Peter, a 5-year-old in my class, has severe asthma. His parents have asked us to curtail some of his school activities and to be prepared for the possibility that he may have an acute attack. We're comfortable dealing with Peter's physical limitations, but we want to be sure we're doing all we can for him emotionally. Can you advise us?

I would like to try to address your question first from the point of view of this child and then consider strategies for you to use in the classroom.

Right now, it's important to give Peter only the information he needs to optimize his health, and to give it in a way that he can understand. For example, he needs to know what having the illness means in terms of his daily activities. He also needs reassurance that he can still have fun and play and enjoy activities with other children.

Unfortunately, we often tend to project our own concerns onto chronically ill children. For example, we may assume that a child would feel terribly left out or different because he has this problem. We might then feel so sorry for him that we could cause him to feel that his world is about to crumble, when the fact is that he simply has to be careful in certain situations.

Let's start by reviewing Peter's physical needs. Here are some things you can help Peter be aware of in order to prevent an attack:

  • He needs to avoid running so much that he gets too tired.
  • He has to be especially careful in cold weather or in the spring when his allergies may be a little worse than usual.
  • As soon as he starts coughing, he needs to rest or use his inhaler or other medication.

You can help him accept these conditions of the illness as simply one aspect of himself, like his wonderful smile, his sense of humor, or his ability to do magic tricks. Granted, his illness may mean having to do some things he's not terribly fond of, like taking rests when he gets tired, going to the doctor for checkups and tests, and possibly having allergy shots. But these things are because you, the doctors, and Mommy and Daddy are working together to help him feel better.

Any child in this situation may at times feel that life is not fair. He sees other children who don't have to rest and go to the doctor often. You can acknowledge that yes, in a way it is a little unfair. You can also remind him that, on the other hand, not all children can tell funny stories as well as he can or make friends smile when they're feeling sad the way that he does.

This is a good time to introduce the concept that everyone is different. We all have different challenges and talents. Help him look at his situation in a more balanced way so that he can see the big picture, including the other really wonderful things in his life.

You can watch for two possible negative reactions in children who have this or any chronic illness. In one case, the child becomes a daredevil as a way to deny any limitation. In the other, the child becomes a couch potato, avoiding any potential danger. Neither of these reactions is inevitable. Children have a wonderful ability to adapt when life throws them a curve ball. But we have to give them implicit permission to be joyous by not feeling sorry for them or being pessimistic ourselves.

Teachers have their own special concerns in these situations. It does mean extra work and extra worry to have a chronically ill child in class. However, chances are that at least every couple of years, a teacher will have one or two children in class with heart problems, asthma, or diabetes. It's part of teaching. If you feel it's an extra burden, that this is not what you were expecting, then you have less chance of coping with it in a constructive way. Just as you expect to have children in your group who exhibit a wide variety of behaviors and cognitive abilities, you also need to expect to have some children with physical limitations.

It's important to work out a plan with parents and the director that covers all contingencies, such as making sure there is someone to take over your class in case you need to call 911 and be there for the ill child, or having a nurse on call.

To enhance the child's social standing in the classroom, the other children should be helped to understand the ill child's situation. In very matter-of-fact terms, they should be told what the child, himself, has been told. In Peter's case, they should know that he may have some problems breathing if he runs too fast or too long and that during some seasons he may have to rest more often. If any child becomes rejecting, saying, for example, "Oh, you can't play because you can't run," you have an opportunity to teach empathy and compassion in a very respectful way, not in a way that invites pity. You can talk with children about the fact that we're all different. You can explain that some children may have trouble with counting, some may be slow runners, and some have to be extra careful during allergy season-yet we all work together as a group and help one another.

Ideally, as you, Peter, and the other children in the class come to terms with the reality of the illness, it will be seen as only one attribute of this wonderful child.