Special Education

This page includes information about the laws that affect children with feeding tubes who are attending school, as well as general special education information. For information on the practical aspects of going to school with a feeding tube, visit our Feeding at School page. Another helpful resource is Resources for the Provision of Nutrition Support to Children in Educational Environments, a forthcoming article in Nutrition in Clinical Practice, developed in part by staff from Feeding Tube Awareness Foundation.

IEPs, IHPs, and 504 Plans

If your child is attending school with any kind of feeding tube in place — whether the tube is being used or not — he needs a plan in place to make sure the feeding tube is handled properly. This plan can be handled in one of three ways:

• IEP: An IEP is an Individualized Education Plan. It is typically used for children who need any type of special education services or an adapted curriculum. If a child has very extensive medical needs but no developmental or cognitive issues, an IEP may still be used if the medical condition severely impacts the ability to learn. The category of “Other Health Impaired” allows children with medical conditions to have an IEP. IEPs are incredibly comprehensive, and will include all the adaptations and accommodations a child requires to access the curriculum, including how feedings will be handled, and if nursing or aide services are required. They have the greatest legal protections, and are the easiest type of plan to enforce legally.
• 504 Plan: A 504 plan is perfect for children who have relatively straightforward medical needs and no special education needs, but require some assistance or adaptations to attend school. These plans outline how special care, such as feedings, will be provided to a child during the school day. A 504 Plan can include the need for an aide or a nurse. 504 Plans are legally binding, but the language in the relevant laws is not as specific as it is for an IEP. In addition, complaints are handled by the Office of Civil Rights and not due process or the court system.
• IHPs: An IHP is an Individual Health Plan. These are developed between a parent/child and the school, with no legally binding protections. Unless your child’s needs are extremely minimal, you should avoid a stand-alone IHP. In some school districts, however, the IHP is a component of either an IEP or 504 Plan. The IHP is helpful for the school nurse and is a good opportunity to give the school the details of how to care for your child. However, since the IHP is not a legal document that the school has to abide by, make sure you also have an IEP or 504 plan that encompasses the IHP.

For more on the difference between IEPs, 504 Plans, and IHPs, see IHPs, 504 Plans, and IEPs: What’s the Difference? by Donna Noble.

Nurses and Aides

If your child’s physician states your child can only attend school with a nurse or aide to handle the feeding tube, the school MUST provide this related service as part of the IEP or 504 Plan. Whether a child receives care from a nurse or aide may depend on the laws in your state. Some states only allow nurses to handle feeding tubes and give medications, while other states permit an aide to handle these tasks, if he or she has been trained to do so. In rare cases, a teacher may also provide feedings or medications.

For more information on the laws requiring schools to provide medical procedures and nursing services at school, see Medical Procedures and Nursing in Schools from Complex Child Magazine.

Homebound Education

A feeding tube should not prevent your child from attending school. If, however, your child has additional needs and requires homebound education, this is an option. Schools must provide a teacher in the home for a child who is unable to attend school. The laws on homebound education are unfortunately quite vague and vary considerably from state to state. Most states will provide homebound services for any child who will be unable to attend school for a period of time, or intermittently if a child misses school frequently. For more information, see Homebound Instruction for Children who are Medically Complex from Complex Child.