COVID-19 and School Re-Entry for Special Needs Children

Ruchi Kaushik, MD, MPH, Medical Director, Complex Care Clinic, The Children’s Hospital of San Antonio, Baylor College of Medicine

What you need to know about special considerations for Children and Youth with Special Health Care Needs (CYSHCN)

Distance learning for children with special needs this past spring was challenging for everyone — students, parents/caregivers, and educators. As a result, if you are a parent/caregiver of a child receiving special education services or other accommodations, you are likely anxious about the start of the school year. Should your child attend virtually or in person? How will you be sure your child will wear a mask or physically distance themselves? Will they receive the rigorous instruction and services they need virtually? What are some methods to reduce the risk of contracting the COVID-19 virus? Here are a few ideas to address these questions, but keep in mind each child will need an individualized plan for the 2020-2021 academic year.

In June, the American Academy of Pediatrics (AAP) published guidelines for school re-entry, advocating for students to be physically present in schools. That said, the AAP also recommended that:

  • School policies should be flexible, responding quickly to new information
  • Strategies should have the ability to be revised and adapted depending upon virus activity in the community
  • The developmental stage of students should be considered to devise practical, feasible, and appropriate policies

Pediatricians recognize that ideally children are best taught in person, but each community and each family need to weigh the benefits and risks of in-person learning. Additionally, it is important to remember that every child is entitled to a free appropriate public education in the least restrictive environment.

On August 7, 2020, the Bexar County Health Authority issued an Amended Health Directive, marking the school risk level as “high” (red zone) on the health indicator bar. In the red zone, it is recommended that ancillary services that do not require prolonged close contact be provided one-on-one to special needs students. See the Amended Health Directive and any timely updates here.

General Precautions

The Centers for Disease Control and Prevention (CDC) recommend wearing masks and physically distancing (six feet apart) to prevent transmission of the virus. You, as a parent/caregiver, need to assess whether this is possible for your child.

  • Have you tried placing a mask on your child for gradually increased periods of time at home? Can your child tolerate wearing a mask for up to eight hours?
  • Will your school allow a plexiglass barrier to replace a mask?
  • Is your child cuddly and unlikely to understand why they cannot cuddle at this time?
  • Does your child have equipment (particularly respiratory equipment such as a tracheostomy) that will require frequent manipulation by the school nurse?
  • If you plan to send your child to in-person school, will they ride the bus?
  • Will someone need to feed your child due to aspiration risk?
  • Will the school allow your child’s private duty nurse to accompany them?
  • What is your school’s plan for cleaning and disinfecting the classrooms, hallways, bathrooms, playgrounds, and school nurse’s clinic?

The answers to these questions will help you come to a decision about virtual versus in-person learning. Be sure to discuss your concerns and thoughts with your pediatrician so you can make an informed, shared decision that is best for your child and your family. Consider connecting your pediatrician with your school nurse for seamless coordination and communication.

And, finally, working with your health care professionals (doctors, nurses, therapists, social workers), compile a list of resources and support your child will need for both virtual and in-person learning and discuss them at your Admission, Review, Dismissal (ARD) meeting to inform the development of your child’s Individualized Education Program (IEP). (Examples include a paraprofessional to ensure physical distancing from other students, use of a plexiglass barrier in place of wearing a mask when possible, etc.) Remember that your school and district cannot advocate for what your child needs if it isn’t in your IEP.

For more information, visit

If you found this blog helpful, consider hitting the subscribe button on top so you are among the first to receive new blogs when they are posted. And keep up with what’s happening at The Children’s Hospital of San Antonio by visiting our website.


5 Ways to Prep for School During a Pandemic

Mahwish Khan, DO, PGY2, Resident, Baylor College of Medicine at The Children’s Hospital of San Antonio

It’s that time of the year again, the time when stores’ aisles are filled with back-to-school supplies and composition books are 50 cents apiece. Back-to-school time used to be one of my favorite times of the year, and I really looked forward to getting to pick out all of my things for the new school year. But this year will be a little different with COVID in play. Whether your child will be in school in-person or partaking in distance learning, parents need to prepare children for a very different school year. Here are some tips to prepare you and your child for back to school:

1. Buy your school supplies online

While it may be tempting to go to your local department store for that specific blue three-pronged folder your child has on their school supply list, try and see if you can order school supplies online. Most department stores right now have options to order online and either deliver or pick up items curbside. We want to limit our exposure to others as much as possible, and back to school aisles can be some of the busiest aisles this time of the year.

2. Have your child practice wearing a mask at home

When schools open up for in-person learning, many schools will require their students in 1st grade onward to wear face masks all day. It’s hard for most adults to wear a mask all day, and this is going to be a big change for our kids. You can try to ease into this by having your child and family members wear their masks at home for extended periods of time. Start with just 30 minutes at a time and gradually work your way up to a full day. Make sure to demonstrate the proper way to wear a mask (covering both the mouth and nose).

3. Have your child practice proper hand hygiene

Make sure you go over proper hand washing techniques and have your child practice it at home. Remember, your child should wash their hands anytime they touch their face or mask, eat or drink, touch any contaminated surface or object, blow their nose, cough, or sneeze. Your child should follow the following five steps in hand washing. (These steps are from

  • Wet your hands with clean running water, turn off tap, and apply soap.
  • Lather your hands together by rubbing them together with soap. Lather the backs of your hands, between your fingers, and under your nails.
  • Scrub your hands for at least 20 second. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
  • Rinse your hands well under clean running water.
  • Dry your hands using a clean towel or air dry them.

4. Demonstrate social distancing to your child

We should be staying at least six feet apart from each other when possible, but do you really know how far six feet is? Take out a tape measure at home and show your child just how much distance they should keep between themselves and others. You can also practice this among family members at home and try to maintain at least a six-foot distance for a whole day. If you are at the grocery store or any other public place with your child, make sure to put this into practice, by standing at least six feet apart from others and keeping your mask on at all times.

5. Be flexible with your children and yourself

This school year is going to be very different from other years. With many of our children in distance learning classrooms and having to learn outside of the traditional education model, we may need to adjust our expectations for our students and for ourselves. Many of our kids may need extra help getting their assignments done on time and communicating with their teachers. And with parents having to both work and help their children with schoolwork at home, it can be easy to get overwhelmed. Don’t be afraid to ask for extra help, be it from teachers, other parents, counselors, or anyone else.

We hope this list has given you some ideas on ways to prepare for back to school. If you or your child are having a difficult time coping with the pandemic or any of the changes that it has brought to our everyday lives, please talk to your pediatrician. If you need help finding a pediatrician, check out The Children’s Hospital of San Antonio Primary Care Clinics for a location near you.