Unexpected absences: The school should make allowance for a higher number of school interruptions for health reasons (medically excused tardy, absent, or early dismissal days).

Decreased stamina and strenght: Adjustment to physiocal education expectations and grades to reflect decreased stamina, energy and endurance. If the school grounds are extensive, some students may need to use a wheeled backpack, keep heavy books in the classroom, have more time to pass between classes, or other accommodations to allow for stamina and strenght differences if class-to-class transitions are physically demanding.

Temperature extremes can trigger sickle cell pain crises: Bus pick-up in front of home on cold winter days;alternative plan for recess or outdoor physical education on days when the weather is extreme. Protection from prolonged exposure to very cold or very hot temperatures as well as protection from extreme temperature changes like running into cold weather from a warmroom or jumping into a cold pool.

Dehydration can trigger sickle cell pain crises: Water bottle at deskwith free access to water for drinking at school. Ensure that the child likes the taste of the water and is actually drinking it. If not, provide an alternative beverage for the child to ensure adequate hydration.

Increased metabolism due to higher red cell turnover causes more hunger: Ensure that the child is not hungry and do take any complaints of hunger seriously. Provide quick, healthy , snacks in locker or from teacher or school nurse to sustain energy.

High fluid intake and more urination: Provide more frequent excused bathroom breaks. In addition to haveing to drink a lot, children with sickle cell disease are not very efficient at concentrating urine, so are less capable of holding urine. Some may not be able to hold it at all and have to go when they need to go.

There may be medications to take: This is especially true of medications for pain, called ‘as needed’ medications. These children should always be taken seriously when they complain of pain. Pain is one of the hallmarks of sickle cell disease and is unpredictable, and severe. Ensure that pain medicines are always available for the child in case of pain.

Allow for school nurse visit and nurse management if child complains of pain. Create a nursing care plan with the child’s parents and school nurse so that that school and family agree about when to call the parents, and when to call 911.

FAST response is necessary for good health: Teachers, lunchroom and playground supervisors, as well as nurses should be educated to recognize and know what to do in case of warning signsof stroke and of an acute painful episode including  acute chest pain.

Attention, organization, short term working memory, learning and speed of processing can be directly affected by sickle cell disease: For some individuals, they may requirerelated services from Learning Disabilities/ADHD specialists, speech-language therapists, occupational or physical therapists, DAPE and AT.

Self-regulation of mood and impulsivity, self esteem, social skills and self-advocacy: these can be directly affected by sickle cell disease: SCD affects brain functions eitrher overtly through strokes of covertly through silent strokes or poor neurocognitive functions. The degree varies and in some extremes children may need psychologists, counsellors or special educators.

This addendum was originally produced by Karen Wills of Psychological Services, Children’s Hospitals and Clinics of Minnesota and is published here with her permission.