Blackboards and Bathrooms: A comprehensive resource to help teachers support the education of children with IBD
Written by: CDHF
Updated: November 14th, 2022
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Blackboards and Bathrooms has been created especially for you – the educator.
Inflammatory bowel disease (IBD) is an umbrella term for two disorders: Crohn’s disease and ulcerative colitis. IBD causes inflammation (redness and swelling) and ulceration (sores) in the digestive tract. Those living with the disease frequently experience the urgent, unexpected need to have a bowel movement and often require immediate access to a bathroom. The disease is unpredictable, embarrassing, debilitating and stressful. Students with inflammatory bowel disease (IBD) may need additional support.
The Canadian Digestive Health Foundation (CDHF) has created Blackboards and Bathrooms, a guide to provide educators with the resources they need to support students living with IBD. Our goals are to help minimize the burden of teaching students with IBD and minimize the negative impact this disease has on a student’s academic performance and school experiences.
Blackboards & Bathrooms provides practical strategies and tools to help students with IBD thrive in your classroom. As a teacher, you have a special opportunity to enrich the lives of students living with IBD. We’re hoping this guide will ease the way for you and your students.
The Impact of Inflammatory Bowel Disease
Inflammatory bowel disease is chronic and inconsistent. Symptoms can vary dramatically from wellness one week to illness the next. Students with IBD may have flares (when symptoms get worse) that occur unexpectedly and with alternating periods of remission (when they are well). Your student may not appear ill even when the disease is active.
Frequent diarrhea can lead to weight loss, poor growth, dehydration, malnutrition, and anemia. And, medications for IBD can affect mental functioning and mood in highly variable ways. IBD symptoms, clinic appointments and tests may also interfere with punctuality, attendance and engagement at school. If students don’t have the opportunity to catch up, they may become frustrated and lose interest during learning activities and risk falling behind.
All of these factors may lead to day-to-day fluctuations in energy, concentration, participation, and achievement. While every day is different for people with the disease, we have tried to summarize some common issues to help you understand what these children live with.
Students with IBD may suffer from:
- frequent diarrhea/ bloody diarrhea
- abdominal pain, cramping and urgency
- nausea and vomiting, decreased appetite
- weight loss and anemia
- malnutrition, fatigue
- poor growth, pubertal delay
- joint pain, joint stiffness
- skin afflictions
Students with IBD often miss out on school experiences because:
- they may be unable to participate fully in activities requiring strength or stamina, such as physical education or extracurricular sports
- medications can have side effects that impair concentration and well-being
- they require regular clinic visits and may require hospitalization for surgery and other health care related reasons
- their overall wellness is hindered by the disease
When attending school, students may struggle with:
- fatigue and reduced energy levels
- impaired focus
- impaired mood
- social discomfort or inhibition, emotional withdrawal, depression
Privacy in the school and classroom
Certain people at school will need to know your student has inflammatory bowel disease. You, the principal, and resource teacher will be part of an inner circle. Staff members should also be made aware of the student’s need to immediately access the bathroom. The student should always carry the CDHF IBD All Access Pass with them.
Decisions about whether to disclose the illness to schoolmates are best left to the student. Some students are eager to share information about their illness while others prefer complete privacy, and still others fall somewhere in between these two extremes.
Helping classmates understand
To help build a better understanding about inflammatory bowel disease and better relate to the IBD student, you can share some basics with your class. First, be sure to ask your IBD student for permission, to be sure they are comfortable with your doing so.
Here are some helpful facts:
- Inflammatory bowel disease is not contagious so there’s no risk of catching it
- Students with IBD may need to go to the bathroom often and urgently
- The disease tends to flare up and quiet down so children may feel well one day and terrible the next
- Students with IBD may sometimes find it hard to eat
- Students with IBD may be on a special liquid diet where they are unable to eat normal food for up to 8 to 12 weeks. They may also have a tube inserted through their nose into their stomach to deliver a special liquid diet
- Students with IBD may have to miss school, sometimes for long periods of time
- Medications used to treat IBD can make the student look puffy, trigger or worsen acne, and cause mood swings
Returning to School After a Flare
While school can sometimes be a challenge, especially during flares, going to school helps the child with inflammatory bowel disease regain a sense of normalcy and provides a lifeline of hope for the future. The child’s physician or parent should provide the school with a summary of what to expect.
