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Question re 504 for Kindergartner who uses Omnipod

Discussion in 'Parents of Children with Type 1' started by Snowflake, Jul 22, 2015.

  1. Snowflake

    Snowflake Approved members

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    This is probably the first of many questions I'll post as I draft a 504 plan to take to a meeting with the school where our daughter starts kindergarten next month:

    The school has already told us that with their last T1 child (a 5th grader), all bg checks were performed in the office by the health room aide, and that they want to do the same for our daughter, with no checks performed anywhere else (they gave me a b.s. line about exposing other children to blood-borne pathogens).

    I'm ok with routine testing in the health room for pre-meal bolusing etc, but it makes me nervous for times when she feels low (generally not till under 60) and also for when she's in the gym or on the playground. But because she uses the Omnipod, her diabetes bag and PDM/meter will be in the health room office all day. So, I'm thinking about proposing two things: 1. that I supply the school with a mini kit with a backup meter and a few low treatments that must go with dd any time she leaves the classroom; and 2. that anytime she feels low or the Dexcom alerts low, the teacher on site must test and treat instead of making her go to the health room.

    I'd love some advice on how others have handled this with a child who isn't old enough to self-test, and also whether my instincts on these points are "reasonable."
     
  2. mikegl31

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    Hello,

    My son was diagnosed last year 5 weeks before the start of Kindergarten. He does not wear a pump, so I can't really respond to that part of your post, but I can tell you about our experience. I feel like we were really lucky, because the nurse was outstanding, and the school was overly accommodating. I'll just list some things.

    1. The nurse came to the classroom before snack time (around 10AM) to do the BG check and to give insulin. My son went to her office on the way to the cafe before lunch to get checked. He returned to her office after finishing eating so that she could give the shot. He was escorted by a lunch aid, and he would bring his uneaten lunch with him so the nurse could estimate carbs. There was an issue with my son having to stop at the nurses office before going to lunch, because he was getting to the cafeteria after the rest of the school and was unable to sit with his friends. We spoke to the nurse about this, and she ended up pulling him out of class 5 mins prior to everyone going to lunch so that he was able to attend lunch at the same time as everyone else, and pick his own seat. He had gym around 2PM and she always checked him before gym. I believe he stopped at her office for that check.

    2. The nurse had a spare set of everything - test strips, insulin, glucagon, etc... She also had a bag of the different things we use to treat a low. My son also had his own diabetes bag with him in the classroom - and it went with him when he went to other areas of the school. In that bag was everything he could possibly need. So, there were 2 sets of everything at school at all times, and 1 set was always with my son.

    3. My son wears a Dex. The teacher in the room had a walkie-talkie. If it alerted low, the teacher would call the nurse, who would then come to the room to check and treat, if necessary.

    4. There were probably 5 or 6 times when my son could not take gym because his BG was bordering on the low end and the nurse did not feel comfortable letting him run around.

    The nurse was awesome - should would call me 3 times a week to ask my opinion on dosing, or to give me an update if he had gone low, or had been high for awhile. It got to the point that by the second half of the year, I totally trusted her with whatever decisions she made. I am very thankful for that. She did tend to run him a little higher than I would at home - especially for the first few months - and I totally understood that. But as she learned how he reacts to certain foods and activities, she got more aggressive in some of her treatments. She still always called me first just to run it by me, but 9 times out of 10, I agreed with what she wanted to do.

    I will say, I found it amazing how his numbers ran differently during school then compared to the weekend or a holiday break. At school he ran slightly higher - breakfast seemed to spike more then compared to times he wasn't in school. I guess it was excitement, or stress, or nervousness, or a combination of them all. But we played with his carb ratios, and timing of dosing, quite a bit throughout the year.

    My son's 504 is really basic. He can eat and drink in the classroom when needed, can go to the nurse or bathroom whenever needed, can participate in any and all school activities. That's about all. I know that as he gets older, the 504 will change to include assessments.

    As I said, I feel lucky with the situation we got at school. He will be in the same school next year, but unfortunately it is a different nurse (they have 1 nurse for all kindergarten classes, and then 1 nurse for grades 1-6). I am really hoping that I have the same relationship with this new nurse.

    Good luck, and if you have any questions, feel free to ask.
     
  3. Lakeman

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    Others will have more details but it is my understanding that there is a law regarding diabetes which states that testing can happen wherever it is needed.

    Always push for all cares to be given "anytime, anywhere" in written plans but then be flexible in practice so that when it is not a problem to go down to the nurses office you are a cooperative parent.
     
  4. kim5798

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    I think it is completely reasonable to have the child tested in the classroom when a low is suspected. Period. A test kit, low treatment, maybe a granola bar for good measure...

    For sake of "going with the flow" I would agree to the health room testing for pre-meal bolus. Child needs to be able to test/treat in the classroom. Teacher needs to deal. If not, they need to supply a one/one aide to assist with that.

