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Students with Health Conditions Protected Under Federal Law, Education Department Stresses

Students with four common health conditions may be entitled to protections under federal disability-rights laws, including accommodations at school, the U.S. Department of Education stressed Tuesday.

The conditions—asthma, diabetes, food allergies, and gastroesophageal reflux disease, or GERD—may be considered disabilities under Section 504 of the Rehabilitation Act of 1973 if they “substantially limit” one or more of [a student’s] major life activities,” including bodily functions like breathing, the agency’s office for civil rights said in new fact sheets on the conditions.

Section 504 prevents discrimination against students in federally funded educational settings, including public schools. Under the law, schools are required to create plans detailing how they will accommodate students’ health conditions through policy and practice. For example, a school may offer makeup time for assignments missed during illness-related absences, allow students to carry specialized medication like epinephrine injectors, or train staff to recognize the signs of low blood sugar, the fact sheets say.

Section 504 also requires schools to protect students from bullying and harassment on the basis of their health conditions, the guidance says.

Families have secured Section 504 plans for the four health conditions in the past, and the protections detailed Tuesday are not new. Rather, the new documents provide students and their families and schools “important tools to understand when and how they are protected by federal disability rights laws,” Catherine Lhamon, the assistant secretary for civil rights at the Education Department, said in a statement.

Organizations like the Asthma and Allergy Foundation of America, Food Allergy Research and Education, the GI Alliance, and the American Diabetes Association have long advocated for parents to pursue 504 plans for children with such conditions to ensure that all parties—educators, families, and administrators—are on the same page about how to address students’ needs.

Congress clarified federal law in 2008 to require public entities to broadly interpret the term “disability” to include conditions that substantially limit “major life activities,” but advocacy groups have complained that schools don’t always recognize their obligations to students with episodic conditions, like allergies.

In March 2020, for example, the federal OCR found a Victorville, Calif., elementary school did not respond to a parent’s initial request for a 504 plan related to her child’s severe nut allergy, allowed the child to sit at cafeteria tables where other children ate nut products, and refused to allow him to participate in optional activities in classrooms because they hadn’t been kept free from nut products. The school agreed to additional staff training and student protections to resolve the complaint.

The severity of conditions like GERD, a form of digestive reflux, may be diagnosed through medical tests, but the extent a condition interferes with a major life function can also be observed through patterns like repeated vomiting, the federal fact sheets say.

“A school may always accept that a student has a disability without any documentation or medical tests,” the documents say.

School accommodations for specific health conditions

Among the issues stressed in the federal health guidance:

Asthma: Students with asthma may miss school for medical appointments, feel isolated from peers when they avoid circumstances that could trigger an attack, or be afraid of experiencing an attack at school.

Schools should respond by allowing students to carry inhalers, excusing them from activities that may trigger attacks, and ensuring classrooms are free from triggers, like smoke and dust. Where possible, the same precautions should be taken for field trips.

Diabetes: Students with diabetes may “act irritable, angry, stubborn, or confused when their blood sugar is low,” the fact sheet says, or they may feel lethargic, have difficulty concentrating, or experience increased thirst when their blood sugar is high.

Schools should address these concerns by allowing students access to insulin, testing supplies, and sugary snacks to balance their blood sugar during the school day. If students are too young to administer their own medication, schools must train staff to do so and keep it in a quickly accessible place. Schools may also allow students with diabetes to take additional restroom breaks.

Food allergies: Students with food allergies may deal with isolation from peers, particularly during meal times, and fear related to experiencing severe or life-threatening reactions, like anaphylaxis, at school, the documents say. They may also experience discomfort from milder symptoms, like itchiness and watery eyes.

Schools should respond by designating allergen-free areas in lunchrooms, and permitting students to carry epinephrine auto-injectors if they are old enough to use them. Staff should be trained and prepared to use the injectors on younger children. Schools should also consider prohibiting certain allergy-triggering items in classrooms or entire buildings to ensure students with allergies can participate safely in activities.

Gastroesophageal reflux disease: Students with GERD may require frequent restroom breaks because of associated vomiting, the fact sheet says. They may fall asleep in class because the condition can affect their ability to sleep and they may experience throat pain.

Schools should respond to these concerns by allowing more frequent restroom breaks, allowing students periods of distance learning during GERD flare-ups, and modifying meal times where appropriate.

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