Could the school nurse help? Who to speak to?

[UndertheCedartree]

I am so upset. My 9yo DD has post-Covid syndrome. The doctor said she still has inflammation in her stomach. She is often suffering with stomach ache and nausea, as well as tiredness and muscle aches. She has had quite a lot of time off school due to this, which upsets her as she likes school.

So, this morning she was in pain but wanted to give school a try. By the time we arrived she was crying. One of the pastoral care teachers came up and I explained. She asked DD if she would like her to take her in and see how she went and if necessary they would phone me. I agreed that with DD. About 11.30 the office phoned me to say her stomach was hurting her. The lady asked whether she should suggest she tried to stay another 30 min. I said please can you ask my DD if she wants to try another 30 min or if she wants me to come and get her now. She phoned the class and then told the member of office staff told me she would try for another 30 min. After 30 min I rang back and was told she had been crying but had now perked up a bit.

When my DD came home she was really upset and clinging to me. Apparently her class teacher had her ready to come home but the message given to her that she passed onto DD was that 'Mum said you need to try to stay at school a bit longer'. Obviously, that went against what we had agreed and DD was completely bewildered and started crying. She was still in a lot of pain but didn't say anything else as she didn't think there was any point. So she stopped crying and the teacher thought she had 'perked up'.

Not only was thinking s bad enough but due to circumstances my DD is very sensitive to being 'abandoned'. This was why she appeared to 'perk up' as she just pushed it all down to cope emotionally.

What is worse is a comment was made by a TA insinuating that she was making it up, perhaps as a response to them thinking I refused to pick her up. But I find it so disheartening. DD loves school - she's not making this up!

Now, her teacher and pastoral care know all about the post-covid syndrome and all the background. Obviously, the receptionist does not and I think she got involved inappropriately. She should have followed mine and the teachers instructions. Also TA probably doesn't know so also shouldn't have got involved.

I'm now feeling really uncomfortable about letting her back to school and she's feeling if she is in a lot of pain noone will believe her/I won't pick her up. So now she is less likely to want to try if she is in pain in the morning.

When I emailed the school about the situation I did ask if the school nurse could help. I'd like a proper plan of how to deal with this. For example is there somewhere she can lie down quietly if her stomach is hurting or she is feeling sick. I didn't get any response to this.

So what would be best? Try and contact the school nurse myself? Speak to someone at school? Sorry this is so long and thank you for reading!

@JaneExotic

Head teacher here. There has to be a plan to move your DD back into full time education as she is entitled to this, and it is the legal standpoint. A reduced timetable can’t be open-ended and should last no more than a few weeks. Good practice would be to tweak it slightly every few days so it gradually builds up her stamina to full-time (for example, 3 days at 10-2 and then 3 days at 10-2:20) At every stage, you can take into account how she is doing and what medical advice is, but it can’t be open-ended. Sounds like the school is being very supportive.

The trouble is this could go on for months. So only a few weeks is unlikely to be helpful. I mean I would love it if she was well enough for full time school in a few weeks but it might not happen. From everything I've read gradually increasing time is not recommended. As every time you push them beyond their limit it causes an increase in symptoms so it is self-defeating. It appears better to find the right amount of activity and rest and then stick with that, obviously until there is an improvement in her condition. But yes, I agree the school are very supportive.

Don’t borrow trouble, as my gran would say!

Take the positives - a solid action plan, a reduced timetable for now to get on top of her current exhaustion - and worry about the increase/return to full-time as and when it’s needed. You can push back if it’s warranted, but it might be just the right approach. Wait and see.

@Imitatingdory

DD can take paracetamol tablets - half a tablet (which is 250mg, so slightly less mg than she could have with liquid) every 4-6 hours.

Part time timetables should be short term aimed at reintegration, so the SENCO is right to be looking at ahead to working towards getting DD back attending full time. If DD cannot attend school full time the LA should be providing alternative provision to ensure DD is receiving a full time education. Only if DD cannot receive a full time education, which isn’t the same as full time school, at all for medical reasons is part time education appropriate.

Thank you for that about paracetamol.

My DD really isn't ready for reintegration. It is only now that I can start to find out how much activity she can do without exacerbated symptoms.

I'm a bit confused about what you are saying about full time/part time education. When DD has been off school we have done some of the online work. To be honest the 1:1 Maths has probably helped her progress. I'm not really worried about her academically but obviously there is more to school than that. But for medical reasons she can't do full time school atm. With the work I do with her I think she probably is getting close to a full time education, at least.

@cansu

I think the plan the senco has is a good one. Reduced timetables can lead to long term problems getting a child back into school long after the reason for the initial reduction.

