David Ray DeMaso, MD, Child and Adolescent Psychiatrist
at Children's Hospital Boston noted that the following could be considered in approaching the school needs of a youngster facing pediatric heart disease.

• Treat as "children with cardiac illness" not "cardiac children. It is important for the school to view a child as having a pediatric heart problem, rather than responding as if the illness defines whom they are. This approach is critical in supporting a youngster's identity as well as how they are viewed in the school. Encourage the school to treat your child as "normally" as possible within the constraints of his/her illness.

• Clarify the specific type of heart disease for the school. Pediatric heart disease represents a wide range of heart disorders ranging from the very mild with no significant disability to the severe with disabling effects. Clarification of the specific heart disease provides critical understanding for the school. It is helpful for you to provide this information. Your child's pediatrician and/or cardiologist. can also guide the school in providing reasonable accommodations for your child's physical limitations (e.g., allowing more time to change classes, placing all classes on same floor, etc.)

• Be alert for potential school fear. Parents of children with pediatric heart disease occasionally will report that the school is afraid of their child. Understanding the type of heart disease is one approach to reducing this worry. You can work with the school's psychologist or counselor to provide the necessary education for the teacher and other staff around the illness.

• Pediatric heart disease is not adult heart disease. It can be important to clarify with the school that pediatric heart disease is different than adult heart disease that is characterized by myocardial infarctions or heart attacks. Chest pain is an uncommon symptom of cardiac disease in children, occurring only occasionally. Arrhythmias are more likely to cause chest discomfort or heart awareness (i.e., fluttering, skipping beat, or turning sensation).

• Be alert to learning problems. Children with complex cyanotic heart lesions are at significant risk for motor and language problems. There is a strong association between behavioral problems and expressive learning delays. You may want to consider psychology testing should your child have any academic, emotional, attentional, or behavioral problems.

• Transition back into school. Following cardiac surgery, children often need a graduated transition back into the school. The provision of tutoring or assistance with homework that they have fallen behind on can be immensely helpful. Individual counseling or peer groups can be helpful for children and adolescents struggling with longer-term issues related to their heart problem.

• Consider classroom education. A child's classroom can benefit from educational information regarding the heart illness. This should be done only if the child wants this to occur. Parental permission and review of "what will be said" is critical. This recommendation is generally most useful in younger children. In these younger age situations parental participation is often a consideration. Older children tend not to want to highlight differences in the classroom.

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