FUDiabetes

504 Accommodation Considerations for Children


#1

Today is Liam’s birthday…he’s 5 today. I told myself that on his 5th birthday, I’d begin perusing the 504 materials that Michel and Chris provided and come up with a solid list of “specific accommodations” that I know I will need to bring to the table whenever we have our March meeting with the school district regarding Liam’s 504 plan.

I thought this would be a great place to begin listing some of the accommodations so that other parents in similar circumstances can benefit from these as well. Most of these are taken from Chris/Michels 504 plans, but I’m interested in those who have “been there, done that” to add more to this list so that we can hopefully come up with an all-inclusive list of accommodations that we can bring to the table and work on negotiating for our children.

So, I’ll just list these in number bullet style format and I welcome anyone to add additional comments that I’ll add to this list and perhaps when it’s all done, we can make it a Wiki.

NOTE: I realize that some of the items below are not going to be relevant in K, 1st or 2nd, but around 3rd, 4th and 5th grades, they begin having more obligations regarding testing, homework, etc., so this is why they are included in the 504 plan for Liam…so that they are there whenever he enters those grades and has those accommodations.

Question for everyone who has gone through this: Is the 504 plan something that is reviewed and updated every year that the child is in the district? Or is it one of those things where…you better think of every possible accommodation from K to 5th grade in one fell swoop?

SPECIFIC ACCOMMODATIONS LIST

  1. The student will work with teachers on deadline extensions and/or shortening assignments if diabetes is affecting attendance ( at whatever grade homework/examinations begin ).

  2. The student may check blood sugar level before an exam. If blood sugar is not in the normal range, the student may show the blood sugar number on the meter and take the test at a later date & time. The student will arrange to take the exam at the earliest convenience ( at whatever grade homework/examinations begin ).

  3. If the student needs to take breaks to use the water fountain or restroom, check blood glucose, or to treat hypoglycemia or hyperglycemia until back to a normal blood glucose range, during a test or other activity, the student will be given extra time to finish the test or other activity without penalty (immediate accommodation request) .

  4. The student will work with teachers on deadline extensions and/or shortening assignments if diabetes is affecting attendance (immediate accommodation request) .

  5. The student shall be given instruction to help make up any classroom instruction missed due to diabetes care, without penalty (immediate accommodation request) .

  6. The student shall not be penalized for absences required for medical appointments and/or for illness.

  7. The parent/guardian will provide documentation for appointments and exceptional illness from the treating health care professional if otherwise required by school policy. This Plan will constitute appropriate documentation for absences consequent to ongoing diabetes care such as night treatment of lows and highs (immediate accommodation request) .

  8. Information on student’s diabetes (healthcare plan and 504 plan) will be included in all substitute teacher plans.

  9. A staff member trained in diabetes care will accompany the student on all field trips unless a parent/guardian is with the student (at whatever grade field trips begin).

  10. Diabetic management may be done in the classroom, or other location of students preference (except in bathroom or at a location where the student may be jostled while performing care, e.g. at a locker in the hallway during passing time.) [[This one is questionable because Liam will be too young to do this himself at first…so we need two accommodations, one for early on and one for later when he is able to manage - I’m thinking 2nd or 3rd grade maybe??? Anyone have other solutions for this that won’t take Liam out of the classroom?? I really don’t like the idea of my child missing out on important education due to needing being treated for his Diabetes.]]

  11. Student and student’s parent/guardian will work with the counselor to adjust course schedule as needed for diabetes (_at whatever grade this becomes relevant).

  12. The student may carry a cell phone at all times to be able to contact parent/guardian regarding diabetes care (immediate accommodation request) .

  13. The student may have a choice of locker location (_at whatever grade this becomes relevant).

  14. The student’s teachers and office staff will be notified of the student’s healthcare plan. Office staff will be trained on diabetes care and Glucagon administration at the beginning of each school year (immediate accommodation request) .

  15. Parent/guardian or student will notify district nurse and counselor of any extracurricular activities if desired. District nurse, parent/guardian, and the student will notify the extracurricular staff of student’s diabetes and health care plan (_at whatever grade this becomes relevant).

  16. Parent/guardian will notify district nurse and counselor of any changes in medical treatment that will affect care at school (immediate accommodation request) .

  17. School staff supervision of diabetes care as deemed needed by physician (immediate accommodation request) .

  18. The student may carry all supplies needed for diabetes care (drink, snack, glucose meter, insulin, etc.,) in a pack at all times (immediate accommodation request, although this kit, initially, will be for the teacher/nurse) .

  19. Sharps container for safe disposal of needles will be made available in last class before lunch and last class of the day (immediate accommodation request) .

  20. If the student misbehaves in any way that could lead to disciplinary measures, the student’s Blood glucose must be checked immediately to verify the student is not currently experiencing hypoglycemia or hyperglycemia (both of which alter mental states and can impact a diabetics behavior.) (immediate accommodation request) .

