Practical support for identifying and meeting need
Physical and sensory
Health needs
Some children and young people have physical health needs which affect their everyday lives, including their time at school.
The support of school staff in meeting these needs makes all the difference, giving children and young people the chance to stay in school, stay well and live their lives.
These physical health needs can occur:
- alongside a special educational need – so that the health need is in addition to, or related to, their learning needs. These children and young people may require an education, health and care plan so that a holistic approach can be taken to meeting their needs.
- in the absence of any learning needs. These are the children and young people who don’t need academic support but do need help in school to overcome the barriers that their health or physical needs present.
Schools’ responsibilities in relation to health and accessibility needs
Some health needs can be met in school quite easily. Through working in partnership with parents and carers and children/young people, appropriate arrangements can be put in place.
The links in the boxes below have more information about the important role that schools play.
Information and advice on how to support children with common health conditions can be found below.
Supporting pupils at school with medical conditions
Healthier Together has further advice for parents and professionals about children’s health issues
Guidance on schools’ responsibilities in relation to accessibility
Accessing support from the wider system
Under construction
A guide to nursing services working with schools
There are a number of different community nursing services that work with school aged children and their families – and provide support and advice to school staff.
0-19 integrated public health nursing service
Who’s in the team?
The team is made up of health visitors, school nurses, children’s nurses and other children’s health workers e.g. dental care advisor, nutritionist, early years practitioners, early attachment workers.
What’s their main purpose?
This service has a real focus on health promotion and early intervention. A lot of their work focuses on pre-schoolers and the delivery of the Healthy Child Programme>.
Their overall aim is to make sure that:
- parents get the right information and support to keep their children safe, healthy and on track with their development
- young people can access the right help and information to stay well, physically and emotionally
- children’s health and developmental needs are picked up at the earliest possible opportunity and that families receive the right advice and signposting to other services when needed.
The 0–19 team are usually the lead nursing team for safeguarding unless a child has complex medical needs.
How they work with schools
This team offers:
- a ‘single point of access’ telephone service so that parents and other professionals can access support and advice – tel: 01709 423333
- partnership working to support vulnerable children with health needs e.g. those on a child protection plan
- drop in sessions for young people at secondary schools
- height and weight checks in school in Reception and year 6
- a follow up service for children identified as overweight through the above checks
- immunisations
- health promotion in schools, including dental care.
Special education nursing team
Who’s in the team?
The team is made up of children’s nurses and health care assistants. They work closely with the paediatricians, children’s therapists and specialist clinical teams.
What’s their main purpose?
This team focuses on children with complex health care needs to make sure that they can safely access education.
What support do they offer?
The team does a lot of work in special schools but also supports children and young people with complex health needs who attend mainstream schools.
They act a point of contact for school and home, will write care plans and run training courses for school staff.
Specialist nurses – for specific conditions
Who are the specialist nurses?
There are specialist nurses for asthma, diabetes and epilepsy. They work as part of specialist teams led by medical consultants.
What’s their main purpose?
When a child’s main health need is one of these conditions, the specialist nurse will be the lead on writing their care plan and liaising with school to ensure staff have the knowledge and skills they need.
Who can access this support?
Specialist nurses tend to work with the children worst affected rather than mild to moderate cases. For example, a child with mild to moderate asthma will get the medical help they need via their GP.
The links below provide more information about training and support when working with children and young people who have complex health needs.
Common health issues – how to help
Fussy eaters
Some children may eat a very limited range of food. This can be worrying for adults, particularly parents, who are concerned that their child is not getting a nutritious diet. If children are busy, active and a healthy weight, there isn’t normally anything to worry about.
Why are some children fussy about what they eat?
It is common for children to go through phases of being very choosy about what they will and won’t eat. However, there can be an underlying cause:
- They are very sensitive to taste. This may be the case with children who have social communication needs/Autism>
- They are exercising control through food.
- They have some difficulties with chewing and swallowing which puts them off some foods. This is not common but can be associated with general physical or speech difficulties.
Working with parents
What parents feed their children can be a sensitive issue and, when children don’t eat, it can cause parents a lot of anxiety. For this reason it is really important to work closely with parents in a supportive way, providing them with the encouragement and signposting them to information.
Having a shared approach across home and school can make a real difference – and provides consistent signals about food for the child.
