Hello all! (+ question)

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Hello! I am a brand new elementary school nurse (previous experience is 2 years in adult psych with some assistance to the child/adolescent clinic). First I just want to say that I've perused this message board since I received the job offer and you all have been super helpful - seriously, I've taken notes! Students are back in school on the 14th, but I've already received a teacher question. Since I've spent all of my nursing career in psych, I'm a little fuzzy on some details of physical diagnoses. Combine that with my limited experience with children, I'm a little anxious.

Anyway, the question:

We have a type-1 diabetic and the teacher likes to provide a snack if the child earns enough "points" in the afternoon. She typically gives a small snack-size bag of Goldfish crackers, maybe 15 pieces. To me, this seems fine but I still told her I'd look into it and ask the parents.

The teacher also says she gives a starburst or peppermint candy for good behavior. I know these are fast-acting sugars so wasn't quite sure... but I didn't think one or two of these would be a problem either. She did say she's willing to buy sugar free candy. Any advice on any of this? Should this all be strictly left up to the parents?

And sorry in advance if you hear from me a lot in the upcoming month!

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Specializes in retired LTC.

Not a school nurse, but I have a concern. Could that teacher switch from a food-ORIENTED reward to something NON-FOOD??? (Happy face stickees comes to mind.)

With the epidemic of obesity now in our schools and the terrible incidence of fat shaming/bullying, I question why must society still revert to food for enabling behavioral response? As an adult with SERIOUS and MAJOR weight problems all my childhood and adult life, I just see the pattern being initiated and then ingrained at earlier and earlier ages.

Now to be really down & dirty, I'm reminded that people use food rewards for dog & cat behaviors.

And in that teacher's classroom, what happens when students don't 'earn' enough points for a reward?

I really do like the idea of rewards & positive reinforcement, but not by calories.

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Specializes in school nurse.

Diabetics SHOULD have a mid-morning and afternoon snack as part of their regimen, but it should be covered per their treatment plan, and hopefully be relatively "healthy". Food reinforcers are probably not a good idea, however, because it will make it all the harder to maintain a normal sugar. (And it doesn't create a healthy relationship with food...)

As an aside, sugar-free candies, if consumed in too large quantities, have a laxative effect.

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Specializes in School Nurse.

My son is a diabetic so I'm a bit sensitive to the issue. I agree with the previous poster. Food should not be an incentive (for diabetics or any one else). Giving high-sugar treats to a diabetic is a bad idea as well.

Our schools have departed from allowing any food in the classrooms (just not set up for the sanitation).

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Specializes in Pediatrics Retired.

The diabetes management plan trumps everything; class schedule included. IF a classroom snack would be coincidental with the management plan snack time and IF the carb count would fit...no big deal. Of course, there can be exceptions for special events but those decisions are made jointly between you and the parent in advance. Do not budge on this.

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Specializes in Med-surg, school nursing..

I would check with the student's diabetic management plan like OD said. For example, my diabetic kiddos get 1 unit of insulin for every 20g of carbs, they half half pens, so 10g, 0.5 units of insulin. Therefore anything under 10g is "free" meaning I do not dose for. So mom sends snacks that are less than 10g carbs, and if for some reason they are more than 10g, they are dosed.

I would check with the parent first to make sure they are okay with a snack, though I feel the student should be getting a snack daily, not just as a reward. And then suggest a snack that falls under the child's "insulin for __ carb" number if that makes any sense.

As far as candy, again, speak with the parent and make sure it is okay, if it is, I would still tell the teacher to get sugar-free for this student. Thought peppermints may not be many carbs, pennies make dollars.

Best of luck on your new journey.

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Specializes in NCSN.
The diabetes management plan trumps everything; class schedule included. IF a classroom snack would be coincidental with the management plan snack time and IF the carb count would fit...no big deal. Of course, there can be exceptions for special events but those decisions are made jointly between you and the parent in advance. Do not budge on this.

^^ This^^

The little one probably has a snack already built into her plan and really there is no room for extra. I'm starting to learn that the younger students with type one are VERY sensitive to any change (sometimes I swear they would spike/drop because the wind blew to hard that day).

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Not a school nurse, but I have a concern. Could that teacher switch from a food-ORIENTED reward to something NON-FOOD??? (Happy face stickees comes to mind.)

With the epidemic of obesity now in our schools and the terrible incidence of fat shaming/bullying, I question why must society still revert to food for enabling behavioral response? As an adult with SERIOUS and MAJOR weight problems all my childhood and adult life, I just see the pattern being initiated and then ingrained at earlier and earlier ages.

Now to be really down & dirty, I'm reminded that people use food rewards for dog & cat behaviors.

And in that teacher's classroom, what happens when students don't 'earn' enough points for a reward?

I really do like the idea of rewards & positive reinforcement, but not by calories.

I absolutely agree. The entire concept seemed off to me but as the newbie I didn't feel confident enough to really discuss this bigger issue with the teacher. Thank you for your response, I feel like this has given me a lot of good talking points to bring up.

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Thank you everyone for your responses, I'm feeling a lot better about my initial thoughts on the subject. I appreciate it!

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Specializes in School nurse.

Ugh the "food" rewards. It's a battle. Why can't little Joey have a 30 carb cookie at 9:30 in the morning, it's Susie's birthday? Followed later by the candy for good behavior. I tried explaining it various ways and got everything from eye rolls to hostility. So I had to think creatively until we change the process. It helped a lot when I explained to the teachers that food, especially the quick carbs, are like a medication to a student with diabetes.

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