Special Accommodations and Requests: What Are the Limits?

Amy B. from Jackson, Miss., routinely asks her son’s teacher to excuse missing classwork when he is absent from school.

Kelly M. from Philadelphia dropped P.E. from her son’s schedule when a low he experienced after gym class landed him in the emergency room.

Ginny P. from Toronto, Canada, has cut lines after explaining that her child can’t wait because she has type 1 diabetes.

Parenting children with diabetes means making choices every single day about how best to keep them healthy. On the one hand, you want your child to be treated just like everyone else — to never let diabetes hold him or her back. On the other hand, some special accommodations may be crucial to kids’ safety. How can you know if a special request is truly in your son’s or daughter’s best interest?

Special Request Litmus Test

According to developmental psychologist Marilyn Price-Mitchell, Ph.D., when contemplating any special request, first ask yourself whether the choice you are making for your child in any way removes your child’s ability to learn more about caring for his or her diabetes. If the answer is yes, she says, proceed with caution.

“Learning to overcome challenges is the greatest gift we can give a child. When you help children think through and respond in situations at school and with friends that may affect their health, you give them the tools to become resilient young adults,” she advises.

Another good ground rule for parents, according to psychotherapist Eliot LeBow, L.C.S.W., an emotional health and wellness advisor for the American Diabetes Association, “is to avoid making decisions based on fear or anxiety.” While this can be a challenge when circumstances are stressful, “look at accommodations from the perspective that a child with diabetes is just like any other child . . . given that he or she has the means to keep blood sugar numbers in range,” adds LeBow.

Following her son’s episode of hypoglycemia, Philadelphia mom Kelly believed pulling her son from gym class was the safest thing to do, despite his generally in-range numbers. However, when she told her son’s diabetes educator about her decision, “I am not kidding, she almost fell out of her chair,” she admits.

This led to a very frank conversation about the potential consequences for her son, including feelings of social isolation, depression, and a perceived lack of control over his life.

Kelly also realized that getting her son’s feedback before requesting an unusual accommodation was important. When she did sit down with him, “it turned out that he felt like he had done something wrong, and now he was being punished.” Upon the recommendation of her son’s care team, Kelly’s son returned to gym class, only this time with a plan in place to better safeguard against lows.

It’s this kind of balance between managing blood sugars in the short term and setting kids up for long-term success that may be the best guidepost to use when requesting accommodations. The bottom line, according to clinical psychologist Brian MacDonald, Ph.D., is that “participation in classroom activities is important for kids, because it adds to a sense of belonging and community . . . it helps children feel that they’re part of the group.”

What Would You Do? Amusement Parks, Crowded Restaurants, and Homework

These general guidelines may seem pretty reasonable in most circumstances, but what about all those situations that aren’t so clear cut? When murkier questions about accommodations arise, here are some thoughts on possible ways to proceed.

SAT Exams: Your child has the SATs (or PSATs or state testing) coming up. Is it appropriate to request accommodations, such as access to a glucose meter and low blood sugar supplies like snacks? Absolutely, says Korey Hood, Ph.D., associate professor of pediatrics at the University of California, San Francisco, and staff psychologist at U.C.S.F.’s Madison Diabetes Center. “Parents should get in touch with the test administrator well beforehand to put in place accommodations, including extra time, because it takes time away from the test for the child to check blood sugar.”

Sports Tryouts: Your teenage daughter was running low on the day of softball tryouts and didn’t make the team. Do you ask the coach for a do-over? Some experts say no. “If it happens, then it’s a learning experience,” says LeBow. Talk with her about how she can better manage blood sugar in the future to improve her performance.

But there may be exceptions, especially for younger children. “A kid with type 1 deserves a fair tryout just like any other kid . . . if you know ahead of time that your child’s sugars are off that day, it’s reasonable to request for the tryout to be held another day,” Hood explains. Bottom line? “It’s acceptable to call the coach to at least talk about this,” Hood adds.

Priority Seating at Restaurants: When there’s a long line at your favorite pizza joint, do you inform the hostess that you need the next available table because your child with diabetes can’t wait? Hood recommends getting a snack from the bar area, if needed, and putting your name on the waiting list right alongside everyone else. “Remember, it’s a privilege to go out to a restaurant to eat dinner; lots of people can’t do this.”

Cutting Lines at Amusement Parks: “My child’s doctor told me that prolonged sun exposure could affect his blood sugar, so after spending an hour in the hot sun waiting to go on a few three-minute rides, I began showing attendants my son’s medic alert bracelet, and we cut the line,” explains Ginny P. about her special request during a family water park trip. According to Hood, “From a temperature perspective, there may be valid concerns why parents want to cut outdoor wait times at amusement parks.” If weather’s not a concern, be prepared to wait.

Eating Where No Food or Drink Is Allowed: “If you carry a letter from your endocrinologist stating that your child has type 1, don’t hesitate to show it if questioned about your child needing to eat or drink something in the event of a low,” says Hood, who also says that stopping to munch a handful of candies because a child is low is not the same as sitting down to eat a normal snack. “Normal eating should take place where allowed,” he feels.

Homework: Your child missed a week of school due to a bad cold, and now there’s a mountain of work to make up. “I don’t want my son to become overwhelmed after just going through a stretch of sick days,” says Amy H., who asks his teachers at the beginning of the year to keep make-up work to a minimum. According to MacDonald, parents can touch base with the teacher about missing assignments, not necessarily to excuse the work, but to come up with a make-up schedule that “works for everyone.”

What works for you?

 

Disclaimer: The experiences and suggestions recounted in these articles are not intended as medical advice, and they are not necessarily the “typical” experiences of families with a child who has type 1  diabetes. These situations are unique to the families depicted. Families should check with their healthcare professionals regarding the treatment of type 1 diabetes and the frequency of blood glucose monitoring.