It was the usual busy emergency department shift, and I went in to see a 14-year-old boy with an asthma exacerbation and upper respiratory infection. After the medical history, I asked him, “Which grade are you in?”, and he said, “Grade 9”. I asked him how much school he has missed, and he said one week. When I asked, “How are you doing at school?” He said, “Fine”. When I asked him what were the marks for his last math test, he started telling me how unwell he has been for the past couple of weeks, the sorry school system that does not care for students and that his math teacher was a mean person. I smiled and told him that I was expecting a number and not a lecture. He laughed and said his mark was a four out of 10, and proceeded with the rest of the story. He had been admitted for appendicitis the past month and had been in hospital for five days. When he went back to school after one week, everything was new and he has not been able to catch up; the math test was the last thing he needed. The teacher had suggested a retake, but he caught a cold in the past week; his asthma got worse, so he stayed home for the whole week. He came to the hospital to get treatment for his asthma exacerbation and to get a note for school.
I wrote a detailed note to the school explaining that the youth may need some extra help to catch up. I told the boy that he should start going back to school, and suggested that he and his mother speak to the guidance councillor; I gave him my office number in case he needed any further encouragement to go to school. I also wondered if this youth could have received some educational help earlier to ease the transition from hospital to school.
According to the World Health Organization, “child rights are fundamental freedoms and the inherent rights of all human beings below the age of 18. These rights apply to every child, irrespective of the child’s, parent’s/legal guardian’s race, colour, sex, creed or other status” (1). One of these rights is the right to ‘education and access to appropriate information’. The question is, ‘Who is responsible for that?’
In Canada, primary and secondary education is free for all children, and the law requires all children younger than 16 years of age to attend school. However, when a child becomes ill, he or she is usually kept at home and comes to the attention of the health care team if he or she does not get better within a few days. Most schools ask for a doctor’s note if a child needs to stay home for more than three days. Some acutely ill children and some chronically ill children need care in hospital, often for a short period of time (less than three days) or occasionally longer.
Each illness leads to loss of school days and loss of education for these children. The sick children may have lost a few days of school before seeing a member of the health care team, more days if hospitalization is required and more days if further convalescence is needed at home before returning to school.
The attention of the medical team in the hospital is focused on helping the child get better to send him or her home. The role of the child as a student and the impact of loss of school days on learning is sometimes forgotten. A child who has recently recovered from an acute illness or is dealing with a chronic illness and has missed several days of schooling may have a hard time adjusting to class. In an attempt to support the educational needs of ill children, some paediatric hospitals have teachers who provide small group or one-on-one teaching either in a hospital classroom or at the bedside. These teachers not only support learning, but also give hope to some patients and their families that the illness is not going to make ‘life go away’ as one teenager expressed. The teachers liaise with the school and help the student catch up on missed work so that returning to school is easier. However, not all children have this opportunity. Many hospitals do not have teachers. Even in hospitals with teachers, children may not be referred to the program for multiple reasons including severity of illness, the reluctance of the child or family to have the teacher, oversight from the health care team and/or a limited number of teachers and too many patients.
Children who are recurrently ill at home or in hospitals, in which access to a teacher is none or limited, lose many school days. Raising the awareness in the medical community, followed by advocacy on the part of physicians, could help overcome some of these problems and could facilitate an earlier and smoother return to school.
Anecdotally, the teachers who I have contacted regarding recently hospitalized or chronically ill children have gone above and beyond their call of duty to accommodate the children and provide remedial help. A high school teacher at The Hospital for Sick Children (Toronto, Ontario) noted that the doctor’s letter helps them not only to understand the child’s need for extra help, but is also used to document their reasons for repeating examinations or for allowing extra time for completion of assignments.
I suggest that all health care professionals caring for children and school-age youth take responsibility to ensure that the education of children and youth occurs even when they are set back by illness. We should learn to ask and document simple questions such as, ‘Which grade are you in?, ‘When did you last go to school?’ and ‘How are you doing at school?’. All hospitalized children and youth should have a back-to-school plan when discharged home. When children or youth are admitted to hospital for more than a couple of days, we should involve a teacher if possible. The patient and family should be encouraged to contact the school early and work out an arrangement for catch-up schoolwork. Hospitals admitting children and youth that do not have teachers should explore the possibility of having teachers or volunteers to help admitted children with schoolwork, as well as lobbying local school boards for help in solving this access problem. Sometimes all it takes for the process to start is for the doctor to ask about school. Education may be a child’s right, but it will not be implemented if all adults, including doctors, do not take the responsibility to ensure that every child exercises that right.