Depending on the student’s academic performance before and during the absence, the resource teacher may recommend setting up an IEP meeting that includes faculty, administrators, special education personnel, and parents.
IBD All Access Pass
Students living with inflammatory bowel disease need immediate access to a bathroom. Every student in your school with the disease will have their own CDHF IBD ALL ACCESS PASS. Teachers and administrators need to understand that a child who shows this pass is not to be questioned or penalized.
Please post a copy of the pass along with the student’s photograph on staff information board(s) to ensure all staff are aware of the child’s disease and need for immediate bathroom access.
As a teacher, what do I need to know about working with students who suffer from IBD?
Issue: Attendance
What you need to know:
- ·Students with inflammatory bowel disease may require multiple,absences from school
- ·Response to treatment is variable; a child may stop responding,to one treatment and,require a change of medication
- You may need to provide resources, tutoring, note-taking assistance,,rest periods,,extensions, and make-up exams
Issue: Classroom Experience
What you need to know:
- Urgent need to go to the bathroom and accidents from incontinence are the most stressful classroom situations for students with inflammatory bowel disease
- Full and easy access to bathrooms should be arranged
- Post-surgical care may require temporary absence from the classroom. When planning coursework, consider that IBD-related pain and fatigue can impair performance
- Children with inflammatory bowel disease may absorb nutrients poorly. As a result, supplemental nutrition may be needed
Issue: Physical activity
- Encourage exercise when the student is feeling up to it·
- Allow rest periods for fatigue
- Physical activity may stimulate bowel urgency; allow the student to leave the activity and go to the bathroom at any point
- IBD or its treatment may raise the risk of joint pain and fractures
Issue: Mental Health
- Expect behavioural changes in students with inflammatory bowel disease because the student never knows when the next flare will strike, the fear of needing to rush to the bathroom or fear of having an embarrassing “accident” causes significant distress so they may have trouble relaxing and focusing on school tasks
- Students are at increased risk of depression and anxiety. Depression may manifest as irritability, low tolerance, frustration, and complaints of aches and pains
- Inflammatory bowel disease and its treatment may lead to withdrawal, denial, depression and anxiety; if you have any concerns, discuss them with staff and caregivers
- Bodily changes caused by inflammatory bowel disease and its treatment (e.g., weight gain, acne, delayed growth, ostomies) may impact self-esteem
Issue: Medications
- Medication side effects may impair academic and social performance and may prompt students to stop taking the medication
- If you suspect side effects, or you think a student has stopped taking his or her medication, report it to parents
- Some inflammatory bowel disease medications can impair children’s resistance to infection; let caregivers know about any infectious disease outbreaks in school
How can I support a student who suffers from IBD?
| Issue | What you need to know |
|---|---|
| Bathroom Access | Students with inflammatory bowel disease must be allowed to leave the classroom to go to the bathroom without delay or fuss. Other staff need to be aware of this as well. Questioning a child in front of classmates is embarrassing and the delay may result in an accident which adds to the humiliation. You can design a signal to avoid drawing attention. If the student needs to use the bathroom often, consider moving the student to a seat near the door and allowing him/her to use staff or disabled toilets as communal toilets offer little privacy. NOTE: It is possible that an IBD student may use the unlimited bathroom pass to avoid certain responsibilities. It is important that you have an open discussion with the student in private if you suspect this to be the case. |
| Dealing with pain | Children don’t always let adults know when they are experiencing pain and most people prefer privacy when they are in pain. If you suspect your student is in intense pain, ask him/her in a private moment and offer them the option to leave the classroom to rest in a predetermined location. |
| Impact of treatment | Students with IBD often take medications that may impact their energy levels, cognition, and focus. Students may also experience physical side effects due to their treatment, such as puffy cheeks and acne. Some medications also weaken the immune systems, making students more susceptible to illness and infections. Students with IBD should avoid classmates with infections/ infectious disease. Ensuring good hand hygiene in the classroom is an effective protective measure. A small minority of children with inflammatory bowel disease have ostomies (an artificial opening allowing waste products to drain into a bag outside their bodies) on their abdomen and may require assistance with their ostomy supplies. Ideally, classroom interruptions will be timed so the student doesn’t miss important work or events. |
| Social issues | Social adjustment is as important as academic success. As a teacher, you can observe signs of social distress, such as interpersonal difficulty with peers, avoidance of social activities, or reluctance to attend school. In such cases, you can inform the student’s caregivers and put appropriate support systems in place. |
What steps can I take to help students with IBD?