  21. The Student may, upon request, check his or her own Blood Glucose level at any time during class (immediate accommodation request) .

  22. If the student complains to the teacher that they “feel low”, the teacher or applicable caregiver should check the student’s blood glucose immediately and correct as necessary (immediate accommodation request) .

  23. An appropriately trained staff member will administer the lunchtime bolus and be responsible for all calculations and dosage decisions (immediate accommodation request) .

  24. The student will be permitted to carry the following diabetes supplies and equipment with him or her at all times and in all locations: Insulin, snacks (including candy or other fast carb for low corrections), water, injection equipment, glucose monitoring equipment, glucagon kit, CGM and CGM monitoring and sharing equipment including smartwatch, and/or cell phone, insulin pump and control equipment if any, carry-on bag, other supplies as needed to provide services required (immediate accommodation request) . .

  25. Diabetes supplies and equipment that are not carried by the student and additional supplies will be kept in the school nurses office and/or in the student’s locker (immediate accommodation request) .

  26. Parent/guardian is responsible for providing all diabetes supplies and food to meet the needs of the student.

  27. The school nurse will work with student and parent/guardian to coordinate a meal and snack schedule that will coincide with the schedule of classmates to the closest extent possible. The student shall eat lunch at the same time each day, or earlier if experiencing hypoglycemia (immediate accommodation request) .

  28. The student shall have enough time to finish lunch (immediate accommodation request) . .

  29. The student shall be allowed to take part or all of lunch into later classes in order to properly manage blood glucose levels (immediate accommodation request) . .

  30. A snack and fast-acting source of glucose must always be immediately available to the student.

  31. The student will be permitted to eat a snack no matter where the student is (immediate accommodation request) . .

  32. Parent/guardian will provide all snacks needed in addition too or instead of any snacks supplied to all students.

  33. The School district shall provide carbohydrate content information for all meals provided by the school to be consumed by the student (immediate accommodation request) .

  34. Parent/guardian will provide carbohydrate content information for snacks and meals brought from home (immediate accommodation request) .

  35. Adjustments to snack and meal times will be permitted in response to changes in schedule upon request by the parent/guardian (immediate accommodation request) .

  36. Students Blood Glucose will be actively monitored by staff during any physical activity and correct blood glucose as necessary (immediate accommodation request) .

  37. The student shall be permitted to have immediate access to water by keeping a water bottle in the student’s possession and at the student’s desk as well as permitting the student to use the drinking fountain without restriction (immediate accommodation request) .

  38. The student shall be permitted to use the bathroom without restriction (immediate accommodation request) .

  39. The student shall be permitted face-to-face, electronic and phone communications about diabetes care with parent/guardian and health care team without restriction (immediate accommodation request) .

  40. The student shall be provided with privacy for blood glucose monitoring and insulin administration if the student so desires (immediate accommodation request) . .

  41. If blood glucose monitoring and insulin administration are completed by a nurse or other staff member, the student shall decide whether this should be done in the classroom, or in a private setting (immediate accommodation request) .

  42. Whenever the student asks for assistance, or when any staff member believes the student is showing signs of high or low blood glucose levels, the staff member will immediately seek assistance from the school nurse while making sure another person stays with the student at all times (immediate accommodation request) . .

  43. The student with high, low, or SUSPECTED high or low, blood glucose levels should NEVER be sent alone to the nurse’s office or anywhere else. The student should have someone with them that is capable of holding up the student in the event the student loses consciousness and falls (immediate accommodation request) . .

  44. Any staff member who finds the student unconscious will immediately contact the school office. The office will immediately perform the following in the order listed (immediate accommodation request) . :

  45. Contact the school nurse who will confirm the blood glucose level with a monitor and immediately administer glucagon. Glucagon should be administered if no monitor is available.

  46. Call 911. Office staff will do whit without waiting for the school nurse to administer glucagon.

  47. Contact the student’s parent/guardian and physician at the emergency numbers provided._

  48. School staff including physical education instructors and coaches will provide a safe location for the storage of the student’s insulin pump and other monitoring electronics if the student chooses not to wear it/them during physical activity or any other activity (at whatever grade this becomes relevant).

  49. The student shall be permitted to participate in all school-sponsored field trips and extracurricular activities (such as sports, clubs, and enrichment programs) without restriction and with all the accommodations and modifications, including necessary supervision by identified school personnel (immediate accommodation request) .

  50. The student’s parent/guardian will not be required to accompany the student on field trips or any other school activity.

  51. If the student’s parent/guardian desires to accompany their student as a chaperone on any field trip or extracurricular activity, they will be permitted to do so and they will serve as the sole caregivers for the student and make all necessary decisions for their child during these events (immediate accommodation request) .

