Kids with Heart Defects: Ready for Kindergarten
Ages 3 - 5 Years
Are you getting ready to send your child with a congenital heart defect (CHD) to school for the first time? Are you wondering if they are ready? Are you wondering if YOU are ready? Planning for Kindergarten can feel intimidating, especially when a child has a serious health condition. However, if you plan ahead, you can approach the first day with confidence.
In this section
A family transition
Sending a child with a heart defect to Kindergarten is a momentous transition for many families. Parents often report a wide range of thoughts and emotions as they prepare their child for their first day of school.
They often feel:
Grateful that their child has reached this milestone
Fearful that their child will not be protected
Proud that their child has come so far
Sad that their child will not be home as much as before
Excited for their child to have new opportunities
Worried whether their child will make friends
Overwhelmed by new procedures, programs, and providers
Relieved that their child is doing something that feels normal and healthy
Parents should recognize these feelings and thoughts as normal. When a child has been very ill, it can be especially emotional to watch them grow bigger, and send them to school. Families should know that with preparation, the transition to Kindergarten is usually smooth, and often joyful. This transition is a time to recognize how far a child has come, and to look forward to new things.
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Understanding the child’s needs
Before sending a child to Kindergarten, families should make sure they understand their child’s strengths and needs. Schools will need this information in order to serve each child.
Ideally, children with high risk heart defects should have an evaluation well before they start Kindergarten. If a child with a complex heart defect is getting ready for Kindergarten and has not been evaluated, the family may want to:
Ask for a neuropsychological evaluation through their local cardiac neurodevelopmental program. If they do not have a local program, they should ask their doctor for a referral to a psychologist.
Ask their doctor to perform a neurological examination
Ask their doctor to perform a developmental screener
Request a Special Education Evaluation from the school district
Ask their doctor to describe any activity restrictions, and the child’s medical care needs in school
Families should talk with the people who evaluate their child, and make sure they understand:
The child’s areas of strength
The child’s areas of need
Whether the child is diagnosed with any delays or disabilities
What services (if any) the child will require in school
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Get a plan in place
When families know that a child with a heart defect has special needs, they should work with the school to get a plan in place before the child starts Kindergarten. Depending on the child’s needs, this can mean:
An Individualized Education Plan, describing the child’s Special Education program
A Section 504 Plan, describing the services, accommodations, and modifications the child needs in order to access what is being taught
An Individual Health Care Plan, describing the medical care a child requires in school
An Emergency Care Plan, describing how the school would respond to a medical emergency
An Emergency Evacuation Plan, describing how the child would be evacuated in the event of an emergency
Families should reach out to their school district before their child turns five if they think their child requires any special plan(s).
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Practice school skills
Families can help their child get ready for Kindergarten by practicing school skills. Children feel more confident when they know what to expect.
Many children like to play “school” before going to Kindergarten. By playing school at home, parents can help children practice the new skills they will need. Parents and children can take turns playing the role of teacher and student. For example, parents can help children:
Listen to a picture book
Recognize their written name
Pack up their backpack
Identify shapes and colors
Draw shapes and people
Write letters and numbers
Count sets of objects out loud
Practice sitting at a desk
Line up, and walk in a line
Eat lunch from their lunchbox
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Set a routine
The schedule of Kindergarten can be hard for some children, especially children who did not go to preschool. Families can help by setting a daily routine that matches the school schedule. Most children do well when families set a new routine at least two weeks before school starts.
The new routine can mean:
Wake up every day at the time they will need to get up for school
Get dressed and eat breakfast at the time they will need to on school days
Have 1 morning snack, a lunch, and 1 afternoon snack
No naps during the hours of the school day
Go to bed at the same time every night
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Talk about feelings
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Just like parents, children often have big thoughts and feelings about going to Kindergarten. Parents can help by giving children lots of opportunities to share what they are thinking and feeling. Parents can ask questions like:
How do you feel about Kindergarten?
Do you have any questions about Kindergarten?
Can I help you understand what Kindergarten is going to be like?
Is there anything you are worried about?
What are you hoping for?
Some children may have trouble coming up with emotion words. Parents can help by showing children faces that represent different emotions. Then, they can ask children to choose what they are feeling.
