Many children with congenital heart disease (CHD) do well in middle school. Like all children, people with CHD have strengths and challenges. During this stage, schoolwork becomes more complex and social expectations increase, which can make some challenges more noticeable.
Common Challenges #
Some middle-school age children with CHD may experience:
Attention or Self-Control Difficulties
This may look like trouble paying attention, being easily distracted, impulsivity (acting before thinking), hyperactivity (always moving, as if driven by a motor), or problems with executive functioning.
Executive functioning involves skills related to planning, organizing, and being able to change plans when needed.
In middle school, this may look like difficulty keeping track of assignments or planning ahead for tests and projects. Children this age may be “consistently inconsistent” in their learning and performance from day to day.
These challenges can be signs of attention-deficit/hyperactivity disorder (ADHD), which is a condition that affects attention and self-control and must be diagnosed by a professional.
Fine Motor and Handwriting Challenges
Handwriting may be messy or hard to read. Letters may be very large or spaced unevenly. Children may avoid handwriting tasks or may not show their work in math.
In middle school, children may be required to type on a computer. Some children may have difficulty with this.
Challenges with Problem Solving or Memory
This may look like difficulty thinking through steps, remembering what to do next, learning new information, or remembering what they learned.
Academic Challenges
This can include learning disabilities in reading (dyslexia), math (dyscalcula), or writing (dysgraphia), or falling behind classmates.
Mental Health Concerns
Some children may feel anxious, worried, or sad. You may notice avoiding new activities, discomfort with changes in routine, withdrawal, or strong emotional reactions.
Worries About Health
Some children may fear getting sick or worry that something is wrong with their heart. This is sometimes called health anxiety.
Social Challenges
Some children may have trouble making or keeping friends. They may also struggle with using social communication (called pragmatic language).
Pragmatic Language means using language in social ways, like understanding sarcasm or other people’s points of view.
This may look like: Difficulty understanding jokes or sarcasm, reading facial expressions or tone of voice, or seeing things from another person’s perspective (putting themself in someone else’s shoes).
Some children may also have trouble understanding, responding to, and asking for help in more complex social situations, such as bullying.
Frequent Absences
Some children with CHD have to miss school more often because of doctor’s appointments, procedures, or illnesses.
Missing school affects learning, but can also impact a sense of belonging to a child’s school community. This connection is important in avoiding anxiety related to school or school refusal. Work with the school ahead of time when possible to make sure your child is able to make up any missed work and can maintain a connection to peers
Children with CHD may have challenges in one, some, all, or none of these areas. If you have concerns, reach out to your medical team
How You Can Support Your Child #
Support Emotional Well-Being
A psychologist can help your child learn to understand and cope with their feelings. If possible, look for someone who has experience supporting children with long-term medical conditions. Your child’s cardiologist or pediatrician may be able to help you find a provider.
Continue Developmental Follow-Up
Many children’s hospitals have developmental follow up programs specifically for children with CHD. Keep appointments with your child’s development follow up program – even if they seem like they are doing ok!
Stay in Close Contact with Teachers
Talk regularly with school staff about your child’s progress and needs. You may request an evaluation for individualized learning plan for your child if support is not already in place. In the United States, these are often referred to as IEPs or 504 plans.
Support Healthy Routines
Encourage regular sleep, balanced meals, and consistent daily habits
Limit screen time
Encourage fun physical activities that are safe for your child
Encourage activities your child enjoys. This may include:
- school clubs
- sports that are safe
- extracurricular activities
- play dates
- hobbies at home.
Stay Connected to Your Medical Team
Talk with your child’s care team about developmental progress. Adjust therapy and supports as needed.
Looking ahead #
As your child plans the transition to high school, make a plan about how your family will work to build your child’s independence at school and at home. Encourage independence with tasks around the home like tidying up, dishes, and laundry. It is also important to support your child’s independence in learning how to manage their medical care.