The NHS has some useful resources:
Red flags – when to seek help
If a child or young person seems to be losing weight rapidly, is eating a very restricted diet (fewer than 500 calories a day) and/or is having physical symptoms such as dizziness or fainting, then it is important to make sure the child or young person accesses medical through their GP as a matter of urgency.
Change 4 Life has some top tips on promoting healthy eating across the whole school:
Wetting and soiling
Children are normally expected to be dry during the day and night by the age of 5 years. If there is any wetting (either day or night) over 5 years of age, signpost the parent to the 0–19 public health nursing team (health visitors and school nurses) or the GP for support. This also applies if the child is soiling.
What are the reasons why some children need help with this?
Most wetting is usually functional which means the physical structures (e.g. the kidneys and bladder) are normal but may not be working correctly. For example, this could be having a small bladder or the muscles in the bladder are overactive so the child needs to go to the toilet frequently or urgently.
Constipation is a major contributing factor and it is important that this is investigated first. The GP will be able to assess for this and treat appropriately. Wetting can also be hereditary.
Some children who have sensory issues (e.g. Autism) do not get the signals their bladder is full or even recognise when they are wet.
In a small amount of cases the child may have a neurological disorder (e.g. cerebral palsy, spina bifida or spinal cord injuries) which affect the bladder and brain communicating effectively which causes the child to wet.
The potential impact of wetting and soiling on a child’s wellbeing
Watch out for:
- Poor self esteem
- Bullying
- Anxiety about social activities due to fear of others knowing about the issue
- Physical or emotional abuse by others as a response to wetting or soiling
Top tips for when a child is wetting and soiling at school
- Encourage the child to have a drink mid-morning, lunchtime and mid-afternoon – so they stay hydrated.
- Remind them to go to the toilet either at the end of break or 20–30 minutes after a drink so they have a toilet routine.
- Some children might like a toilet pass they hold up (or item they put on their desk) to indicate they need to go to the toilet. This keeps it low key and may be less embarrassing.
- Make sure all staff are aware the child has free access to the toilet and lets them go.
- Ensure a private and clean toilet, handwashing facilities, a change of clothes and some wet wipes are available so the child is able to clean and change themselves.
- Have a plan – written with the child and their parents – which covers all of the above and helps ensure an approach consistent with home.
- Don’t expect parents to come to school to assist with toileting or changing.
- Use a home/school book to stay in touch with parents (and them with you) about how it’s going.
- Signpost parents to services that can help.
- Above all, make sure that the child doesn’t feel blamed or a nuisance and is supported with sensitivity.
If there is wetting (daytime, night time or both) age 5 years or over, sign post parents to the 0–19 public health nursing service (health visitors and school nurses) or the GP.
Other resources:
Epilepsy
Electrical activity is happening in our brains all the time as the cells in the brain send messages to each other. A seizure is caused by a sudden burst of intense electrical activity within the brain which causes a temporary disruption to the way the brain normally works.
- Most seizures happen suddenly without warning, last a short time (a few seconds or minutes) and stop by themselves.
- Epilepsy is usually only diagnosed after a person has had more than one seizure. Not all seizures are due to epilepsy.
- It is a variable condition that affects people in different ways. For example, someone may go ‘blank’ for a couple of seconds, they may wander around and be quite confused, or they may fall to the ground and shake.
- Injuries can happen during seizures, but many people with epilepsy do not hurt themselves and do not need to go to hospital.
- For some people their epilepsy might ‘go away’ and they stop having seizures. This is known as a spontaneous remission.
- Epilepsy can occur in all ages, races and social classes but is most commonly diagnosed in children and the over 65’s.
Signs to look out for in the classroom – absences or day dreaming?
One of the most common seizure types seen in children are absence seizures. With typical absence seizures:
- Children will lose consciousness (impaired awareness) for a few seconds.
- They will not know what is happening around them, and they cannot be brought out of the seizure. They will not respond to stimulus such as voice or touch.
- They will suddenly stop doing whatever they were doing before it started, but will not fall.
- They may appear as daydreaming or ‘switching off’, as if someone as pressed the pause button.
- Sometimes their eyelids may flutter and they may have a slight jerking movement to their body or limbs.
- In longer absences, you may observe some brief, repeated actions.
Some people have hundreds of absences a day. They often have them in clusters of several, one after another, and they are often worse when they are waking up or drifting off to sleep.
Typical absence seizures almost always start in childhood before the age of 14.
