who can check blood glucose and ketones and administer insulin, glucagon, and other medications as indicated by the student's DMMP.

    7. School nurse and back-up trained school personnel responsible for the student who will know the schedule of the student's meals and snacks and work with the parent/guardian to coordinate this schedule with that of the other students as closely as possible. This individual will also notify the parent/guardian in advance of any expected changes in the school schedule that affect the student's meal times or exercise routine and will remind young children of snack times.

    8. Permission for self-sufficient and capable students to carry equipment, supplies, medication, and snacks; to perform diabetes management tasks; and to have cell phone access to reach parent/guardian and health care provider.

    9. Permission for the student to see the school nurse and other trained school personnel upon request.

    10. Permission for the student to eat a snack anywhere, including the classroom or the school bus, if necessary to prevent or treat hypoglycemia.

    11. Permission to miss school without consequences for illness and required medical appointments to monitor the student's diabetes management. This should be an excused absence with a doctor's note, if required by usual school policy.

    12. Permission for the student to use the restroom and have access to fluids (i.e., water) as necessary.

    13. An appropriate location for insulin and/or glucagon storage, if necessary.

    14. A plan for the disposal of sharps based upon an agreement with the student's family, local ordinances, and Universal Precaution Standards.

    15. Information on serving size and caloric, carbohydrate, and fat content of foods served in the school (27).

"Toddlers and preschool-aged children: [are] unable to perform diabetes tasks independently and will need an adult to provide all aspects of diabetes care. Many of these younger children will have difficulty in recognizing hypoglycemia, so it is important that school personnel are able to recognize and provide prompt treatment. However, children in this age range can usually determine which finger to prick, can choose an injection site, and are generally cooperative."

(Source: Diabetes Care in the School and Day Care Setting Diabetes Care January 2010 vol. 33 no. Supplement 1 S70-S74 )