A free appropriate public education is the mandate for all children who receive special education services and supports due to the presence of a qualifying disability. Students are to be educated alongside their typical peers to the maximum extent possible to benefit from the myriad of experiences provided both by the richness of the general education curriculum and the social landscape that imparts the lessons of belonging to a community of learners. Children who, in addition to having cognitive and/or physical disabilities, also have concurrent, complex medical needs require the support of extra consideration, planning and collaboration from the IEP team.

The term “medically fragile” is commonly used to describe children with special healthcare needs. It is important, however, to remember that these children are children first. They have strengths, gifts, shared interests and valued roles to contribute. They also happen to have medical challenges such as: asthma, diabetes, or a seizure disorder. These healthcare diagnoses and others often require medication to be administered during the schoolday, skilled assessment and monitoring with medical intervention as appropriate, and management of medical equipment and other assistive technology.

The Individuals with Disabilities Education Act of 2004 specifically added nursing services to the list of related services that must be considered and/or provided if identified by the IEP team to be necessary, so that the student can participate in and benefit from their educational program. Logistical and funding challenges naturally follow the efforts of school districts to provide these supports. One of the more common responses is the tendency to educate children with special healthcare needs in more restrictive environments. Another is to have nurses increasingly delegate medical tasks to nonlicensed personnel, with varying degrees of training and oversight. Some tasks cannot be delegated according to State Nurse Practice Acts. These challenges require mindful consideration and management.

Every child belongs in his or her community of learners. A continuum of placement options exists to accomodate an individual student's learning requirements. It is not necessarily easy to coordinate the related services and supports these children require to receive a free appropriate public education (alongside their typical peers to the maximum extent possible), but it is possible. Creative thinking, innovative partnerships with agencies and organizations in the community, and an unswerving commitment to the education of ALL children will be key in the IEP team’s diligent efforts to make it all come together.