COVID Update: Advice Regarding Returning to School

COVID Update: Advice Regarding Returning to School

Categories: Blog, Family Empowerment

By Dr. Tim Benke, Rettsyndrome.org Medical Advisor

Here is one big reminder:
Get a flu shot as soon as possible!

  • Please see prior guidance on this blog. Not much has changed: catching Covid-19 is still a risk to be avoided by all.
  • Outside the home: The child should wear a cloth mask if they can tolerate it. If they cannot tolerate a mask, then maybe they should not go out, especially if they will be indoors or in other situations where social distancing cannot be followed and exposure risk is high.
  • Frequent handwashing by all.
  • In school: Teachers, therapists should wear masks. If possible, other students should wear masks.
  • Family members should wear masks outside the home.
  • Family visits over the holidays pose a risk. Consider having visitors tested or quarantined first.
  • Social distancing (6 feet), as recommended by the AAP and CDC, must be observed as much as possible.
  • Consideration of school attendance on a reduced schedule limited to allow participation in therapies only in order to further increase social distancing.

The American Academy of Pediatrics (AAP) has updated their guidance slightly listed on its page: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-planning-considerations-return-to-in-person-education-in-schools/. Please note that these may change as the situation evolves, especially with the development of a vaccine. From the AAP page and section on Special Education and Students with Disabilities:

“Every child and adolescent with a disability is entitled to a free and appropriate education and is entitled to special education services based on their individualized education program (IEP). Students receiving special education services may be more negatively affected by distance-learning and may be disproportionately impacted by interruptions in regular education. It may not be feasible, depending on the needs of the individual child and adolescent, to adhere both to distancing guidelines and the criteria outlined in a specific IEP. Attempts to meet physical distancing guidelines should meet the needs of the individual child and may require creative solutions, often on a case-by-case basis. Additional safety measures for teachers and staff working with students with disabilities may need to be in place to ensure optimal safety for all.”

“The impact of loss of instructional time and related services, including mental health services as well as occupational, physical, and speech/language therapy during the period of school closures is significant for students with disabilities. All students, but especially those with disabilities, may have more difficulty with the social and emotional aspects of transitioning out of and back into the school setting. As schools prepare for reopening, school personnel should develop a plan to ensure a review of each child and adolescent with an IEP to determine the needs for compensatory education to adjust for lost instructional time as well as other related services. In addition, schools can expect a backlog in evaluations; therefore, plans to prioritize those for new referrals as opposed to re-evaluations will be important. Many school districts require adequate instructional effort before determining eligibility for special education services. However, virtual instruction or lack of instruction should not be reasons to avoid starting services such as response-to-intervention (RTI) services, even if a final eligibility determination is postponed.”

If necessary, consider asking your child’s physician or provider to provide a letter to the school with advice to assist with advocating for your child. This advice may include a recommendation, based on your situation, regarding return to school versus staying at home.


August 11, 2020
By Dr. Tim Benke, Rettsyndrome.org Medical Advisor

While we do not have any specific data, such as reports in the literature, children with Rett syndrome may be at high risk of complications due to Covid-19.  Children with Rett syndrome are prone to stereotypies in which they constantly bring their hands to their mouths.  Not only does this make it difficult to wear a mask at all times, but it makes it difficult to continuously keep the child’s hands clean. These issues increase the risk of exposure to Covid-19.

Currently, the recommendations from the American Academy of Pediatrics (AAP) in regards to attending school and wearing a mask are listed on their page: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-planning-considerations-return-to-in-person-education-in-schools/.  Please note that these may change as the situation evolves, especially with the development of a vaccine.

It is recommended that special needs children return to school if it is safe in the estimation of the parent and school based on the AAP guidelines.  School is often the primary provider of therapies, and patients with Rett syndrome have regression or stagnation of skills without the provision of regular therapy.  Each family and school district must weigh the risks and benefits based on their individual situations. 

Recommendations, based upon the current guidelines, are that the following steps should be undertaken to help protect the child in consideration of returning to school:

  • The child should wear a cloth mask if they are able to tolerate it.
  • The child’s hands will be sanitized multiple times a day to attempt to decrease germs being introduced.
  • Teachers, therapists should wear masks at all times.
  • If possible, other students should wear masks at all times.
  • Social distancing (6 feet), as recommended by the AAP and CDC must be observed as much as possible.
  • Consideration of school attendance on a reduced schedule limited to allow participation in therapies only in order to further increase social distancing.

Consider asking your child’s physician to provide a letter to the school with advice.  This advice may include a recommendation, based on your situation, regarding return to school versus staying at home.

Read additional COVID-19 community updates here.

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