Medical & Physical

Other Health Impairment

For chronic conditions — epilepsy, diabetes, asthma, and more — where health is what's standing between your child and the school day.

If you're here because you're scared, that's okay. You're not alone, and noticing is the first act of advocacy.

Read as much or as little of this page as you have room for today. It will still be here tomorrow.

What this is

Understanding Other Health Impairment

Other Health Impairment (OHI) covers chronic or acute health conditions that limit strength, vitality, or alertness enough to affect education — epilepsy, diabetes, asthma, sickle cell disease, cancer, heart conditions, Tourette's, ADHD, and more.

Two documents matter here and they are not the same: an Individualized Healthcare Plan or Emergency Action Plan (medical procedures, written with the nurse) and an IEP or 504 plan (educational access). Your child likely needs both.

Attendance is the sleeper issue. Chronic illness means missed days, and missed days quietly become academic gaps and truancy letters. Get a written plan for absences before you need one.

Could this be it?

Early signs, by age

None of these are a diagnosis, and no child shows all of them. This is a list to help you notice patterns and describe them clearly to someone who can evaluate.

Any age

Frequent absences or partial days due to symptoms or appointments
Fatigue and reduced alertness during class
Missing key instruction and falling progressively behind
Anxiety about medical events happening at school
Medication side effects affecting attention or energy

Early elementary

Needs adult help managing medication or equipment
Trouble keeping up on days after a flare or a hospital visit
Sitting out of PE, recess, or field trips

Older kids & teens

Growing need to self-manage — testing blood sugar, using an inhaler, tracking symptoms
Social self-consciousness about the condition
Credit and graduation risk from accumulated absences

What to do next

In this order, when you're ready

1
Get a written medical statement from your child's physician
It should describe the condition, its educational impact (energy, alertness, attendance), and specific recommendations. This is the document that anchors OHI eligibility.
2
Meet with the school nurse before the IEP meeting
Build the Individualized Healthcare Plan and Emergency Action Plan first — medication, symptoms to watch, who is trained, and what happens on field trips and substitute-nurse days.
3
Request an evaluation for IEP eligibility, not just a 504
If your child needs specialized instruction — not only accommodations — request a full evaluation under IDEA. A 504 provides access; an IEP provides teaching.
4
Get the absence and make-up-work plan in writing
Ask for a written homebound/hospital instruction plan and an attendance accommodation so medical absences don't trigger truancy action.
5
Write down what you're seeing
Dates, examples, the exact words your child used, how long homework took. You don't need a diagnosis to keep a record — you just need a notebook. This becomes the backbone of every conversation that follows.
6
If your child is under 3, call early intervention today
IDEA Part C gives every state a free early intervention program for babies and toddlers from birth to age 3. You do not need a doctor's referral and you do not need a diagnosis — a parent can refer their own child. Search "[your state] early intervention Part C" or ask your pediatrician for the number. For ages 3 and up, the same law (IDEA Part B) makes your local public school district responsible, even if your child doesn't attend school there yet.
7
Put your request for an evaluation in writing
Email or hand-deliver a dated letter to the school principal and the special education director asking for a full initial evaluation, and say what you're worried about. Writing it down starts the legal clock. Ask for a copy of your Procedural Safeguards at the same time.
8
Talk with your pediatrician
A medical visit can rule things in or out — hearing, vision, sleep, iron levels, anxiety — and can open the door to outside evaluations and therapies that run alongside anything school provides.
9
Say it out loud to your child, gently
Kids usually already know something is harder for them. Naming it kindly — "your brain works in a particular way and we're figuring out what helps" — turns shame into a plan.

Try this at home

Small things you can do this week

These are everyday activities, not therapy or instruction. Ten warm minutes beats an hour that ends in tears — stop before either of you is done being pleasant.

Ages 5+2 min

Track energy, not just symptoms

A simple 1–5 energy rating each afternoon. Health conditions show up at school as stamina, and stamina data is what wins shortened assignments.