    I'm sure others can chime in with your state's rules for treatment in the classroom. We did private school when ours was that small...teacher would test at her desk if child indicated she felt low. They had a "code" of sorts...child would touch her ear so the teacher would know she had a diabetes issue, not just a question, or need to potty type thing. Our kinder teacher was excellent in that she learned to see when the child was low by how pale she looked, etc. The teacher was better than me at that point! And we were two years in!
    One of the biggest things with school, is to be cooperative, not just demanding. I was always of the thought that I wanted them to take care of my child because they cared, not because they HAD to.

    The school has to realize that a kindergartener is not the same as a 5th grader. So things may have to be handled differently.



     
  5. jenm999

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    My son was dx in first grade, now in second, so a little older, but I thought I'd share what we do. Dex alarm is set at 80 and nurse watches via Nightscout from her office. If Dex alarms OR he feels low (no matter what the Dex says) he is to take a tablet immediately (he keeps them in his little shoulder bag) and then be escorted by an adult to the nurse for confirmation fingerstick and further testing. They don't want BG checks in the classroom either. I can't fathom why there would be an issue with having low supplies in the classroom. We are working on teaching everyone to PREVENT lows by watching the trend and avoiding the trip to the nurse entirely. Here's the little chart we gave everyone.

    Capture.PNG

    We don't bother with hot lunch because I don't want to put the burden of carb counting on the nurse, and getting through the line takes up half of the lunch period anyway. He leaves class 10 minutes early with the lunch we've packed with the carb count on a post-it and joins his class in the cafeteria.

    Snacks are no-carb, to minimize his time away from class. Once he's older and they will let him bolus himself (which he does at home) I may change that but for now it's not really about food so much as the break from schoolwork and a little social time. Usually cheese, olives, sugar-free jello, or one of those little Emerald nut packs (<3 carbs and all protein) - no allergies in his class this year but usually there are.

    Highs we don't treat outside meal times unless it's outrageous and clearly unrelated to the most recent food intake.

    Happy to email you a copy of our 504 if you'd like. Good luck!
     
  6. Snowflake

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    Thanks for the support and thoughts, everyone!

    Mike, I'm glad to hear that you've had success with your child carrying a back-up kit when he leaves the classroom, I think we will include that. It's also great to hear about your experience with the nurse. We met the school health room aide last spring, and she seems both very flexible and very sharp. I'm hoping that we can build a good line of communication with the aide no matter what's written in the 504 document. We hope to have Dexcom Share in place by the time she starts school, and it's a great idea to offer to set the health aide up with access to that.

    Jen, I like the idea of requiring that dd at least take a tab before she's escorted to the office for suspected lows, if the school won't bend on treating lows on site (although that's the one point I intend to really push hard on!) That's great that you wrote in that the escort for lows must be an adult, because in our first conversation, dd's school said that her escort would be a classmate, and it just seems like all kinds of wrong to expect another kindergartner to chaperone her when she's super low. Thanks for the offer to share your plan. I'll PM you my email address!
     
  7. dpr

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    My daughter was diagnosed the February before she started Kindergarten. She's starting 4th grade next month.

    We use a flow chart very similar to Jens and it works well.

    We did a 504 right away. Ours says checks and treatment any time anywhere. We taught the teacher and aides to check blood sugar and the nurse would come to class to bolus when she was still on injections. We feel that any time away from class is time away from what she's there for, learning. She has never even once gone to the office for anything related to diabetes. Write your 504 how you want it. If they don't call in a hazmat team to clean the playground every time a kid gets scraped or a bloody nose and send them home right away then I don't find it reasonable to make them go to the office to test. Push for what you want in your 504 and don't take the "well all the others do it that way" crap they may try and give you. Hopefully your school will be accommodating and you won't have to worry about it.

    At the beginning of First grade my daughter was coming out of the honey moon and her numbers were all over the place. The teachers aide said she did not want to be responsible for a diabetic child. So we asked for and got an aide. We had her for 2 years. All of my daughters teachers loved having all the extra help. Her 2nd grade teacher said she had the best reading scores ever because of the extra help.
     
  8. mamaberkhie

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    There are some really good ideas here. My DS is starting kindergarten this fall and I am so nervous!
     
  9. selketine

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    My son is 13 now but was dx'd at age 2 so we went through the kindergarten and early years of school with him. Absolutely getting a 504 in place in the best idea. On where and how testing is done... I think this issue is VERY situational. Our son was in public school but it was small and the kindergarten rooms were in the same hallway as the nurse's office. The teacher could literally watch him walk there but often she just sent an adult with him. He couldn't manage self-testing and treating himself those early years so it worked well for us to specify in the 504 that an adult must walk him to the health room (or eyes on him all the way). He was also allowed to eat tabs if he felt low before he went to the health room or to have a juice (we kept both in the classroom). If he seemed "out of it" - everyone knew that could be an emergency and would be treated as such (the nurse would be called to the classroom with glucose given to him in the meantime). The classroom teacher was trained on glucagon and it was kept in the classroom in case of a lockdown and she would know how to use it when on a field trip (although I did all the field trips when he was little). We never had a classroom emergency.