My DD loves school, loves her teacher and loves her class! She wants to go to school! But since Christmas she has only been managing school around 2-3 times a week and often she was sent home too. She also hasn't been able to do any of her hobbies. So if she can manage 4 hours a day she will be in school more often. What's the point in then going back to a routine that means lower attendance at school?

@NoSquirrels

Don’t borrow trouble, as my gran would say!

Take the positives - a solid action plan, a reduced timetable for now to get on top of her current exhaustion - and worry about the increase/return to full-time as and when it’s needed. You can push back if it’s warranted, but it might be just the right approach. Wait and see.

Yes, that's true! I'm just so worried about her and having had Long Covid for about 9 months myself I worry it will be a long haul for her too! But fingers crossed this will help her get back on her feet in a few weeks.

Apologies if my post was unclear.

Full time education is not the same thing as full time school. You can be in receipt of a full time education without being at school at all. Full time education could, for example, include medical needs tuition at home, online, hospital school etc. The LA have a statutory duty to provide DD with a suitable, full time education. If DD cannot attend school full time they should make alternative arrangements.

I think if you go in with a negative attitude to reintegration several weeks down the line the school will be concerned. No one is saying DD must do more than she is medically capable of or jump to full time within a month, but you don’t know what she will be able to manage further down the line and the ultimate aim is reintegration. And long term part time timetables are unlawful whether or not you agree, if DD cannot attend full time the LA should make alternative arrangements. DD is entitled to a full time education, although that may not all be at school. It could be part time at school and e.g. part time home tuition. Only if DD cannot manage full time education in any form (school, online, home tuition, whatever meets her needs) is it appropriate to only offer a part time education.

What is the online provision like? Is it marked? Does DD receive support from school with it?

I'm a school nurse.We do cover all the borough but would definitely support the school and you in writing a care plan.That may range from giving advice to arranging a meeting in school to write it together.I'm in schools every day seeing pupils.Careplans should be medical or consultant led so we assist schools in that.We don't do vaccinations or weight and heights.

Posted too soon!Worth seeing what your school nurse role is in your area as it seems to be different across the country.Good luck op.

@Imitatingdory

Apologies if my post was unclear.

Full time education is not the same thing as full time school. You can be in receipt of a full time education without being at school at all. Full time education could, for example, include medical needs tuition at home, online, hospital school etc. The LA have a statutory duty to provide DD with a suitable, full time education. If DD cannot attend school full time they should make alternative arrangements.

I think if you go in with a negative attitude to reintegration several weeks down the line the school will be concerned. No one is saying DD must do more than she is medically capable of or jump to full time within a month, but you don’t know what she will be able to manage further down the line and the ultimate aim is reintegration. And long term part time timetables are unlawful whether or not you agree, if DD cannot attend full time the LA should make alternative arrangements. DD is entitled to a full time education, although that may not all be at school. It could be part time at school and e.g. part time home tuition. Only if DD cannot manage full time education in any form (school, online, home tuition, whatever meets her needs) is it appropriate to only offer a part time education.

What is the online provision like? Is it marked? Does DD receive support from school with it?

I actually home educate my eldest so I know DC need a 'full time education' but there is no definition of what that is. Ultimately, if it comes to it, I can home educate my DD.

The thing is 4 hours a day might be too much so initially we might need to cut down rather than increase. It could take a couple of weeks or more to actually find the right level of activity that doesn't exacerbate her symptoms. And of course her attending school will be based on if she is well enough in the first place. Poor thing is desperate to go in for World Book Day tomorrow but is currently in agony with her stomach and having diarrhoea. If a few weeks down the line we find the right hours for DD that enable her to attend school consistently, then I'm not going to want to increase that and make things worse. Don't get me wrong I'm happy to review regularly. But let's find the right level of activity/rest for DD first, before we jump ahead to attempting full time school again.

The online provision is mainly Oak Academy and BBC. Then they have My Maths, TT rock stars and Oxford Owls. If you upload work onto Google classroom, the teacher will comment. She doesn't get help from school with it but I'm able to support her with it. I supplement it with my own workbooks etc.

@Chrispackhamspoodle

Posted too soon!Worth seeing what your school nurse role is in your area as it seems to be different across the country.Good luck op.

Yes, it might be worth it. So would you suggest it is a good idea to have a school nurse involved with a health plan?

My DD has been unwell for 10 weeks now. If this is still going on in another 2 weeks I am going to request a referral for DD as 12 weeks seems to be when it becomes 'official' Long Covid.

@UndertheCedartree

She only went and got thread worms too so had to have a day off for that!

Why dud she need a day off with thread worms?

In my experience, every single child whose parents say " you can come home if you feel ill" will say that they feel ill. Every single one.

