School can be a challenge for some families who have children with special health care needs. For example, they must determine how their child’s nutrition plan will fit into the school day. Dietitians play an integral role in assisting families with this process.
According to the Americans with Disabilities Act, any child with a “physical or mental impairment that substantially limits one or more major life activities” is entitled to receive free and appropriate education in public schools. Major life activities affected can include speech, hearing, vision, reading, concentration, communication, cognition, and eating.
There are three different ways a child can be accommodated at school that RDs need to be aware of.
Individualized Education Program (IEP): Once a multidisciplinary team has determined that a student has a disability and requires special education and services, an IEP can be developed. Parents and school staff (including classroom teachers, therapists, intervention specialists, and school nurses) collaborate to set appropriate goals and develop a plan for the child to meet the goals set forth.
If a child’s disability affects his or her diet, the school must provide appropriate accommodations. An IEP includes such nutrition interventions as accommodations for food allergies or sensitivities, provision of an extra snack or supplement, and provision of tube feedings.
504 Plan: A 504 plan provides a description of what the school will do to provide the student with a disability access to learning.
A 504 plan differs from an IEP in a few ways. The IEP is required for qualified students by the Individuals with Disabilities Education Act, and the 504 is covered under the Rehabilitation Act of 1973. A 504 plan doesn’t require that the student undergo an evaluation, and the rules aren’t as detailed as those for an IEP.
Examples of accommodations that may be made for a student on a 504 plan include providing extra time for a test, quiet space for testing, and defined behavior interventions. There are also nutrition-related accommodations such as allowing time for a snack. Some school districts may use a 504 plan to develop a plan for managing a student’s food allergy.
Individualized Health Plan (IHP): This plan is managed by a school nurse for a child with special medical conditions that may affect his or her school day. The IHP is developed through collaboration between the school, health care providers (including RDs), and the family. The IHP may be part of an IEP.
An IHP may address the need for blood sugar management for a child with diabetes, a tube feeding schedule provided at school, hydration needs for a child with kidney disease, medications given at school, and other health care requirements that may need to be addressed to allow the child to be successful in school. RDs may be asked to complete a feeding schedule and nutrition recommendations for an IHP. The IHP needs to be signed by a physician.
The RD’s Role
RDs need to provide specific details of the nutrition plan to be provided. If a child is tube fed, the RD should list the name of the product or the tube feeding recipe, times and amounts for feedings, and guidelines for any flushes to be provided.
In the case of a child with diabetes, an RD must state the parameters for checking blood sugars and develop an action plan for high or low blood sugar. A child with cystic fibrosis requires a nutrition plan for snacks and enzyme provision.
RDs developing these plans need to remember that children are at school to learn and interact with peers, a fact that must be considered when designing a school nutrition plan with the family. The following are suggestions to develop a nutrition plan that’s best for the student:
- Minimize the child’s removal from class for feeds or a snack.
- Discuss the school day schedule with the family and the school staff to determine the best ways to meet the goals with minimal school day interruption.
- Because some children don’t like to be singled out, provide special products such as supplements in a manner that draws the least attention to the child.
- If a child is tube fed, keep in mind the child may need to be removed from class to receive the feeds and fluids; therefore, try to schedule it around planned class breaks.
- If a child requires a snack, provide multiple suggestions for how needs can be met. For example, the RD could suggest that the child either drink a 250-kcal supplement or have a snack that’s calorically similar (eg, a banana and 8 oz of milk or a granola bar and applesauce cup).
- Provide your contact information so the school staff can reach out for clarification and support.
The RD is an integral part of the child’s care team to ensure their nutrition plan fosters optimal health and the best school experience.
— Amy E. Reed, MS, RD, CSP, LD, has spent her career working in pediatrics. With more than 18 years of pediatric clinical experience, she educates families about important nutrition issues. She’s an active member of the Pediatric Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics, where she serves as the co-chair of member support. To learn more about Amy, visit her blog at www.amyreednutrition.com.