August 24, 2017, Silver Spring, MD
: Just in time for a new school year, the American Society for Parenteral and Enteral Nutrition (ASPEN) has released a special report, Resources for the Provision of Nutrition Support to Children in Educational Environments
, to aid educators and healthcare professionals involved in the oversight of nutritional support in the classroom setting. To date, there has been a lack of standardized guidelines for medically complex children requiring nutritional therapy in order to remain stable and productive during the school day.
Most children requiring nutrition support — nutrients provided either enterally (via feeding tube) or parenterally (intravenously) — have an underlying health condition such as such as short bowel syndrome, intestinal malabsorption, congenital disorders, or neurodevelopmental diseases, making them susceptible to malnutrition. Managing this complex nutritional therapy is especially challenging in schools.
“No child wants to feel different or stigmatized, especially in school,” stated Peggi Guenter, PhD, RN, FAAN, ASPEN Senior Director of Clinical Practice, Quality, and Advocacy. “We at ASPEN hope this guidance gives educators and health professionals a road map to creating a safe, healthy and supportive learning environment for students who require nutrition support therapy.”
In the report, ASPEN emphasizes the importance of a close partnership between parents, the medical care team, and school district representatives in order to provide both a safe and optimal educational experience for the child. With the understanding that every child is unique, ASPEN recommends that the parents first work closely with the school to come up with an individual education plan or a 504 plan —which requires that the needs of students with disabilities are met as well as those of nondisabled students — to ensure a meaningful education experience. While these types of plans typically focus on the educational needs of a child, a health plan can and should be incorporated.
According to the report, there are seven key needs that should be considered when creating such a plan for the child:
Minimizing time away from classroom learning - Consider facilitating care during natural transition times between activities or classes in hope of minimizing the time away from classroom instruction.
Designating location to receive care – A child’s safety and privacy must be considered when determining an appropriate space for receiving care.
Ongoing monitoring – Teachers and school personnel need to be trained to recognize the adverse signs and symptoms of complications, such as dehydration or hypoglycemia, and know how to respond accordingly.
Special attention/planning for physical education, recess, and extracurricular activities – Many devices that infuse nutrition are easily disguised under clothing and are not noticeable. However, they are easily damaged, especially during physical activity. Special precautions should be taken during gym class and other active times during the school day to ensure devices stay intact.
Emotional and social support – Teachers should try to normalize a child’s nutritional therapy whenever possible. Planning ahead for any uncomfortable situation can make a big difference. For instance, if a child cannot eat lunch with the rest of the class, come up with a fun alternative rather than having him/her feel isolated.
Proper storage conditions for nutrition support solutions and equipment – The availability to properly store nutrition supplies, such as formulas and syringes, must be taken into consideration.
Education of classmates – Help other children in the class understand their peer’s need for nutrition support. Depending on the age of the children, tailor the learning with books, illustrations or dolls with devices.
ASPEN’s report also explains how to ensure the facility and faculty are prepared to administer care properly, such as having a set of physician orders on file that details how care is to be administered, established school policies, education materials and instructions on administering care.
Finally, the report covers best practices for monitoring and addressing complications that may arise with the most common devices used in parenteral and enteral nutrition therapies. Specifically, the report looks at central venous catheters and enteral access devices. In each instance, the report outlines the most common adverse complications, lists signs and symptoms, and provides best-practice action items for immediate response.
“Having these protocols in place makes all the difference when the life of a child is impacted,” stated Mandy L. Corrigan, MPH, RD, CNSC, FAND, lead author of the report. “Understanding hand hygiene, position for feeding, reasons to hold or discontinue feedings, signs and symptoms to monitor, equipment needed, contact information for parents/medical team should complications or questions arise – these are all critical to the care of a medically complex child.”
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The American Society for Parenteral and Enteral Nutrition (ASPEN)
is dedicated to improving patient care by advancing the science and practice of nutrition support therapy and metabolism. Founded in 1976, ASPEN is an interdisciplinary organization whose members are involved in the provision of clinical nutrition therapies, including parenteral and enteral nutrition. With more than 6,500 members from around the world, ASPEN is a community of dietitians, nurses, nurse practitioners, pharmacists, physicians, scientists, students and other health professionals from every facet of nutrition support clinical practice, research and education. For more information about ASPEN, please visit www.nutritioncare.org.