You have missed the point of my posts. I didn’t say you can’t EHE.

My points were if DD cannot attend school full time the LA have a statutory duty (s.19, the Education Act 1996) to provide an alternative so that they meet their statutory duty to provide a suitable, full time education (which isn’t the same thing as full time at school). You do not need to EHE. And part time timetables should not be a long term solution (pg19). The only time a part time education (which isn’t the same thing as part time school) is legal and appropriate is if DD cannot cope with full time education in any form (pg4).

Whilst full time education isn’t legally defined government guidance (pg4) recommends 25 hours in school is considered full time for KS4. So, even reducing the amount for KS2 15 hours (4 hours a day minus the hour for lunch, that’s not even taking off time for break or the fact DD isn’t attending 5 days a week) a week in school would not be considered full time. The LGO generally consider full time education to be the equivalent of 22-25 hours in school. Case. More recent case showing it is still the basis the LGO work from. Although alternative EOTAS provision doesn’t need to be 22-25 hours, only the equivalent of that. For example, if the LA provide 1:1 tuition it can be fewer hours as content is covered quicker 1:1.

The online provision by the school isn’t really appropriate as an ongoing alternative so the LA should be providing provision.




@Skelligsfeathers OPs daughter LOVES school though, remember? Loves it. Course she wouldn’t swing the lead.

@Skelligsfeathers not my dd. She was distraught at having to miss so much school and would desperately hang on and try not to alert the teachers to how ill she was to avoid getting sent home. Fortunately, her teacher was really on the ball and dd looked dreadful when the pain was bad, so they would take charge.

Same with my ds. He has more complex needs and is now physically disabled, but spent two and a half years desperately trying to get into school whenever he could and avoid getting sent home if possible. Unfortunately for him his condition deteriorated and he has now been at home for almost 5 years.

@UndertheCedartree we had the same initial feelings re the phased return plan, as it does sound like they are going to try and force them back in whether they have improved enough or not. In reality, what happened was review meetings at strategic points to decide on when/if a phased return was appropriate. I would definitely get her referred if you can, as medical input was a vital part of these meetings. Even if she can’t get into a LC clinic a gastro appointment would be appropriate at this point.

With dd we didn’t need a phased return as her gastro protocol kicked in. With ds, we tried a phased return once and the end result was him being made so much worse that he missed the rest of the school year as a result (which is why he has been educated other than at school ever since, with consultation and collaboration from his medical team).

Ds’ EOTAS provision started out a 8 hours a week, but had to be gradually reduced as his illness got worse. In the end he only had 4 hours a week, as that was all he could manage and he regularly didn’t even manage that.

When was the worms vs the covid?
Have you checked the worms are gone? As apparently they can cause stomach pain.

Might it be worth keeping her home for another week to catch up on sleep and relax? Just thinking if your dd is in pain she won't be learning anyway. My sister took ages to recover from Covid and 5 months later still sleeps one whole day over each weekend just to get through the week. She has been to Long Covid Clinic and they told her to add in rest breaks into every day and at weekends get extra sleep.

@Skelligsfeathers - I phoned school to say she had threadworms and that I would buy the treatment, give it to her and then bring her in. They said it was best for her to have the day off as some DC feel unwell with the medication. So I was just following their advice.

I don't know about other DC but just mine. Since she has had Long Covid I have made it clear if she needs to come home I will get her. She has only asked to come home twice, the other times she has been sent home. She is very much one not to complain and she is quite shy so doesn't speak up. Hence, school sending her home as she was quite obviously unwell but hadn't said anything herself. On Monday she was feeling unwell in the morning but still went to school to give it a try, this is not the first time. I would have happily let her stay at home but she wanted to go to school. Not all DC are the same.

@Imitatingdory

You have missed the point of my posts. I didn’t say you can’t EHE.

My points were if DD cannot attend school full time the LA have a statutory duty (s.19, the Education Act 1996) to provide an alternative so that they meet their statutory duty to provide a suitable, full time education (which isn’t the same thing as full time at school). You do not need to EHE. And part time timetables should not be a long term solution (pg19). The only time a part time education (which isn’t the same thing as part time school) is legal and appropriate is if DD cannot cope with full time education in any form (pg4).

Whilst full time education isn’t legally defined government guidance (pg4) recommends 25 hours in school is considered full time for KS4. So, even reducing the amount for KS2 15 hours (4 hours a day minus the hour for lunch, that’s not even taking off time for break or the fact DD isn’t attending 5 days a week) a week in school would not be considered full time. The LGO generally consider full time education to be the equivalent of 22-25 hours in school. Case. More recent case showing it is still the basis the LGO work from. Although alternative EOTAS provision doesn’t need to be 22-25 hours, only the equivalent of that. For example, if the LA provide 1:1 tuition it can be fewer hours as content is covered quicker 1:1.

