Ruth E. K. Stein, MD
UpdateJune 30, 2010
Honoring Do-Not-Attempt-Resuscitation Requests in Schools
Update Author:
AAP Council on School Health and Committee on Bioethics
Increasingly, children and adolescents with complex chronic conditions are living in the community. Federal legislation and regulations facilitate their participation in school. Some of these children and adolescents and their families may wish to forego life-sustaining medical treatment, including cardiopulmonary resuscitation, because they would be ineffective or because the risks outweigh the benefits. Honoring these requests in the school environment is complex because of the limited availability of school nurses and the frequent lack of supporting state legislation and regulations. Understanding and collaboration on the part of all parties is essential. Pediatricians have an important role in helping school nurses incorporate a specific action plan into the student’s individualized health care plan. The action plan should include communication and comfort-care plans. Pediatricians who work directly with schools can also help implement policies, and professional organizations can advocate for regulations and legislation that enable students and their families to effectuate their preferences.
The entire AAP policy statement can be accessed at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;125/5/1073. This policy statement is a revision of the policy statement “Do Not Resuscitate Orders in Schools” posted in April 2000.
All children experience minor illnesses and injuries while they are growing. Although most children have no ongoing consequences from these episodes, some children have more serious or recurrent impairments or disruptions of their health with which they live for prolonged periods. These conditions, and the children who have them, have been given many names over the past decades. Some authorities have referred to them as having chronic illness, but some of these children are not ill. Other authors have referred to them as having disabilities or handicaps, but many children do not exhibit these features. The term in vogue most recently has been to refer to these children as having special health care needs. Children with special health care needs (CSHCN) was a term originally coined as a euphemism for the other terms.[1] More recently the term CSHCN has been defined to include children who are not currently having any condition or impairment but who are at risk for them, such as foster children.[2] Because no agreement exists on which children to include in the at-risk category, they are referred to in this chapter as children with ongoing or chronic conditions, though many others refer to them as CSHCN and count only those with identified impairments or service needs.
Chapter 64: Children With Ongoing Health Conditions has been found in AAP Textbook of Pediatric Care
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