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Returning to School in the Midst of the COVID-19 Pandemic for Children with Chronic Disease and Special Needs

  • Jennifer L. Hamilton
    Correspondence
    Corresponding author at: 81 N Mario Capecchi Dr Salt Lake City, 84103, UT, United States of America.
    Affiliations
    University of Utah, College of Nursing, UT, United States of America

    University of Utah, School of Medicine, Department of Pediatrics, UT, United States of America

    University of Utah Health Sciences, UT, United States of America
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      To the Editor:
      I write to share my thoughts on the issue of children with chronic disease and special needs returning to school. This is an issue of concern for pediatric nurses, pediatric providers, parents, children, and educators. In the absence of specific guidelines related to children with chronic diseases returning to school in the midst of the COVID-19 pandemic we are left to rely on guidance from the American Academy of Pediatrics () “COVID-19 Planning Considerations: Guidance for School Re-entry” and the Centers for Disease Control and Prevention (CDC) “Interim Guidance for Administrators and US K-12 Schools and Child Care Programs” (
      • Centers for Disease Control and Prevention
      Interim Guidance for Administrators of US K-12 Schools and Child Care Programs. Retrieved July 9, 2020, from Coronavirus Disease 2019 (COVID-19).
      ;
      • Centers for Disease Control and Prevention
      Interim Guidance for Administrators of US K-12 Schools and Child Care Programs. Retrieved July 9, 2020, from Coronavirus Disease 2019 (COVID-19).
      ), our expertise as pediatric nurses, the opinions of those providers caring for each individual child with chronic diease or special needs, as well as the families perferances. As a pediatric nurse practitioner working with children who have Cystic Fibrosis and the parent of a child with Spina Bifida these are issues that weigh heavily on my mind.
      Dr. Fry-Bower eloquently points out that that “children are at risk from COVID-19”, just not always in the traditional sense of increased morbidity and mortality from the direct effects of infection from novel SAR-CoV-2 virus (
      • Fry-Bowers E.
      Childern are at risk from COVID-19.
      ). The AAP's guidance on school echoes this point. There is much that children loose in prospect of not attending school, including the physical aspects of safety, food and shelter, as well as the emotional-social aspects of an in person of the home-based education (). For children with chronic disease and special needs the situation is even more complicated. The risks for poor outcomes from COVID-19 are less know and the resources accessible with in person education from our public-school system even more vital.
      Pediatric nurses are uniquely posed to advocate for children, especially those with chronic disease and special needs with in our clinical arenas and communities. This is a time where we can use our voices to discuss with families the multifaceted needs of their child and their family unit as a whole and provide support as families make decisions regarding their child's return to school. In areas where there will be the option to return to school in person there will not be a one size fits all approach for children with chronic disease and special needs.
      As I consider sending my children to school and council the families of children I work with I reflect on the following. What are the needs of the child and the family? The whole child is to be considered, not just their chronic disease or special needs. Will home-based learning meet their age-appropriate, diagnosis specific educational, social, and developmental needs? Are these needs better met by in person educational setting? For my own child with spina bifida there are specific supports and resources that are impossible to replicate at home. For a child with a chronic pulmonary disease like Cystic Fibrosis, where the data on outcomes with COVID-19 are extremely limited, the potential risk may not be worth the benefit for the family.
      Other considerations include the capability of the family to provide home-based learning. There are many factors that can limit a family's ability to deliver effective age-appropriate home-based learning. These many include parental work schedules, parental education, parental mental or physical health issues, as well as technology availability. Parents of children with chronic disease and special needs have higher rates of mental health issues. There is evidence to suggest that for mothers of
      Returning to school in the midst oF COVID-19
      Children with CF anxiety has increased during the pandemic (
      • Senkalda B.P.
      • Eyuboglu T.S.
      • Aslan A.T.
      • Gursoy T.R.
      • Soysal A.S.
      • Yapar D.
      • Ilhan M.N.
      Effect of the COVID-19 pandemic on anxiety among childern with cystic fibrosis and their mothers.
      ). It would be likely that this is the case for many parents of children with chronic disease or special needs. This potential increase in mental health issues may result in even more difficulties with home-based learning. Families and the pediatric nursing within their circle of influence need to reflect on these factors as they assess their ability to provide the structure and supervision, depending on the age of the child, needed for effective home-based learning.
      I echo Dr. Fry- Bower assertion that we, as pediatric nurses, need to “remain vigilant” and use our voices, as well as our experience to speak out for the needs of children especially in the area of education and schools.

      Declaration of Competing Interest

      I have no known conflict of interest to disclose.

      References

        • American Academy of Pediatrics
        COVID-19 Planning Considerations: Guidance for School Re-entry.
        (Retrieved July 7, 2020, from American Academy of Pediatrics)
        • Centers for Disease Control and Prevention
        Interim Guidance for Administrators of US K-12 Schools and Child Care Programs. Retrieved July 9, 2020, from Coronavirus Disease 2019 (COVID-19).
        • Fry-Bowers E.
        Childern are at risk from COVID-19.
        Journal of Peditaric Nursing. 2020; : A10-A12https://doi.org/10.1016/j.pedn.2020.04.026
        • Senkalda B.P.
        • Eyuboglu T.S.
        • Aslan A.T.
        • Gursoy T.R.
        • Soysal A.S.
        • Yapar D.
        • Ilhan M.N.
        Effect of the COVID-19 pandemic on anxiety among childern with cystic fibrosis and their mothers.
        Pediatric Pulmonology. 2020; : 1-7https://doi.org/10.1002/ppul.24900