Christopher Rodriguez should have started kindergarten last year at PS 28 in the Bronx, but he's starting a year late.
When his mother, Marileida Rojas, tried to enroll him in 2008, she was told Mount Hope Elementary School did not have the resources to care for Christopher, who has type 1 diabetes and was too young to recognize when his blood sugar was slipping dangerously low.
Though Rojas said she'd quit her job and come help, the administration suggested she send her son to another school that could better serve his needs.
Rojas' son now attends PS 28, but it has taken lengthy negotiations with a system that doesn't speak her language and quitting her job to get her son into his neighborhood school, she says through a translator.
Although more schools have fewer full-time nurses while, experts say, there is an increasing number of children being diagnosed with both type 1 and type 2 diabetes, many schools are successfully adapting to the needs of these kids, which the federal Americans with Disabilities Act requires they do, says attorney Ed Kraus, an associate professor at Chicago Kent Law School who works with the American Diabetes Association (ADA). Yet, too many schools are still falling short, he says.
A team approach
He says to reroute a child to another school, away from his friends and siblings, because of a health condition is discrimination. Still, some schools feel pressured and unprepared to serve the constant monitoring needs of a child with diabetes.
According to the ADA, 186,300 people under 20 have type 1 or type 2 diabetes -- when the body either does not properly make or process the hormone insulin. About one in every 440 children and adolescents have diabetes.
The reductions in school nurses are adding to that pressure, says nurse Karen Johnson, a diabetes educator and wellness coach for diabetes website Fit4D.com.
According to 2007 National Center for Education Statistics, 30% of schools have a part-time nurse, and 25% have no nurse.
"That whole model that any medical need a child has is handled by the nurse is no longer in place in most schools," Kraus says.
Making inquiries, Rojas eventually learned that though PS 28 does not have a school nurse, a Montefiore Hospital satellite medical clinic for students is housed right in the PS 28 building. Spanish-speaking staff there told her they could help Christopher, who now visits the clinic as many as four times a day for blood sugar checks, insulin and snacks if needed, says nurse practitioner Jacqueline Kelderhouse with Montefiore's School Health Program there.
After a dangerously low blood-sugar episode in the first few weeks of school, clinic staff requested that the child be provided a paraprofessional, a trained non-medical staffer who could shadow Christopher daily until he is mature enough to monitor himself. The school came through five weeks later.
Students with diabetes benefit from a team approach, says endocrinologist Frederick Schwenk, a professor of pediatrics at Mayo College of Medicine in Rochester, Minn. He says multiple staff members -- everyone from cafeteria workers and bus drivers to gym teachers and the principal -- should know about a child's medical condition and what to do in case of an emergency.
The ADA has a Safe at School Campaign to help families and schools create support plans. And Kraus says some states have laws that protect a student's well-being beyond federal requirements.
"In North Carolina, two people in each school must be trained to serve a child with diabetes, in case one is absent," says nurse Jean Litton, a diabetes educator with Duke Medical Center's Pediatric Diabetes Program.
Other schools more amenable
Not all parents have to battle it out with their school systems to get the care their child needs.
Miranda Rudd says she has confidence in her son's school. Nicholas, 10, has type 1 diabetes and is a fifth-grader at Franklinton (N.C.) Elementary School. When he came to the school in second grade, the nurse and staff were very willing to help, Rudd says.
"Even as his medication routine has changed over the past two years, they've adapted to his needs," Rudd says.
"They have three first responders, teachers who are certified and I know them pretty well. One of them comes every day at 11:30, 15 minutes before lunchtime, and pulls Nicholas out so he can go to the teachers' lounge, where she monitors him as he checks his blood sugar."
Though Christopher's mom still worries, she feels more at peace now. "I have three sets of eyes -- the nurse practitioner, the teacher and the paraprofessional -- watching him," she says.
Says Kraus: "There's really no excuse. When you're getting schools outside their comfort zone, schools tend to shy away. But it's all very doable. There are lots of school districts that show it's very doable."
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