From New York, USA:
My son who is 13 years old was diagnosed 5 years ago. He wants to attend a school field trip to Boston, which will end up being 4 nights and 5 days. When I asked at the parents' meeting who would be going on the trip that is medically certified to distribute medication, I was told that one spouse of a teacher had First Aid, and another spouse used to be an Emergency Medical Technician! Well, that wasn't the answer I was looking for. To make a long story short, the school suggested that if I feel so uncomfortable with my child going, I could go with him on the trip! Isn't there something written in the antidiscrimination laws that it is illegal for school to make a parent attend a school outing instead of providing the correct medical personnel? A medical form was also sent home that said he could not carry any of his "medical supplies" with him, that an adult would have to carry them. I don't want to have to tell my son that he cannot attend the trip with his friends.
As the parent of a child with diabetes, I am acutely sensitive to any form of discrimination my daughter might face due to her diabetes. I am also aware of the very real budgetary limitations that schools and other institutions face. While I will argue to my last breath for her right to test in the classroom and inject insulin as needed at school, I also understand that there will be times when my wife or I must assist the school. The laws are about reasonable accommodation, and that means that sometimes we as parents must make the accommodation.
In the case of your son's five-day field trip, I do not believe that it is reasonable to insist that your school provide a doctor or nurse to accompany your son. Not one of my daughter's teachers has ever been "medically certified to distribute medication," yet each has learned to identify hypoglycemia, treat it with emergency glucose stored in the classroom, and contact my wife or I via pager. And my daughter can inject her own insulin if needed.
I would take strong exception to the school's statement that your son is not allowed to carry his blood testing supplies, insulin, emergency glucose, glucagon and ketone test strips (preferably foil wrapped!) with him. That is foolish and dangerous. If he doesn't yet have a carrying case for his diabetes supplies, get one for him. There are many on the market that will easily hold five to six days of supplies. And if you don't yet use a pen injector, get one. They are perfect for a quick injection. (You'll likely need two: one for short acting and one for long acting.)
You will also need to provide your son with a way to contact you any time he needs to. If you don't already have a pager, you should get one. A simple numeric pager is fine and is quite inexpensive. Give him a pre-paid long-distance card so that he won't need to carry change. Ask him to call in his blood sugar readings whenever you feel he should, such as before breakfast and dinner and before bedtime. Be sure that he wears some kind of medical identification and be sure that the adults on the trip have all of your emergency contact numbers.
Will everything be perfect? Probably not. Will your son experience low and high blood sugars? Almost certainly. Will he learn to deal with it? Yes. Will you be scared? Absolutely.
Based on my experience at summer camps, the separation is often harder on the parents than the kids. My advice, as the parent of a child with diabetes, it to use this as an opportunity to relax the reigns a little on your son and give him an opportunity to grow.
Additional comments from Dr. Lebinger:These out of town overnight trips often pose many problems, not just medical. For instance, what does the family do who can't afford the expense of such a trip? Is their child entitled to a free trip?
I don't know what the "letter of the law" is, but I agree that it is not realistic to expect the school to send along a doctor or nurse. If you do not feel your child is capable of accepting the responsibility of testing his blood sugar, giving his own insulin, and following his diet, I think it is reasonable for a parent to go with him. (If he is not capable of accepting this responsibility, you should not send him alone.)
I would suggest you sit down with the school and discuss your child's needs. He definitely should be allowed to carry his own meter, strips, and some food with him at all times. You should send along glucagon even if no one knows how to give it in case of an emergency. It doesn't make sense for him to carry it, as if he needed it, he couldn't give it himself or tell anyone where it was. In case of a severe low blood sugar, it helps to have glucagon readily available if emergency help is called.
I think you should discuss with the school and your child how the insulin should be carried. Your child might not want to carry around his own insulin. It might be a better idea for a responsible adult to be in charge of carrying the insulin and making sure it is not left on a hot parked bus for hours where it could be exposed to severe heat and spoil. You should also make sure your child does not dispose of the syringes in the motel room or public bathroom. Even if he does carry his own insulin supplies, it would be a good idea to make sure an adult has an extra set of supplies and prescriptions in case he loses them. If the class will be eating out in restaurants or picnicking and your child will need to take insulin before the meal, you should make sure to work out a plan in advance that is acceptable to your child and the adults where he will give his insulin (Some teenagers are too embarrassed to give their insulin in public places, including their own motel room if they are sharing it with other teenagers). It is not unreasonable for the school to insist that they watch him actually give his insulin to make sure he doesn't forget to give it during the excitement of the trip.
Although I agree, neither you nor the school should panic if he has some highs or lows, you need to make it very clear to them what an "emergency" is, (vomiting, ketones, fever). They should feel free to contact you for any question at all. It might be good to set up a time agreed upon before the trip where either your child or an adult calls you with a daily report.
Boston has many excellent Pediatric diabetes specialists. You might ask your own local doctor to recommend the name of one he/or she may knows in case of an emergency and give the name and number to the school.
Keep in mind, that although it is important to help your child learn to control his diabetes so he can participate in all school activities, you should not give your child more responsibility than he is capable of accepting. A trip like this can also be an excellent opportunity to motivate a teenager to learn more about his diabetes and start taking more responsibility.
Good luck and I hope your son can go on the trip!
Last Updated: Tuesday April 06, 2010 15:08:54
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