  52. The school nurse will be available on-site at all school-sponsored field trips and extracurricular activities.

  53. The school nurse will provide all usual aspects of diabetes care (including, but not limited to, blood glucose monitoring, responding to hyperglycemia and hypoglycemia, providing snacks and access to water and restrooms, and administering insulin and glucagon) and will ensure that the student’s diabetes supplies travel with the student (immediate accommodation request) .

  54. The school nurse and anyone else privy to the child’s diabetes will keep the student’s diabetes confidential, except to the extent that the student decides to openly communicate about it with others.

  55. The student shall be treated in such a way that does not isolate, singularize or stigmatize; rather, deal with diabetes treatment as the normal day-to-day activity that it is (immediate accommodation request) .

  56. Teachers and/or the school nurse will provide reasonable notice to the parent/guardian when there will be a change in planned activities such as exercise, playground time, field trips, parties, or lunch schedule, so that the lunch, snack plan, and insulin dosage can be adjusted accordingly (immediate accommodation request) .

  57. Every substitute teacher and substitute school nurse will be provided with written instructions regarding the student’s diabetes care and a be provided with a list of all school nurses, office numbers and phone numbers (immediate accommodation request) .

  58. In the event of emergency evacuations or shelter-in-place situations (whether planned or naturally occurring due to a specific threat), the student’s 504 plan will remain in full force and effect (immediate accommodation request) .

  59. During an emergency drill or shelter-in-place situation, the teacher or nurse will ensure they keep the student’s diabetes kit with them at all times (immediate accommodation request) .

  60. Parent/guardian should be notified immediately in any of the following situations ***(immediate accommodation request)

    • Symptoms of severe low blood sugar such as extreme tiredness, seizure, or loss of consciousness
    • Student’s blood glucose test results are below 55 or remain below 60 15 minutes after consuming juice, glucose tablets or other fast-acting carbohydrates.
    • Symptoms of severe high blood sugar such as the presence of ketones, vomiting or blood glucose level above 350.
    • Student refuses to eat or take insulin injection or bolus
    • Any injury
    • Insulin injection device or pump malfunctions that cannot be remedied
    • Continuous Glucose Monitor “Sensor” or “Transmitter” come off of the student’s body.

These are all of the accommodations that I extracted (and some I created) from the documents that were provided to me. I would love to hear more suggestions - especially for young children in Elementary school.

Thanks!


#2

Just a suggestion on format. Could you number or letter each bullet item? Then when people comment, it is easier to track back to your list.

I don’t have D kids, but interested in following this.


#3

Sure. I can do that! Thx for the suggestion!


#4

Done


#5

Wow! That is super comprehensive. I had an IEP going through school, though I don’t think diabetes was ever formally accommodated, which it probably should have been. We had two IEP meetings per year to update the document, and that’s still how things are today with IEPs, but I’m not sure if 504 plans are the same.

Do most schools in the US have school-based nurses? Here we don’t have school-based nurses. Instead, nurses train specific school staff members (often educational assistants) on things like insulin, glucagon, EpiPens, feeding tubes, seizures. When I had field trips as a kid, a school staff member (I had a full-time aide for my visual impairment, so it ended up being her) supervised all diabetes-related tasks and contacted my parents for dosing decisions.

The only thing I can think of adding is that I’d probably want the school to contact you in the instance of vomiting.


#6

Bullet number 60, 3rd sub bullet.


#7

Ah, I missed that!


#8

Yes. Every school has a nurse’s office… At least to my knowledge. We also use IEP for our son with autism so I am familiar with that process. The difference is that IEPs (in my experience) has more to do with the way the child is going to be taught, the educational exceptions, alternative learning curriculum, etc but 504 is more tailored to treating every child in as similar a manner as any child that has no medical need… So 504 is the document (backed by Federal law) where parents and schools negotiate for the medical care of child.


#9

Here is a good site that describes the differences between an IEP and a 504 plan (in the US).

(the video is especially good at explaining the differences)

To qualify for IEP, a student must fall under one of 13 categories:

There are 13 categories of special education as defined by the Individuals with Disabilities Education Act (IDEA). In order to qualify for special education, the IEP team must determine that a child has one of the following:

  • Autism
  • Blindness
  • Deafness
  • Emotional Disturbance
  • Hearing Impairment
  • Intellectual Disability
  • Multiple Disabilities
  • Orthopedic Impairment
  • Other Health Impaired
  • Specific Learning Disability
  • Speech or Language Impairment
  • Traumatic Brain Injury
  • Visual Impairment

#10

Thanks for that information - interesting how different the systems are at times. I don’t think we have anything equivalent to a 504 plan here, but school districts do have documented strategies for dealing with common medical conditions, and parents can work with a school to cover more uncommon ones.