Read books and watch videos
Many children have trouble imagining what Kindergarten will be like. Families can help by reading books and watching videos about children starting Kindergarten. Families can ask their local librarian for suggestions of books and videos. Below are some books and videos that many families find useful.
These titles and links are provided as resources only. Boston Children's Hospital and the Benderson Family Heart Center don't necessarily endorse all of the information on these sites.
Books:
Countdown to Kindergarten, by Alison McGhee
Daniel Goes to School, by Becky Friedman
David Goes to School, by David Shannon
I Am Too Absolutely Small for School, by Lauren Child
Kindergarten Rocks!, by Katie Davis
A Letter from your Teacher: First Day of School, by Shannon Olsen
Look Out Kindergarten, Here I Come!, by Nancy Carlson
Mae's First Day of School, by Kate Berube
On the First Day of Kindergarten, by Tish Rabe
A Place Called Kindergarten, by Jessica Harper
School's First Day of School, by Adam Rex
Wemberly Worried, by Kevin Henkes
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Practice self-advocating
Children can feel intimidated by a new school building and new teachers. Sometimes, children are not sure how to ask for help. Families can help by talking with children about what sort of help they might need at school. For example, children might need help:
Opening their milk
Zipping their coat
Feeling better if they are sad or scared
Finding someone to play with
Knowing where to go or what to do
Finding a bathroom
Parents should assure children that all Kindergarteners need help with lots of tasks. The teachers are there to help the children. Parents can prepare children to:
Notice if they need help
Go to a grownup
Say: “Can you please help me?”
Tell or show the grownup what they need
Sometimes, children like to practice asking for help in a library or another safe space before they go to school.
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Tour the school
Children and their parents often feel better when they can see where the child will go to Kindergarten. Many elementary schools have open houses, or other events for new Kindergarteners to visit the building. Families can also set up their own tour of the school. In the weeks before school starts, parents can:
Call the school principal
Ask for a time when they can visit
Bring the child to see the building, including the classrooms, bathroom, cafeteria, gym, and playground
In some towns, families can also bring their child to play on the school playground in the summer and on the weekends.
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Connect with peers
Children usually feel better about starting school when they know the other children, and have at least one friend. Families can reach out to other people in the community, and set up play dates before school starts.
Many communities have social media groups for families with children of a particular age. These social media groups can be a great way for families and future classmates to connect.
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Meet the teacher
Teachers usually return to school at least a few days before students arrive. Parents can reach out to their assigned teacher, and ask if they can bring their child to meet them. Most teachers are happy to visit briefly with a student.
During the visit, the teacher can show the child their classroom, and some of the fun games, books, and materials. Many children like to see the spaces that are labeled with their names, such as a desk, table, cubby, coat hook, or locker.
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Meet the nurse
Before a child with a heart defect starts Kindergarten, the family and child may want to go into the school and meet the nurse. Parents can call the school and set up this meeting.
When meeting with the nurse, families can talk about the child’s medical history, and any current medical concerns. They can go over any medical care the child will require during the school day.
Many families want to talk about their child's feeding. They can make sure the nurse understands how the child can eat and drink safely and comfortably.
The nurse may have questions about the child’s health. Usually, it is a good idea for the family to sign a document called a Release of Information, which allows the school nurse and the child’s doctor to talk with one another.
If the child has an Individual Health Care Plan (IHCP), Emergency Evacuation Plan (EEP), or Emergency Care Plan (ECP), the family, nurse, and child can review these documents together.
During this nurse visit, the nurse should show the child their office, including the bathroom, exam space, and beds or cots. The nurse and family should make sure the child knows how to get to the nurse’s office if the child does not feel well.
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An ongoing process
As you prepare to send your child to Kindergarten, remember: this is the beginning of a long-term relationship with your school district. You will have many opportunities to meet with your school, and update anything that needs to change. If you ever need help, it is available through advocates and other supports. So try to enjoy this time with your family. It is something for all of you to be proud of.
This content was reviewed by a psychologist and an educator at Boston Children's Hospital.
Developmental care is best when it is local. Families local to Boston can receive educational care from the Cardiac Neurodevelopmental Program (CNP). Families from other regions can use the link below to find their local care team.
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