Students with cystic fibrosis participating in recess.

Lucas, Matthew D. ; Jones, Brett S.

Introduction

The participation of a student with Cystic Fibrosis (CF) in recess can often be both challenging and rewarding for the student and teacher. This article will address common characteristics of students with CF and present basic solutions to improve the experience of these students in the recess setting. Initially the description, prevalence, and symptoms of CF will be presented. The article will then address recommendations for children with CF in recess.

Description and Prevalence of Cystic Fibrosis

CF is a life-threatening, genetic disease that affects approximately 30,000 children and adults in the United States (Cystic Fibrosis Foundation: A Teacher's Guide to Cystic Fibrosis, 2007).. The largest problems that are often faced by people with CF are severe respiratory and digestive problems. This is a result of a faulty gene that causes the body to produce abnormally thick, sticky mucus that can clog the lungs, pancreas and other organs. One in 31 Americans--10 million people--is a symptomless carrier of the defective CF gene. In order to have the disease, the person must inherit two such genes, one from each parent. It is important to remember that CF is not contagious and affects each individual differently. Interestingly, some people with CF are in good or even excellent health, while others are severely limited by the disease and not engaged in everyday life-activities. Children on this end of the spectrum face a variety of difficulties when attending school (Cystic Fibrosis Foundation: A Teacher's Guide to Cystic Fibrosis, 2007).

Special Education Implications of Cystic Fibrosis

The Individuals with Disabilities Education Act (IDEA) states that children who are determined to have disabilities receive special education if the condition negatively affects the educational performance of the child. One such category, which includes a variety of specific disabilities, is other health impairments. CF would be included in this category.

Other health impairment means having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that--

(i) Is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and (ii) Adversely affects a child's educational performance. [[section] 300.8(c)(9)] (CFR [section] 300.7 (a) 9) (IDEA, 2004).

Diagnosis & Symptoms of Cystic Fibrosis

The process of diagnosing CF is relatively simple. Doctors diagnose CF based on the results from various tests. At birth, all states require screening of newborns for CF using a genetic test or a blood test. The genetic test shows whether a newborn has faulty genes. The blood test shows whether a newborn's pancreas is working properly

(United States Department of Health, 2011). CF can affect the individual in either a minor or severe manner. The thick and sticky mucus associated with CF partially restricts the tubes that carry air in and out of your lungs. This can cause a variety of respiratory signs and symptoms. Below are some of these items.

* A persistent cough that produces thick split (sputum) and mucus

* Wheezing

* Breathlessness

* A decreased ability to exercise

* Repeated lung infections

* Inflamed nasal passages or a stuffy nose (Mayo Clinic, 2013).

Benefits of the Recess Setting for Children with CF

Simply stated, the benefits of the recess setting are high for all children. Included in these are physical benefits. Recess has been shown to lead to:

* Improvement of general fitness and endurance levels for children (Kids Exercise, 2009).

* Improvement of out-of-school activity levels - children usually are involved in physical activities on days in which they participate in in-school physical activities (Dale, Corbin, & Dale, 2000).

It is also important to note that there are specific physical benefits from recess for children with CF. Exercise helps loosen the mucus that clogs the lungs. In addition, exercise helps strengthen the muscles that enable one to breath. It is to be remembered that because of the breathing difficulties, these children often will have less endurance and stamina than other children. Thus, they often will tire easily (Cystic Fibrosis Foundation, 2007).

Recess Recommendations for Children with CF

To achieve the aforementioned physical/health benefits from recess, the following recommendations should be followed for a student with CF:

* Use sound judgment when assessing a student's physical capabilities. Talk to the student and parents to determine an appropriate level of physical activity.

* Try to include a child with CF in all games and activities in which he or she is physically able to participate.

* Children with CF are at higher risk of dehydration, especially when exercising or in hot weather. A child with CF may need to drink extra fluids. Water or sports drinks should be easily accessible during physical activities.

* During aerobic exercise, children with CF should drink six to 12 ounces of fluid every 20 to 30 minutes. Drinks with caffeine should be avoided during exercise. Instead, stick mainly with water and sports drinks.

(Cystic Fibrosis Foundation, 2007).

Conclusion

The participation of a student with CF in recess can often be both challenging and rewarding for both the student and teacher. The rewards can manifest themselves in the ability of the teacher to guarantee the safety of all students in recess. This article has hopefully addressed some basic concerns and solutions to improve the recess setting of students with Cystic Fibrosis.

REFERENCES

Cystic Fibrosis Foundation: A Teacher's Guide to Cystic Fibrosis. (2007). Retrieved August 31, 2013 from http://www.cff.org/ livingwithcf/atschool/teachersguide/#Exercise

Dale, D., Corbin, C. B., & Dale, K. S. (2000). Restricting opportunities to be active during school time: Do children compensate by increasing physical activity levels after school? Research Quarterly for Exercise and Sport, 71(3), 240-248.

Individuals with Disabilities Education Act (IDEA), Pub. L. No. 108-466. (2004).

Kids and Exercise: The many benefits of exercise. (2009). Retrieved September 2, 2013 from http://kidshealth.org/parent/ fitness/general/exercise.html

Mayo Clinic: Cystic Fibrosis (2013). Retrieved September 1, 2013 from http://www.mayoclinic.com/health/cysticfibrosis/

United States Department of Health: National Heart, Lung, and Blood Institute: How is Cystic Fibrosis Diagnosed. (2011). Retrieved September 2, 2013 from http://www.nhlbi.nih.gov/ health/health-topics/topics/cf/diagnosis.html

Matthew D. Lucas, Ed.D., C.A.P.E., Associate Professor, Department of Health, Athletic Training, Recreation, and Kinesiology, Longwood University

Brett S. Jones, Teacher Education, Student, Department of Health, Athletic Training, Recreation, and Kinesiology, Longwood University