So I don’t think I’ll be much help with the 504 plan specifically, but if you have any questions about experiences going through elementary and high school with diabetes, I’d be glad to contribute.


#11

Anything you found beneficial / helpful that you think could be fit into such a plan I’d definitely be interested in learning about.

Example questions to consider: What did I need that I didn’t have? What do I wish could have been done differently, or better? How was my learning experience different/worse/better than my peers? What could be changed to make it better if it was worse in some ways? What exceptions do I wish I had had? What things did I have to endure that I wish I hadn’t had to endure because of my diabetes? What things made me feel bad? Good? What things should schools add, remove, amend in their working with children with diabetes?

All these kinds of questions, when considered and examined, may help to formulate additional 504 criteria.


#12

First, happy birthday! :tada:

Anyways,

I am a little curious about why this would be necessary. I can’t imagine how my schooling experience would have changed if my locker was located elsewhere.

The school nurse will be available on-site at all school-sponsored field trips and extracurricular activities.

This wouldn’t have worked for me for field trips as, with the exception of maybe 3rd-5th grade, I was never the only T1 at my school, and obviously the nurse had to also be available to them. I do recognize that you have quite a few different statements about someone supervising on field trips to cover your bases though :grin:


#13

lol. I’m curious about this one too! I sent @Chris a PM this morning to ask him this very question. So we’ll learn together! Maybe it has to do with the child being able to choose their proximity to their classes? Not sure, though!

And thanks for the birthday wishes!!!


#14

I wondered about the nurse on field trips, too. I also wasn’t the only student with Type 1 in elementary or high school. Plus these days there are so many kids with medical needs; it would not be uncommon today to have an elementary school with several kids with diabetes, several with anaphylaxis, several with asthma, several with epilepsy, a few with feeding tubes, and one on a ventilator. I think this is partly why schools here have moved away from school-based nursing to training staff members who are with the students all day, though that’s just a guess on my part.


#15

I answered in more detail to the message you sent, but our son’s junior high and high school are not compact buildings. They are very long winding buildings. We did this, because the first year his locker was nowhere near any of his classes, he would have had to go to a different campus (5 minute walk each way) to access his locker.


#17

Since I’m at home right now, I asked my mom and she suggests

  • Ask for a day to train the staff
  • (Potentially) Ask for teacher selection based on past experience with diabetic students
  • Require that CGM alarms be left on (child not going low is more important than class not getting distracted)

And she thinks the most important thing is to develop a cooperative working relationship with the school


#18

And what level of training is recommended? i.e., they aren’t going to want to, or be capable of, doing things like changing PODs or CGMs, correct? Basically, checking BG, administering insulin via the PDM, Glucogon and that sort of thing?


#19

She said #1 is recognizing lows, then stuff like glucagon, carb counting, checking BG, and administering insulin.

Also, when I was young she used to come in and read a picture book to the class about diabetes (I do believe it was “Taking Diabetes to School”) and it was nice to have my classmates have some basic level of knowledge about diabetes without me having to figure out how to explain it to them. Not really 504 specific but just a general “school” thing :stuck_out_tongue:


#20

Yes! I was thinking about offering up my services to educate the class in a manner that is age appropriate, entertaining and helps them understand what T1 Diabetes is…and especially enforce in them that “Diabetes is not from eating too much sugar”…which is a typical falsehood that folks have in their heads about this disease. He was breastfeeding when he got it! Also it’s a good time to just answer any questions they may have so that there aren’t any other misconceptions about the disease.


#21

I think in terms of staff training, there are two different levels. There are staff who will be expected to supervise or help the student with diabetes-related tasks. These staff members should get detailed training in things like how to measure insulin (not how to determine doses, just measure) and how to test BG.

But then there’s the general “awareness” training that I think all staff members should receive. Things like this is what Type 1 diabetes is, this is how it affects the body, this is how it affects behaviour, these are some things you may see this student doing, these are some things you can do (or not do) to help.

I think teacher training is the biggest thing that could have gone better in my school experience. I think it was partly ignored because I had other educational needs that superseded diabetes. But, for example, I had one French teacher stand up on the first day of class and announce that I woud be permitted to eat because I had diabetes. Well, that’s great that I’m permitted to eat, but that really was not the best way of handling the situation. And that same year (I think) I had a science teacher absolutely flip out and scream at me to get out of the room because I started eating a snack during a dissection. Okay, he was freaking out for my own safety, but that also probably wasn’t the best way to handle the situation.

I think if there had been some sort of general awareness presentation to all teachers about the fact that I would be permitted to eat in class (and other accommodations) and suggestions on how to explain to the class why some students were allowed to eat when most were not, and how to handle specific circumstances like the science experiment (remember to approach me ahead of time and tell me it wasn’t safe to eat in the classroom during that class and I’d need to wash my hands well and go out in the hall to eat and then come back) would have been very helpful.