Ages 7+5 min

Rehearse the ask

Practice the exact sentence for "I need to go to the nurse" or "I need a break." Rehearsed words come out under stress; improvised ones don't.

Ages 7+15 min

Homework in short blocks

Fifteen on, five off, timer visible. Protecting energy across the evening beats one long session that ends the night badly.

These ideas are general parenting suggestions for families reading about Other Health Impairment. They aren't therapy, instruction, or medical advice — follow the plan your child's team has set.

Looking ahead

When your child reaches their teens

Starting somewhere between 14 and 16, the IEP has to begin planning for life after school: postsecondary goals, independent living skills, vocational training, and connecting with adult services before school ends. Decision-making changes at 18, too.

Read the transition planning guide

Where to read more

Organizations we trust

These are national nonprofits, university centers, and government resources. Firm Footing isn't affiliated with any of them — we just think they're worth your time.

Your IEP meeting

Before, during, and after

An IEP meeting is a working meeting, not a verdict. You are a full member of the team, and you can ask for another meeting any time.

Evaluations to ask for

Name these specifically in your written request — a general request gets a general answer.

Medical documentation of the condition and its educational impact
Nursing assessment and Individualized Healthcare Plan development
Academic achievement testing to find gaps from missed instruction
Attention, alertness, and stamina observations across the day
Social-emotional assessment related to living with a chronic condition

Before the meeting

Ask for a copy of the draft IEP, the evaluation report, and any progress data at least a few days ahead. You are allowed to read before you decide.
Send a short list of your concerns and questions in writing before the meeting so they must be addressed on the record.
Write your own one-page "parent input statement" — who your child is, what's working, what isn't, what you want by the end of the year. Ask that it be attached to the IEP.
Bring someone: a partner, a friend, a note-taker, or an advocate. You are allowed to bring anyone with knowledge or special expertise about your child.
Check your state's rules on recording, and give written notice if you plan to record.

During the meeting

Ask each person to say what data they used. "What is that based on?" is a complete, polite question.
Slow the meeting down when a term goes by that you don't know. "Can you say that in plain language?" is your right, not an interruption.
Test every goal out loud: What exact skill? How will it be measured? What's the target number? Under what conditions? By when?
Check that the services page matches the needs page — every need described in the PLAAFP should have a goal, a service, or an accommodation attached to it.
If you disagree, don't refuse to sign in silence. Ask for your disagreement to be written into the meeting notes, and ask what the school proposes instead.

Services to ask about

School nursing services and trained backup staff, named in the plan
Specially designed instruction to fill gaps from missed school
Homebound or hospital instruction during extended absences
Counseling as a related service
Health care plan attached to the IEP and shared with every teacher and sub

Accommodations to ask about

Unrestricted access to the nurse, water, snacks, and the bathroom
Medication and equipment access, including on field trips and buses
Attendance accommodation for medical absences with a make-up-work plan
Reduced workload during flare-ups; extended deadlines
Rest breaks and a place to rest
Two sets of materials for home and school
Emergency Action Plan trained to all staff and substitutes
Modified PE with participation, not exclusion

After the meeting

Send a same-day follow-up email summarizing what was agreed and what's still open. A friendly written summary becomes the record.
Read the final IEP against your notes when it arrives. If something is missing or different, say so in writing within days, not months.
Calendar the progress reporting dates and ask for the actual data, not just "making progress."
If services aren't being delivered, ask for the service log in writing. Missed minutes can mean compensatory services.
If you disagree with the school's evaluation, you can request an Independent Educational Evaluation (IEE) at public expense — ask in writing.

Still not sure

Bring the document, or bring the question

If you already have an IEP or evaluation in hand, Decode My IEP will read it with you and flag the vague goals. If you just want to ask something out loud, Sprout answers in plain language.

Decode my IEP Ask Sprout a question

Related guides

Firm Footing is an independent resource. Nothing on this page is medical, psychological, or legal advice, and none of the organizations linked here are affiliated with us. Special education rules vary by state and district — your state's Parent Training and Information Center can help you with local specifics for free.