Neben der Familie hat der Kindergarten vor allem aber die Schule den stärksten Einfluss auf die kognitive, psychische, emotionale und soziale Entwicklung eines Kindes. Bildung ist wichtig, damit ein Kind Fähigkeiten erlernen und sein Potenzial entfalten kann. Noch wichtiger ist das, wenn ein Kind krank ist. Aus diesem Grund spielen Kindergarten- und Schulpädagogen eine Schlüsselrolle für die gesunde Entwicklung herzkranker Kinder.
Die meisten herzkranken Kinder können ein weitestgehend normales Leben führen. Für eine Sonderbehandlung besteht also kein Anlass!
Damit Pädagogen ihre Aufgabe bestmöglich erfüllen können, sind zwei Dinge entscheidend:
sie müssen über den Gesundheitszustand des Kindes genau Bescheid wissen. Hilfreich kann ein gemeinsam erstellter Notfallplan sein, mit Info der Erkrankung, wichtige Telefonnummern, was im „Fall der Fälle“ zu tun ist, …
Familie, Kindergarten/Schule und Ärzte sollten in engem Kontakt stehen
Werden Pädagogen richtig informiert, bringt das viele Vorteile:
Sie haben keine Berührungsängste mit der Krankheit/der Situation und müssen sich keine Sorgen machen, dass sie das Kind im Kindergarten/im Unterricht falsch behandeln
Sie können die Familie und Ärzte unterstützen. Denn durch den täglichen Kontakt mit dem Kind fallen ihnen gesundheitliche Probleme sofort auf
Sie sind in der Lage, Mitschüler über den Herzfehler zu informieren, falls dies zum Thema in der Gruppe/in der Klasse werden könnte. Wichtig ist, dass die Pädagogen den Kindern die Angst nehmen, die aus Unwissen entsteht. Oft ist das der Grund, warum ein herzkrankes Kind aus dem Gruppe/aus dem Klassenverband ausgegrenzt wird. Pädagogen sollten nach Möglichkeit alle Fragen rund um die Krankheitssituation beantworten können und dabei eine positive Einstellung vermitteln.
Which kindergarten do I send my child to?
Heart children can attend a normal kindergarten. Depending on the situation, the heart child can also be registered as an "integration child" in an integration kindergarten.
Advantage: smaller group, several educators and several support possibilities. You cannot spare your child the infections that many children go through during the kindergarten time. The immune system learns to deal with germs and develops in all children in the course of their childhood.
There are, however, some things that need to be taken into account in order to make the school day as normal as possible. How these adjustments are made depends on three factors:
The frequency and duration of hospitalization
Whether the child needs to take medication regularly
Whether there are physical or neurological limitations
The most important task of the educator is to impart knowledge to the child. Over-cautious behaviour should be avoided. Special treatment gives the child the feeling of being different and is a form of discrimination.
The support that a CHD child receives from the educator must not lead to preferential treatment compared to fellow students. In case of problems of adaptation or learning, the school psychologist (or external child school psychologist) should be consulted if possible.
If a CHD child has academic problems at school, it is sometimes necessary to adapt the curriculum or provide remedial teaching. From a pedagogical point of view, the educator assesses whether the child is progressing properly or whether there are language problems for which additional help must be sought. Educators and parents should keep a close eye on the age-appropriate development of the child.
Up to the age of four years, attention must be paid to difficulties in articulation, alteration or omission of sounds or failed sound replications.
In order to prevent writing problems later on, difficulties in grasping objects as well as motor skills problems - especially of the hands - should be closely monitored. In children from the age of four, objective assessment and diagnosis is only possible if the child cooperates. In children between the ages of four and 16, examination, diagnosis and therapy should be based on the learning and behavioural problems caused by language difficulties.
It is important and helpful if even very young CHD children know exactly why they have to observe special behavioural rules, avoid certain foods or take their medication regularly. Permanent special treatment leads to exclusion. Nevertheless, it is important that caregivers and teachers are prepared at school to accompany chronically ill children.
