As children head back to school, parents are racing to stores to shop for clothes, backpacks and supplies. However, for some children, school nutrition goes far beyond finding the perfect superhero lunch box. Some medically complex children require nutrition support—nutrients provided either enterally (via a feeding tube) and/or parenterally (intravenously)—in order to prevent or treat malnutrition. These nutritional therapies are necessary to allow these young students to remain stable and productive during the school day.

To date, nutrition support in school settings has been difficult to manage due to a lack of: standardized guidelines or understanding by the school staff. But a new report by the American Society for Parenteral and Enteral Nutrition (ASPEN), Resources for the Provision of Nutrition Support to Children in Educational Environments, is intended to aid healthcare professionals involved in the oversight of nutrition support in the education setting.

Many medically complex children require a combination of nutrition therapies due to an underlying medical condition, such as short bowel syndrome, intestinal malabsorption, oropharyngeal-esophageal disease, gastrointestinal dysmotility, congenital disorders, and neurodevelopmental diseases. For parents, ensuring that their children receive this type of support outside of a hospital setting—in the home, for example—is challenging enough, but they manage. Shifting this type of intense care into a school setting, however, creates a whole new set of obstacles, both physical and emotional. No student wants to feel that they are “different.” But those requiring nutrition support may have a device that is visible to their peers. Some may not even eat when they are in the lunchroom. These perceived differences could then create anxiety and a fear of stigma.

To address these concerns, ASPEN emphasizes the importance of a close partnership between parents, the medical care team, and school district representatives in order to provide both a safe and optimal educational experience for the child. With the understanding that every child is unique, ASPEN recommends that parents work closely with the school to come up with an individualized care plan or a 504 plan (a civil rights statute requiring that the needs of students with disabilities are met as well as those of nondisabled students) to ensure a meaningful educational experience. While such plans typically focus on the educational needs of a child, a health plan can and should be incorporated.

According to the report, there are seven key needs that should be considered when creating a plan for each child:

  • Minimizing time away from classroom learning – Schedule interventions during natural transition times between activities or classes to minimize the time away from classroom instruction.
  • Designating a location to receive care – A child’s safety and privacy must be considered when determining an appropriate space for receiving care.
  • Ongoing monitoring – Teachers and school personnel need to be trained to recognize the adverse signs and symptoms of common conditions such as dehydration or hypoglycemia and know how to respond accordingly.
  • Special attention/planning for physical education, recess, and extracurricular activities – Many devices that infuse nutrition are hidden under clothing and are not noticeable. However, they are easily damaged, especially during physical activity. Special precautions should be taken during gym class and other active times during the school day to ensure devices stay intact.
  • Emotional and social support – Teachers should try to normalize a child’s nutritional therapy whenever possible. Planning ahead for any uncomfortable situation can make a big difference. For instance, if a child cannot eat lunch with the rest of the class, come up with a fun alternative rather than having him or her kept isolated.
  • Proper storage conditions for nutrition support solutions and equipment – The availability to properly store nutrition supplies such as formulas and syringes must be taken into consideration.
  • Education of classmates – Help other children in the class understand their peer’s need for nutrition support. Depending on the age of the children, tailor the learning with books, illustrations or dolls with devices.

Once the plan is in place, there needs to be assurance that the facility and faculty are prepared to administer care properly. Ensuring protocols are in place is imperative to delivering quality care. Having a set of physician orders on file that details how care is to be administered is the first step, followed by established school policies, education materials and instructions on administering care that includes everything from proper hand hygiene to feeding positioning. 

Delegation of responsibilities is also key. More than likely, the school nurse will be in charge of determining who performs which tasks related to nutrition support. And, though non-medical personnel may, at times, provide the therapy, anyone doing so must have the proper training and supervision.

Finally, the report covers best practices for monitoring and addressing complications that may arise with the most common devices used in parenteral and enteral nutrition therapies. It outlines the most frequent adverse complications, lists signs and symptoms and provides best-practice action items for immediate response.

All children, regardless of their medical challenges, have a right to a quality education in a safe environment. With more information and direction now available for parents, health providers and educators, we can ensure that children requiring nutrition support not only live, but also learn and thrive. 

The full report is available here.

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