The online provision by the school isn’t really appropriate as an ongoing alternative so the LA should be providing provision.




So could part time school alongside something from the LA be considered full time? Although I'm sure they would only provide something online (as per a couple of local DC I know) so what I am doing with her is preferable. The total break - playtime and lunch is 1 hour at her school. So 20 hours - breaks would be 15 hours plus the 1:1 work I'm doing with her, perhaps it would count as full time? I did message her teacher about the plan. She replied saying as DD will be going in later she will miss 3/4 of their Maths time. She is going to have a think so we can come up with a plan, which I am really happy about.

www.gov.uk/government/publications/supporting-pupils-at-school-with-medical-conditions--3

www.gov.uk/government/publications/education-for-children-with-health-needs-who-cannot-attend-school

[quote PermanentlyDizzy]@Skelligsfeathers not my dd. She was distraught at having to miss so much school and would desperately hang on and try not to alert the teachers to how ill she was to avoid getting sent home. Fortunately, her teacher was really on the ball and dd looked dreadful when the pain was bad, so they would take charge.

Same with my ds. He has more complex needs and is now physically disabled, but spent two and a half years desperately trying to get into school whenever he could and avoid getting sent home if possible. Unfortunately for him his condition deteriorated and he has now been at home for almost 5 years.

@UndertheCedartree we had the same initial feelings re the phased return plan, as it does sound like they are going to try and force them back in whether they have improved enough or not. In reality, what happened was review meetings at strategic points to decide on when/if a phased return was appropriate. I would definitely get her referred if you can, as medical input was a vital part of these meetings. Even if she can’t get into a LC clinic a gastro appointment would be appropriate at this point.

With dd we didn’t need a phased return as her gastro protocol kicked in. With ds, we tried a phased return once and the end result was him being made so much worse that he missed the rest of the school year as a result (which is why he has been educated other than at school ever since, with consultation and collaboration from his medical team).

Ds’ EOTAS provision started out a 8 hours a week, but had to be gradually reduced as his illness got worse. In the end he only had 4 hours a week, as that was all he could manage and he regularly didn’t even manage that.[/quote]
I'm sorry to hear your DC have been/are ill and I wish them the very best. How is your DS managing now?

Thank you for backing me up that indeed some DC do want to go to school! I thought I was going mad with everyone insisting it wasn't possible. I don't think their DC have been chronically ill. I think school is much more fun than lying in bed so they push themselves and don't complain. DD's teacher has sent her home many times as she looked awful. Thank you for the information about phased return - that is good to know and I will phone the doctors about it next week.

@HSHorror

When was the worms vs the covid? Have you checked the worms are gone? As apparently they can cause stomach pain.

The threadworms was ages ago now and have definitely gone! The main symptom is an itchy bottom at night, she didn't have any stomach pain with them.

Yes, it could. The nature of the alternative provision depends on the child’s individual needs. If online doesn’t meet DD’s needs it isn’t suitable and the LA must provide something else. For example, I know a child who currently attends school 9.15-12 (would similar timings be better for DD so she receives the core lesson teaching and also isn’t there over lunchtime in case eating triggers her stomach pain?) Monday and Thursday and receives 1:1 home tuition 10-12 Tuesday, Wednesday, Friday (as they cover content much quicker 1:1 they don’t need the 22-25 hours you would if attending school full time.) 2 of my own DC have done similar in the past, and gradually increased the time in school/decreased home 1:1 tuition as they reintegrate into school.

If DD cannot attend full time the onus shouldn’t be on you to provide, supplement or facilitate education, the LA should be providing it.

DD went into school today 10-2. Despite an extra 1.5 hrs sleep she was still exhausted in the morning and struggled to get going. Once her World Book Day costume was on she brightened up a bit! She managed the whole day, which was great. She was exhausted when she came home and fell straight to sleep and after dinner she started feeling sick so she missed Brownies again. But one step at a time!

@UndertheCedartree Thank you for asking. Ds is still at home, about to start studying a foundation course in the subject he would like to take at uni. He can still only manage very short study sessions and has to work from his bed.

The hardest thing is maintaining friendships. Prior to the pandemic, we used to try and set up a gaming and pizza afternoon a few times a year for ds and his closest friends, to make sure they stayed in touch and he didn’t become isolated. Then covid hit and he’s only seen the, once in two years now, but they keep in touch online. Next year, when they all go off to uni, will be harder. He in involved in online groups relating to his hobby though, so not completely isolated.