Is it normal to have problems at school because of pain and functional symptoms?

More than half of children with chronic (ongoing) pain and functional symptoms have some type of problem with school. These problems can be many absences, a hard time keeping up with schoolwork, lower grades and problems with friends.

Should my child stay at school?

Most children do better in their recovery from pain and functional symptoms if they stay in school. Making changes to your child’s daily schedule or providing accommodations can help your child be successful at school and stay on track.

What could help my child at school?

Below are suggestions to help your child at school. We recommend that you work with the school and your child’s medical team to create a plan just for your child.

Regular check-ins with the school nurse

Your child should be allowed to go to the nurse when in pain or experiencing symptoms, or for a dose of medication (following prescription instructions).

Scheduled breaks: If your child is having too much discomfort/experiences symptoms to stay in the classroom, your child could follow these guidelines:

• Take a short break in the nurse’s office or another quiet place, like the library, to use self-management pain control strategies. These could be relaxation, distraction or imagery.
• After 15–20 minutes, your child should return to the scheduled activities/class.
• Your child should not usually need more than 3 breaks a day.
• School nurses should not need to call parents during these breaks unless your child has new symptoms (a fever, greatly increased pain, new symptoms).
• Classroom teachers should allow your child to decide when these scheduled breaks are needed.

Academic changes

If your child has missed a lot of school because of the symptoms, making some of these changes might help your child catch up with work and encourage participation:

• Modifying/reducing homework assignments
• Providing special conditions for taking tests (quiet space, more time)
• Longer schoolwork deadlines and allow make-up work
• An extra set of books at home
• Access to a resource room/1-1 tutoring
• No penalty for absences, late arrivals or early dismissals

Physical/environmental changes

Some students need changes in their school environment in order to be successful. These may include:

• Extra time to change classrooms
• Using an elevator
• Having a quiet place for lunch
• Snacks/water in the classroom
• A private toilet
• Special seating (close to front of the classroom, chair cushion)

Gym

Your child might not be able to fully participate in all physical activities, even if the medical team says it is OK.

• Your child should be excused from gym without penalty if you have a medical note.
• Gym participation may need to increase slowly over weeks or months.
• Find different ways for your child to get involved in the same activities as their peers. For example, your child could keep score during a basketball game or act as a base coach during a softball game.
• If your child has physical therapy as part of treatment, they may be able to do these exercises during gym time until they can participate in gym class. 

School transition program

• When students have missed over 2 weeks of school, often a gradual return to school is helpful. For example, you might plan for your child to return to school for half-days and work up toward a full school schedule.
• A plan to slowly increase attendance and participation can be created as a team with school staff, parents and your child. Physicians and psychologists can offer specific recommendations as needed.

Parent and school collaboration

• Parents should be involved in school planning as much as possible using information from their child’s providers.
• This website is a great resource for teachers, school staff, and parents: http://teachpain.wordpress.com/resources.

Communication plan

After a school plan is set up, it is important to have regular communication with the school about how it is working.

• Identify one school staff member who can be your contact person and decide how you will communicate (phone, email, meetings).
• Set up a time for your first communication after setting up the plan (within 1–2 weeks).
• Encourage all communications to go through this 1 contact person.