The possible impact of epilepsy on learning and wellbeing
Different children will have very different experiences of how epilepsy affects them and the impact it has on their learning and wellbeing.
Epileptic seizures can disrupt normal brain activity, and this can affect a child’s memory. Depending on the type of seizures a child has, they may feel very tired or confused after a seizure.
Overall, children with epilepsy are at greater risk of learning and behaviour difficulties which may affect concentration, mood, motor skills and processing.
For some children, their epilepsy can affect their emotional health and socialisation. They may also have interrupted sleep, which will make them tired. Feeling tired or confused can affect how well a child can learn.
The more seizures a child has, the more pieces of information they will miss. For example, if a child has hundreds of short absence seizures in a day, they will miss many little bits of information. This will cause gaps in their learning.
Getting help
If you suspect that a child is having absence seizures, inform parents and ask them to seek medical help via the GP. Maintain a possible seizure diary.
Call 999 for medical assistance if someone is:
- having a seizure for the first time
- has a seizure that lasts more than 5 minutes
- has lots of seizures in a row
- has breathing problems or has seriously injured themselves
Allergies
Allergies
An allergy is a rapid and unpredictable reaction which is actually an unhelpful immune response to something that the body perceives as a threat (referred to as the ‘allergen’).
Allergic reactions vary in severity, from mild to severe. Symptoms include:
- itchy eyes, nose or throat
- rashes, hives and/or skin itching
- swelling to the lips, tongue and/or face
- wheezing, coughing, shortness of breath
- stomach pain, vomiting and/or diarrhoea.
Anaphylaxis is a severe and potentially life threatening allergic reaction. Symptoms of anaphylaxis are:
- swelling to the lips, tongue, face – making it difficult to breath, talk and swallow
- fast heart rate or palpitations with pale or blue skin
- loss of consciousness
- panic and anxiety
- cardiac arrest.
Anapylaxis can be life threatening if left untreated.
Intolerances
Intolerances are most commonly associated with food types and do not involve the immune system. Intolerances are never life threatening: they can be managed with medications prescribed by medical professionals (to ease the symptoms) or by eliminating troublesome food from the diet.
Generally, symptoms of intolerances appear gradually and are most likely to be caused by eating a substantial amount of the food type which causes the problem. This is different to allergies where very small traces of foods, or even the smell of problem foods, can trigger a reaction.
How to help in school
The possible impact of allergies on learning and wellbeing
Children and young people with allergies may:
- feel unwell or uncomfortable, which can affect concentration and readiness to learn
- need to take time off school for appointments or because they are unwell. Some children and young people may end up in hospital if they have a severe reaction
- be anxious about certain situations, especially if they have had anaphylactic reactions in the past. Their parents may also be anxious for the same reason!
- feel awkward about their allergies because it makes them different to their peers. Some children and young people, particularly at secondary, can be reluctant to “admit” to their allergies and 33% of adolescents don’t carry their Epipens with them. This creates an additional level of risk.
Training for school staff
It is vital that school staff have the relevant training to support care for children who have allergies, so that they can intervene appropriately and confidently if required. Without suitably trained staff in school, it is not safe for children or young people with severe allergies to attend.
Anaphylaxis and allergy training is required annually, by those who will be working closely with children who have allergies or carry an auto injector (Epipen). This is to ensure individuals feel confident with the signs and symptoms of allergic reactions as well as the technique required to administer emergency medications.
How to avoid making the child or young person feel different
Thinking ahead to remove allergens from activities or equipment can make a big difference. For example, using alternative ingredients in a baking session means that the child or young person with the allergy can join in safely and engage fully in the activity. If these amendments can be made subtly so it is not obvious, then that is even better.
Careful planning, in partnership with parents and carers (and the young person), may be needed for school trips and residentials.
Being supportive if they need time off
Help and understanding if they have missed work is always appreciated. Try to avoid any stigma being associated with poor attendance if this is due to genuine ill health. It is worth considering how best to handle this issue if rewards are given out to individuals, classes or year groups for good attendance.
Taking a whole school approach
It can be very difficult to make any educational setting totally free of a particular allergen – but it is helpful to raise awareness across the school to reduce the risk. For example, if a child in school has a nut allergy, it is recommended that schools send out letters/emails to all families to ask them not to send their child into school with nuts and explaining the reason why.
