Students with medical needs can be supported at school through a mixture of supports and plans. Each school district or charter school can help guide parents and families for the most appropriate level of support. They can look at the Individualized Education Program (IEP), the Section 504 plan, or even an Individualized Healthcare Plan (IHP).

The key in establishing the most appropriate support will be in having open communication with school personnel regarding needs. The IHP, 504 Plan and the IEP process have a beginning step to determine the individual needs of the student. In general, the primary care doctor can help their patient by providing a detailed medical history, including specific health problems, behavioral issues, or learning issues that may interfere with the child's ability to benefit from their education.

Documentation of the specific health problems, behavioral issues, or learning issues, provided to the parent, are the most helpful. Prescribed recommendations without more information are the least helpful.

Detailed information addressing the impact of the child’s health condition or disability on their ability to learn, attend and behave in the classroom, care for themselves, and their need for special dietary or medical interventions, such as medications, interventions, equipment, or other aids. The documented details you provide will help determine your child's eligibility for Special Education, and may be a key part in the development of his/her education plan, including special dietary, personal care and medical requirements.

There is a difference among states, and even school districts, but there are minimum standards for medication administration in school; immunizations; vision, hearing and spinal curvature screening; and other health and safety policies. For information about your state, see State Education Contacts and Information.

A student may have a Health Care Plan (IHP) in addition to a Section 504 Plan or IEP at school that can help describe the medical needs and steps of care associated with this in the school setting. The Health Care Plan is developed by the school nurse and the student’s doctor, specialist or nurse.

When a student has been sick and is ready to return to the classroom, the medical team should provide documentation to the parent of the medication plan (side effects, schedule, etc.), release to return to school, treatment plans and other important information. A liaison from the medical team can help school personnel through telephone contacts and training for the specific need. The parent should ensure that the school has current information listed on the school’s emergency contact form.

The following is a suggested communication checklist of notable issues for education personnel to understand:

• Diagnoses and treatment
• Factors affecting attendance:
  • frequency of outpatient visits
  • frequency/duration of inpatient treatment
  • fatigue
• Factors affecting social interaction:
  • changes in physical appearance
  • changes in motor skills
  • medication induced mood changes
  • changes in appetite, toileting, etc.
• Factors affecting learning:
  • neuropsychological effects of treatments and medications
  • changes in fine motor skills; or changes in vision and/or hearing
  • limitations on physical activity
  • fatigue
  • headaches
  • nausea
• Factors affecting medical care:
  • medication to be administered at school
  • medications to be avoided
  • exposure to infectious diseases
  • availability of school nurse to provide emergency care and troubleshoot
• Who to contact in case of emergency

USDA regulations (7 CFR Part 15b) require substitutions or modifications in school meals for children whose disabilities restrict their diets. One way to help in this process is to ask the child’s doctor to provide a signed statement clearly defining:

• the child's disability;
• an explanation of why the disability restricts the child's diet;
• the major life activity/activities affected by the disability; and
• the food(s) to be omitted from the child's diet, and food or choice of foods that must be substituted.

Food allergies that may result in severe, life-threatening (anaphylactic) reactions meet the definition for "disability", and must also be accommodated, with your written statement. Check with the student’s school to determine the procedure for notifying the school of dietary modifications including food allergies.

For more information and a sample form see: Accommodating Children with Special Dietary Needs in the School Nutrition Programs ( 849 KB) from the U.S. Department of Agriculture, Food, and Nutrition

One role of the school nurse is to bridge the gap between the worlds of medicine/health care and education. Because of the nurse's license and educational background, he/she is the only member of the school team to adequately address the health needs and procedures that must be carried out in the school setting. Through the IHP, the school nurse can plan for, describe, implement, and ultimately have responsibility and accountability for the delivery of student nursing care at school.

The state Nurse Practice Act will provide information about limitations. School nurses should complete care plans on students who have a medical need, which may be as simple as a child taking medication for ADHD while at school or more complicated, like tracheostomy care. School nurses should also be included in the IEP process.

Depending on the child's specific needs, if there is a Health Care Plan that does not involve multiple specialties, the school nurse may complete it and provide instruction to teachers and school staff.

If the student is determined eligible for special education, a multi-disciplinary approach is needed where an IEP team will include the school nurse in planning the student's academic/health needs. The school nurse should write the Individualized Health Care Plan for the student. Check with your state school nurse association, state education agency, or school district to find the nurse for the student's school.

With the health needs in mind, nurses cannot be told what duties they can delegate (or hand over) to another person (including unlicensed personnel). The nurse has the legal license to determine what may be delegated and to whom it may be delegated. While the nurse may delegate the duty to another person, the nurse still retains the responsibility and accountability for it.

Nurses may assess, but not diagnose. Generally, state Nurse Practice Acts allows the nurse to assess the medical situation and perform or delegate a specific procedure that will be done in the school. The nurse can give advice on incorporating the health needs of a student. For more information about your state Nurse Practice Act, see Find Your Nurse Practice Act.