    I personally preferred to have the teacher(s) trained on spotting lows and giving treatment and making sure he got to the health room safely and let the nurse deal with the testing and overall management. For us this worked well until he was old enough to be able to test and treat himself and then testing in the classroom worked fine. There is no bad way of doing this and keep in mind that you can ALWAYS request a change to the doctor's orders and 504 if something is not working out AFTER your child starts the school year. These things are not set in stone by any means. DO be prepared to allow for some give and take with the school on the 504. The teachers clearly didn't want to mess with BG checks in the classroom (as he needed help and supervision - and help with what to do with that number). The school offered a very reasonable solution (adult escorts who were trained and it is a small school after all) so that worked for me.

    The way his Dexcom is now, I would probably have given the teacher a Dex receiver for her desk or pocket as he uses that. CGMS devices really weren't available when he was in kindergarten...lol!
     
  10. deedeep

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    Found this while sitting here working on my draft 504. DD is 5th grade, so much older but just Dx so novice and school is terrifying me.

    Question: When do you sit down and go over this with the school?
     
  11. susanlindstrom16

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    If you can, I would call the school and try to get an appointment to sit down with the nurse or principal now while school is out. The first few days of school is really busy for nurses so you want to have your plan in place before then. Not all staff come in during the summer but it can't hurt to try and see if anyone will be around.
     
  12. Sarah Maddie's Mom

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    The "blood borne pathogen" argument is a crock. Ask them how they manage band-aids, bloody noses etc. It's standard protocol to have a kit in the classroom and to test as needed no matter where. Here's the ADA page on your state's laws concerning schools. http://www.diabetes.org/living-with...state-laws-and-policies-display.html?state=CO
     
  13. Mymommymommy

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    Follow your gut, makes sure your comfortable with whatever the 504 says. It's MY opinion to go for the test anywhere/anytime. Our school didn't want my DD to test in class either when she started school (Kinder as well) She also was on a pump, and up until my daughter arrived at the school all diabetics tested in the office. That didn't make ME comfortable, so I didn't agree. I wanted her supplies with her at all times and her to feel free to check as needed as well as specific times like, before lunch, snack an recess.

    But like I said, follow your gut, and make sure you feel comfortable, we all have different levels of comfort and what works for us, all our kids are different. Good luck!
     
  14. keitrat

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    Even though this is not my Thread I just want to thank you all for all the advice. My DD is going to the 2nd grade and was diagnosed in Kindergarten and we have always done a 504 but I never new that I could request for those type of changes.
     
  15. selketine

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    You can ALWAYS request a change to a 504 plan if something isn't working. For example I didn't want William to test in the classroom in K because he had no idea what to do with the number and I preferred the teacher not to handle it. He could always eat some tabs and the health room was across the hall. So it was not really an issue for me. Plus I had all sorts of problems that first year just getting a nurse there to give him insulin at lunch (wow- that story is a whole other thread...lol!!). But to reassure anyone writing up a 504 right now - you can always request a change to it.

    Also make sure you know the difference between a 504 and a "health plan" - a health plan is NOT a 504. This below is taken from another website but it spells it out:

    What is the difference between an Individual Health Plan and a Section 504 Plan?

    The Individual Health Plan that your child has is a school created document that outlines what the school will do to take care of your child’s medical condition. It works well to keep our school staff informed on how to properly meet your child’s medical needs while at school.

    A 504 is a legal document for students with a disability. Students are eligible for a 504 if the team determines that one of their major life activities (learning, breathing, eating, concentrating, etc.) is substantially limited in comparison to most people. The 504 documents the things that the school will do to accommodate a child with a disability and provides legal protection to ensure that these accommodations are given to the child.
     
  16. dpr

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    Something we have in our 504 that you may or may not want to add is that any substitute teacher must have a copy of and go over my daughters 504 and medical management plan and that we must be notified asap when a substitute is coming in. Fortunately our school has been really great when it comes to diabetes. We have several friends in another school district that have had nothing but problems with their schools. One told them "oh you don't need a 504 for your daughter"..
     
    Last edited: Aug 6, 2015
  17. rgcainmd

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    I am still arguing with my daughter's school that she has a right to keep a vial of insulin with her at all times. Never thought I'd come up against this one...
     
  18. Christopher

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    Don't they realize that she already has insulin with her at all times in the Pod? What is their rationale about the vial?

    This kind of stuff drives me nuts.
     

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