Making sure that individual care plans are in place and up to date
Either the GP or allergy specialist teams provide individual allergy management plans or treatment plans, depending on who has responsibility for the overall management of the child or young person’s clinical care. These care plans should include as a minimum:
- what the child or young person’s allergy is (and there may be more than one)
- what medication they require daily or in an emergency
- the protocol for dealing with an emergency, including signs and symptoms of an allergic reaction (from mild to severe symptoms).
The three main medications used to treat allergic reactions are:
- Antihistamines (usually in tablet or liquid form)
- Salbutamol inhaler (to help support any breathing difficulties as a result of the allergic reaction)
- Auto-Injector – emergency adrenaline pen to treat anaphylaxis.
Getting help
The special education nursing team can offer basic help and advice, but don’t have all children with allergies on their caseload so aren’t familiar with all individual cases.
They offer monthly anaphylaxis and auto-injector training which all Rotherham schools can access.
If you are worried about a child or young person with allergies who is not known to the special education nurses, then you may want to talk to:
- parents/carers
- GP/allergy team (ask parents for contact details)
- 0–19 public health nurses (health visitors and school nurses)
Below are a few helpful resources that may be useful:
Asthma
Asthma is a long term condition affecting about 1 in 11 children. Asthma affects the small airways which carry air in and out of the lungs. A child who has asthma will have “sensitive airways” which become inflamed and react to irritants (also known as triggers). Triggers are individual to the child and can include pets, pollen, weather changes, mould, dust, respiratory infections, and exercise. When the airways react to triggers, they become narrower and more irritated making it harder to breathe.
Asthma symptoms
The usual symptoms seen in children are:
- coughing
- wheezing (high pitched whistling noise when breathing out)
- shortness of breath
- chest tightness sometimes described as chest pain or tummy pain.
The symptoms are likely to come and go. Children will usually be on preventive treatment to reduce the number of symptoms they experience. This is normally given twice a day and not given in school.
If the asthma is not treated properly it can lead to ‘asthma attacks’ which are potentially life threatening.
The possible impact of asthma on learning and wellbeing
Asthma can impact on learning if a child is experiencing lots of symptoms.
A child may need to take time out of school to attend appointments (especially if their care is managed by a specialist service rather than the GP) or to take time off to recover from an asthma attack.
Symptoms can also occur at night disrupting a child’s sleep resulting in them being more tired in school.
The child’s triggers may affect their time at school. If a child informs you of their triggers, actions may need to be taken to reduce their impact whilst at school. For example a trigger of perfumes and strong odours may be helped by staff and pupils not wearing perfume at school or changing cleaning products to ones with a low odour. If exercise is a trigger they may need to use reliever treatment to complete a PE session or playtime. Exercise is encouraged in people with asthma.
Some children (especially at primary school) may need support in taking their inhalers.
How to help in school
All children with asthma should have a care plan in place for managing their asthma. This should be written by the health care team managing the child’s asthma (e.g. GP, practice nurse, children’s asthma nurse) and include what the reliever treatment is (including type of inhaler), triggers, when to give the inhaler, what to do in an emergency and parent/carer contact details.
Since 2014 schools have been able to have a salbutamol inhaler for emergency use. The guideline with further details can be found below in the external sources section.
NB – inhalers should be available at all times and not kept in a locked cupboard. If a child is moving to work in an area that is not close to where the inhaler is kept, it should be taken with the child in case of an emergency.
Please inform parents/carers of any salbutamol usage in school as increased use will indicate the child’s asthma is not controlled.
The children’s asthma nurse can provide training on managing asthma in schools. This training covers what asthma is, symptoms, triggers, how to manage an asthma attack, the correct use of inhalers and school policies and guidelines.
Care plans and help in an emergency
All children with a salbutamol inhaler in school should have a care plan written by the health care team managing their asthma. Emergency treatment should be covered on the care plan.
The inhaler you are likely to see is the pMDI salbutamol inhaler. This inhaler must be given using a spacer, if this inhaler is given without a spacer please ask the parents to provide one. These inhalers are not effective when given without a spacer. Older children may use a different inhaler type that does not require the use of a spacer.
As a general plan give 2 puffs of salbutamol as required using an inhaler and spacer. This should work within 15 minutes and last for 4 hours. If further doses are required increase in 2 puff steps up to a maximum of 10 puffs. If 4–6 puffs are given in one time contact the family (the child may need to have an urgent medical review at the GP surgery).
If 10 puffs of salbutamol are given you must call 999 for an ambulance. Further sets of 10 puffs can be given whilst waiting for the ambulance every 15-30 minutes as required.
