Diabetes care plan for children attending a child care center or school

Federal laws protect children with diabetes from discrimination in schools and child care settings. Schools and child care centers must provide reasonable help for the special needs of children with diabetes while disrupting the usual routine as little as possible. In addition, children should be allowed to participate in all school activities.¹

If your child has diabetes, work with your child care center or school to develop a care plan that meets your child's needs and gives specific instructions for how to handle the following:¹

• Blood sugar testing. Include how often and in what situations your child's blood sugar needs testing. For example, your child may need routine testing before lunch and special testing if he or she appears to have low blood sugar.
• Insulin injections, if needed. Include information on how to give an insulin injection, how much medicine to give, and how to store insulin.
• Meals and snacks. Make a list of foods your child can eat, how much, and when. Talk with the staff about what to do when there are parties at the facility.
• Symptoms of and treatment for low blood sugar. Use the information found under Dealing with low blood sugar level (hypoglycemia) emergencies for people taking insulin in the Home Treatment section of this topic. Give the staff copies of this information for later reference, and tell them how your child acts when his or her blood sugar level is low.
• Symptoms of and treatment for high blood sugar. Use the information found under Dealing with high blood sugar level (hyperglycemia) emergencies in the Home Treatment section of this topic. Give the staff copies of the information for later reference, and tell them how your child acts when his or her blood sugar level is high.
• Testing ketones. Include instructions on how to test your child's urine for ketones and what to do if ketones are present.
• Contact persons. Include how to contact both parents or another adult who cares for the child as well as the name and phone number of the child's doctor.

You may hear a care plan called a "504" plan. 504 refers to Section 504 of the Rehabilitation Act of 1973, the Individuals with Disabilities Education Act of 1991, and the Americans with Disabilities Act. These are laws that protect people with disabilities. It means that schools that have federal funding cannot discriminate against children with disabilities, and that includes children with diabetes.¹ You can find a sample 504 care plan on the American Diabetes Association's Web site.

You will need to give the staff all of the materials and equipment they need to care for your child, including supplies to do a home blood sugar test, insulin, syringes, glucagon (if it's in the care plan), and materials for testing urine for ketones. And you need to teach the staff how to use these materials. Remind the staff that your child needs access to the materials and equipment at all times, even on a field trip. Occasionally check the expiration dates of supplies your child has at school.

The child care center or school should provide safe storage for your child's medicines. In addition, they should provide a private place for your child to receive care, if desired.

The child care center or school should provide an adult staff member and a backup person who are:¹

• Able to test your child's blood sugar level, record the results, and take the correct action for high or low blood sugar levels.
• Trained to give insulin and glucagon, if needed.
• Able to test your child's urine for blood or ketones and know what to do if the results are not normal.
• Aware of your child's meal and snack schedule and can remind your child when it is time to eat again.

In addition, your child should have permission to:

• Eat a snack anywhere, including the classroom and school bus. Make sure this is in the diabetes care plan.
• Use the restroom and drink liquids as needed.
• See school health personnel whenever he or she requests.
• Miss school without consequences for medical appointments.

If your child can perform a blood sugar test, let the staff know that your child may need help when his or her blood sugar level is low and may need to be reminded to eat or drink something during these times.

A child should never be left alone when his or her blood sugar level is low.

Contact the American Diabetes Association for a sample diabetes care plan and other information for teachers and child care providers.

For older children who take their own insulin to school, check the school rules for kids carrying their own medicine, needles, and blood sugar meters. Many schools do not allow kids to carry any kind of medicine without special permission.

Citations

1. American Diabetes Association (2006). Diabetes care in the school and day care setting. Clinical Practice Recommendations 2006. Diabetes Care, 29(Suppl 1): S49–S55.