There are many steps you can take to help students with inflammatory bowel disease get the most out of their school experience, both inside and outside of the classroom. Here’s a summary of the most common school-related needs for a student with IBD – and the best ways to address those needs.
| Issue | What you need to know |
|---|---|
| Bathroom access | Provide student with an “IBD all access” bathroom pass and permission to use an immediately accessible bathroom, without question or penalty. Provide classroom seating that facilitates access to the bathroom. |
| Opportunity to rest | Ensure there is a recognized place to lie down, if necessary. Store a change of clothing at the school. |
| Medications | Allow the student to self-administer medications (if trained to do so) at school. Alternatively, leave the medications in a secure location accessible to trained staff member(s) or to a health worker who visits the school to administer the medications. |
| Personal supplies | Allow student to carry a small bag (subject to inspection) with sanitary products, a change of clothing, medication if applicable, a cell phone for contacting caregivers, and other needed items. |
| Attendance and schoolwork | Do not penalize for tardiness or absences related to IBD. Assign the student one major project on any given date. When the student is feeling unwell, limit the amount of work/ homework required for that day/ week. Do not require him/her to take more than one school test/exam per day, and reschedule tests as needed. Make “stop-the-clock testing” available without penalty. (If the student needs a break, the time for completing the test will be extended by the duration of the break taken). |
| Physical education | The student can determine if he or she feels capable of participating in a given physical education unit. Allow student to use their judgment when participating in physical education activities. Should a consistent lack of participation occur, request a doctor’s note from the student’s physician. |
| Academic support | Assist student in making up any missed class time and work, including waiving, modifying, or substituting assignments. Consider more formal academic accommodations (e.g., individual education plans) on a case-by-case basis. |
| Extra-curricular activities | IBD students should have the opportunity to partake in school excursions, with reasonable accommodations (e.g., being driven by a parent) if needed. ·When outside the school, supervising school personnel should help identify bathroom facilities for the student. |
| Communicating with parents | Inform parents about infectious disease outbreaks in the student’s school. Ask parents to inform you about any medical changes, and share your own observations with parents. Engage resource staff as needed to advocate for the parents and student at the school board level. |
How can I remove obstacles for an IBD student?
For many issues, resolution for your student living with inflammatory bowel disease may be easy. Others issues may prove to be more challenging. Below are some ideas to consider for overcoming obstacles.
| Obstacle | Solution |
|---|---|
| School rules prevent students from going to the bathroom without permission | Provide the student with an all-access bathroom pass – no questions asked, no denial of access |
| School bathrooms are kept locked for security reasons | Work with school administration to develop a protocol to ensure access for your student |
| The student is afraid of being teased or bullied while in the bathroom | Provide student with access to a private bathroom (e.g., staff bathroom or bathroom in teachers’ lounge) |
| The student is reluctant to go to the office to have medications administered | Combine the visit with an unrelated task that the child can feel good about (such as delivering a message or attendance to the office) |
| Foods that worsen symptoms are to be served at a class party | The student will know what foods are “safe” and tolerable. Where possible, try to provide alternatives that the student can eat |
| A field trip location (e.g., conservation area) has poor bathroom accessibility | Research other venues that provide a similar learning experience and have more accessible facilities |
| An extracurricular event is far away, requiring a long bus trip | Arrange to hire a bus with a bathroom. Enlist the student’s parents (or other adults, with parental permission) to drive the student |
| The school doesn’t offer suitable intramural or extracurricular sports for the student | Find out what sports are of interest to the student and consider starting a team |
Blackboards and Bathrooms was made possible through an unrestricted education grant from AbbVie.