Ask the social services at your hospital for advice on compensating for disadvantages, such as transport services or extending examination times. Nevertheless, problems can arise for various reasons. Medication often impairs the ability to concentrate and thus also the learning and performance capacity of CHD children at school.
Hospitalisation and school
School attendance is important for chronically ill children so that they do not grow up in isolation. At the same time, this sets the course for social integration in adulthood. The fact is, however, that children with CHD have to go to hospital time and again - be it for a check-up or for an operation. This means that they are absent from school more often than other pupils. To ensure that absenteeism does not have a negative effect and that the children can settle back into school and class after an operation, a number of things have to be taken into account.
It is important that the teachers are properly informed - for example, how often the child has to go to hospital, when a hospital stay is due and how long it will take. If it is medically permitted, the child should be absent from school for as short a time as possible. If a longer stay in hospital is unavoidable and the child's condition allows it, lessons should be continued in a classroom in the hospital.
Lessons in Hospital
During a stay in hospital, the educator has important duties: He or she should ensure that the child is not excluded from the class community and, for example, encourage contact with friends and other educators. The educator should see to it that the child can continue learning and that his or her performance is assessed. Educators who work in the hospital should follow up on the learning content that was last taught in school. Direct, ongoing interaction with educators from the school is essential to adapt the curriculum to the circumstances. A classroom in the hospital can help to maintain a normal life for the child. Being together and playing and interacting with other children is also important to reduce any tensions.
If the child cannot go back to school immediately after a stay in hospital, lessons should still be continued.
One possibility is distance learning or home schooling. Here the family must of course be involved.
Returning to school
It is important that the children quickly return to normal everyday life. To do this, they must be confident that they will be treated normally at school just like everyone else and with the same consideration by their classmates as before. It is important that they are accepted as they are - despite possible physical changes. For fear of rejection, children with heart disease sometimes no longer want to see their friends. This is often caused by worries about their appearance or fears of being absent for so long. Some children react by withdrawing or are particularly shy, in an attempt to avoid physical contact when playing or being with friends.
This is especially true for children who have been instructed by a doctor not to engage in physical activity or sports.
Educators should pay special attention to such situations. Some children may seem self-confident, but are secretly insecure, feel fragile or easily hurt. If this is not recognised in time, it can lead to depression.
If the children have kept in touch with their friends and can keep up with the pace of learning, reintegration into the classroom is much easier.
The child's return could be celebrated, for example. Here the creativity of the educator is called upon. They can influence the situation in a positive way so that the child finds its way back into school life as quickly as possible. The best way to approach the return to the class community is to discuss the situation with the teacher, parents and child together. It should also be discussed what the classmates should learn about the child's illness and treatment.
In the weeks and months following the return, teachers should pay close attention to any problems. Any slumps in school performance can lead to aggressive behaviour, withdrawal, increased anxiety or social isolation.
The family plays an important role in school education, but it can be (negatively) influenced by two extremes.
One extreme is too much care: the child is overprotected for fear that his or her health might deteriorate. Parents should then strengthen their own self-confidence and also that of the child by giving their child more autonomy and increasing his or her self-esteem.
The other extreme is to deny the heart defect completely.
Parents do not accept the disease and behave as if everything is perfectly normal. The children thus receive contradictory messages:
On the one hand, their schooling is no different from that of other children. On the other hand, they have to cope with the problems caused by their heart defect. In this case, the parents allow their child to do anything they want, because they believe that certain limitations prevent the child from developing and that he or she suffers as a result. These two opposing approaches cause most of the problems that educators face when teaching children with heart disease.
Here it is important for the family to find the right balance.
This is the only way for children with heart disease to receive the best possible school education. It is up to the family to give the child the security and assurance it needs for its development. At the same time, all those involved in school education are required to create an environment full of love, empathy and tolerance for children with heart disease. School is important for the social integration of children and young people. Being integrated into the social environment is a central aspect in the development of all people - both with and without heart defects.
It is not enough for educators to simply impart knowledge, they should also take care of the emotional aspects of child development and ensure that the child understands new concepts.