An example of a pMDI inhaler. These inhalers need to be given with a spacer.
Getting help
Children’s Asthma Nurse in Rotherham – phone 07387 064716 or email Hannah.Lees1@nhs.net. She can provide asthma training for schools, provide general support, liaise with the GP surgery, Rotherham hospital and the respiratory team at Sheffield Children’s Hospital. She will write care plans for children on her current caseload (due to capacity she is unable to offer this to all children in Rotherham with asthma).
Below are some other resources that may be helpful:
Diabetes
There are two main types of diabetes, both of which can be very serious.
Type 1
This is an auto immune disorder in which the body destroys the insulin producing cells. Insulin controls blood sugar levels – so the child or young person needs to have daily insulin replacement in order to stay well. This condition usually begins in childhood/young adulthood.
Type 2
In Type 2 Diabetes, the insulin being produced doesn’t work effectively or not enough of it is produced. This form is more common in adults but is becoming increasingly common in children.
Find out more:
The possible impact of diabetes on learning and wellbeing
Children and young people with diabetes have to come to terms with having a complicated life-long condition. This can present a real challenge, not least because the condition itself requires regular monitoring and adherence to a strict regime of insulin administration and regular snacks and meals.
Children and young people may ask ‘why me?’ and get frustrated that they don’t enjoy the same freedoms as their peers. The condition can place a strain on the whole family, and generate conflict between young people and their parents.
If the child or young person’s diabetes is difficult to control, they can experience periods of ill health, ranging from just feeling ‘off’ to being seriously ill in hospital. They may miss out on learning because they are unwell or off school to attend medical appointments.
Local health services use a wellbeing assessment tool to reflect what, if any, action is needed to support children in coping with the emotional and psychological aspects of their diabetes. The questions included within the assessment tool cover:
- Emotional and behaviour – including family conflict
- Anxiety and depression
- Eating disorders
- Learning needs
- Behaviour
- Non-adherence to treatment
Supporting a child/young person with diabetes in school
A child or young person with diabetes will have s specialist team offering them support and care. They will work with you to ensure that you have the information, training and care plan you need to support the child or young person in the best way.
As children get older, they need support to become more independent in managing their condition. This is important so that they can take responsibility for managing their own health as they move into adulthood.
Getting help
Below are some resources that may be helpful:
Dental care
Impact of poor oral health
Anyone who has experienced dental pain will understand the impact that it has on day to day life. Pain, sleepless nights, inability to concentrate, food refusal and time off school are just a few.
Everyone has a role to play in supporting children and young people in improving their oral health.
Find out more:
Tooth decay
Tooth decay is the most common cause of tooth loss for our children and young people; but everyone can be at risk of tooth decay (dental caries).
Children and young people with additional needs can be more vulnerable to tooth decay. This can be for a range of different reasons, including disliking the sensation of brushing their teeth or struggling with the physical co-ordination needed.
Sugar control
To reduce the risk/prevent tooth decay we need to control our sugar intake; particularly how often we have sugar throughout the day. One of the easiest way to do this is to keep all sugary food and drinks to mealtimes. We need to keep snacks and between meal drinks sugar-free for the majority of the time. Limiting sugar frequency means we can safely have sugary treats as part of a healthy balanced diet without the risk of developing tooth decay.
Tooth brushing
Although sugar control is the main way to reduce the risk of developing tooth decay it is also essential to have a clean mouth. Therefore we need to brush our teeth ‘thoroughly’ twice a day; particularly remembering to brush last thing at night. The night time brushing is vital to ensure all food debris and plaque (sticky layer of bacteria) has been removed and fluoride toothpaste has been used for protection. Going to sleep with a dirty mouth on a regular basis increases the risk to developing both tooth decay and unhealthy gums.
Fluoride it the most important element in toothpaste. It slows down plaque growth, protects against tooth decay and rebuilds some of the damage after eating and drinking sugary things.
Mouth wash
Mouth washes have a much lower level of fluoride. Therefore, if used, choose another time of the day to tooth brushing with the aim to provide the teeth with a fluoride boost.
Dental visits
Find out more about routine dental care:
Getting help
For local support you can contact:
Health Improvement Coordinator/Oral Health Lead
0–19 Integrated Public Health Nursing Service
Email: louise.collins15@nhs.net
Tel: 01709 423333
Links to resources and downloads
