Last updated on July 31st, 2023
Yes. Morally, of course, and countries also have laws around health and discrimination. A pupil cannot recover without a phase of meal support.
Is this child getting the meal supervision they need in school?
More and more, I hear parents telling me how helpful their school has been, how willing to help. Often, there's a dedicated member of staff who bends over backwards to find solutions so that children can, depending on needs:
- attend school, possibly not full-time
- eat reliably in school
- join in school trips, with accommodations
- have some adjustments made to their workload or exams
- be made safe from any recurrence of bullying or fat-shaming
Sadly the fantastic collaboration that I increasingly hear of, isn't happening everywhere. When the school refuses to help, the child is likely to stay ill a lot longer.
Is your youngster at a stage they can eat easily, without your help? If the answer is no, you cannot expect them to eat snack and lunch in school without supervision. Most likely they will cheat, because that's how the illness works. They will be in deficit for hours, and even if you feed lots at breakfast and dinner, daytime restriction keeps them in the hold of the eating disorder.
We're not asking staff to get a child to eat — that takes very special skills. But at some points in treatment, we do need someone to watch that our child is eating, and to report back to parents.
If your school is lukewarm, or point-blank refusing to get involved with your child's needs, your country may have legislation to back you up.
I'll start with the UK, then the US, and hope others will add information about other countries.
The head of pastoral care talked about getting staff to 'volunteer' to supervise eating, giving the impression that any support was being done on a good will basis. It was patchy. Several times our daughter was told she could go into the dining hall to eat unsupervised… resulting in nothing eaten.
UK: A little-known legal requirement comes to the rescue for lunchtimes
Big cheer for a dad in England who discovered that schools have a legal obligation to support pupils with medical needs. I don't think many clinicians or parents know about this.
If a child needs supervision or assistance with taking a medicine, the school is required to have a system to do so. There are other obligations, all to support a child's medical needs so that they are not disadvantaged by their illness.
As this dad wrote to me:
For example, if a child has diabetes, the school is legally responsible for administering insulin. As we know food is the medicine for our ED children.
UK: Write a 'healthcare plan' for a pupil with an eating disorder
If informal agreements with the school are not working, then use the law. Get a 'Healthcare Plan' drawn up, setting out the school's role in meeting a child's medical needs whilst in school.
In this dad's case, when he asked for a plan to be drawn up, the school gave him a form to fill in, after which they completed their bit.
The dad speeded the process up: "The application has to have the support of the relevant clinicians, which I have obtained by approaching them myself."
And the result?
After that meeting the supervised eating has run very smoothly and the staff involved are no longer referred to as 'volunteers'.
There doesn't seem to be a universal form for an 'individual healthcare plan' — it's up to you or the school to write up the details of risk and needs, and how the school will provide the required support.
The website TheSchoolRun tells you more about a healthcare plan.
There is also, for children with 'special educational needs', the legal framework of an Education, health and care (EHC) plan. One parent told me it had helped their child get a place into a smaller school, away from previous 'triggers'. Their child had anorexia with extra-high anxiety, but no other diagnoses.
If you want a ready-made form, you could use the relevant bits on this one proposed by MedicalConditionsAtSchool.
UK nations: laws require schools to support pupils with healthcare needs
The UK school and health system differs from one nation to the other. But it looks like all our nations have similar legal requirements around this issue. Check out details for your area on medicalconditionsatschool.org.uk
For Scotland, the official guidance for 'Supporting children and young people with healthcare needs in schools' is here.
For Wales, 'Access to Education and Support for Children and Young People with Medical Needs' is here.
Note that all this is different from 'Special Educational Needs (SEN)' and is a lot simpler. However the staff in charge of SEN may be the ones who will make this healthcare plan happen for you.
In the US: 504 plans help pupils get accommodations from the school
The US has similar legal requirements to ensure your child has equal access to education. The route to go is the '504 plan'. I tell you more about 504 plans, along with a wonderful template provided by a father in the US, here. That template is great for any country.
The only information I currently have is a word for you to look up: 'Nachteilsausgleich'.
I hope this is useful to those of you — parents, clinicians — who have not found school staff to be ready to support the child. Do contribute more info in the comments. I'd be especially glad to add sections for other countries.
Thank you to Matron Mum for contributing some really useful information in the comments below.