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.

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Author: The Children's Hospital of San Antonio

The Children’s Hospital of San Antonio is the first freestanding hospital in San Antonio solely dedicated to the care of children. Located in the heart of downtown San Antonio, The Children’s Hospital of San Antonio is owned by CHRISTUS Health System. Baylor College of Medicine, one of the top medical schools in the nation, is the academic partner of The Children’s Hospital with 170 pediatric subspecialists affiliated with Baylor. In addition, community physicians in private practice remain a valuable partner in the care of children in our community. We are a health care ministry that works to continually meet the needs of the community to extend the healing ministry of Jesus Christ, following the values and mission of our sponsoring congregations; Sisters of Charity of the Incarnate Word of Houston and San Antonio, as well as our newest sponsoring congregation, the Sisters of the Holy Family of Nazareth.

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