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Nursery & School

Entrusting your child into the care of someone who may have little knowledge of OA/TOF can be daunting but we are here to help. We’ve put together a number of resources to help make the transition from home to school or nursey as easy as possible.

We have also created a dedicated page aimed at early years staff and teachers that collates a lot of the information that we believe they will find useful. 

When our daughter started nursery we were allocated a named carer who took the time to learn about OA/TOF. This really helped to put our fears to rest."

Steps to consider when looking at any childcare settings for your child (nursery, child minder or school).

Contact the setting to arrange to meet with the nominated person/people to discuss your child’s needs. (This may be with a specific child minder, the head teacher, class teacher, Special Educational Needs Coordinator (SENCo) /Additional Learning Needs Coordinator (ALNCo) and/or pastoral support.)

It is best to be prepared and initiate this contact well in advance of any intended start date.

At the meeting, be prepared and share the information below. This will help to build the child’s health care plan with the school:

  • Evidence: videos, or scenarios are important to show staff, to help them understand what happens in worse case scenarios.
  • Download these TOFS guidance sheets (or order hard copy for free from TOFS):
  • Your child’s medical history.
  • Letters from any of your health care team/consultants.
  • List safe/unsafe foods for your child, drinks they use in emergencies.

Make the school staff aware that not all ‘choking’ needs action. It is important to make them aware of the difference. Some appear to choke because of a ‘stickie’ (food lodged in the oesophagus) but are still able to breathe. Some appear to choke due to unsafe swallow or aspiration – would your child need to calm down, take a sip of drink until it passes or need physical intervention?

Clearly if a child is unable to breathe, then physical intervention is necessary. Sharing evidence, videos and scenarios will help with this.

Suggest training on choking for the school staff, including the kitchen team, with first aid information posters placed in key areas. (This advice may be different for children who have had stomach pull ups)

St John Ambulance – choking child guidance

When settled, and where relevant, make the class aware of your child’s conditionYour child’s peers will in time, become their army of support when needed. 

Remember that you are your child’s advocate and their voice in the early years, so do speak up, share information, and ask questions, so that you feel confident leaving them in that childcare setting.  

As your child’s health care plan will need updating annually, do resend updated guidance and information from TOFS every year too. Offer to meet with new staff to explain your child’s condition and needs. 

If ever in doubt, contact TOFS Facebook groups, TOFS Local Contacts and your team of health care professionals.

Click here to download this guide as a PDF.

Useful downloads

TOFS has produced a number of resources to help your child get the most support when attending nursery or school.

Visit our Resources & downloads page and click on school or nursery

Order your resources

Order hard copies of our leaflets along with badges, wristbands, and lanyards direct from the TOFS Shop.

Individual Health Care Plan

It is very important that the school is aware of your child’s additional medical needs and has a clear understanding of the protocols that need to be followed to ensure your child is safe. This information should be combined to create an Individual Health Care Plans (IHCP).

It is important that information included in the IHCP is succinct, does not contain a lot of confusing medical terminology and captures the steps the school should take to help your child manage their condition. 

A school has a member of staff responsible for IHCP’s. Ideally the school, a healthcare professional and parents would write the health care plan together, however this is often not the case.

If you have written the plan, time must be allocated to go through the plan with a member of staff from the school. Keep it simple and reassuring to the school as to which parts are their responsibility, for example, who will oversee the child at snack and lunchtimes and if there is a medical emergency what steps need to be followed.

Outline as basically as you can what is the medical condition, what are the triggers (foods, having a cough or cold, forgetting to chew), behaviours (how your child presents with a sticky) and what are the actions required. Actions may need to be broken down into stages of mild, moderate and severe.

The school’s role will be to identify if the child requires medical intervention and know the steps to follow.

You can download a copy of an IHCP for nursery or school from our resource page along with other useful information like the Emergency Card template.

Medications in school

Medication will only be administered in school if it is deemed detrimental to a child’s health not to do so.

Schools require a letter written by a GP or paediatrician outlining the need for the medication and its purpose, required dose and dispensing method.

The medication will need to be clearly labelled with the child’s name, class and dose. It will be the parents/ guardians responsibility to ensure the medication is in date and to replenish supplies as they run low. It is the schools responsibility to follow their specific ‘medications in school’ policy, to ensure medication is stored securely with a log of who administers the medication, at which time and how often.

Some schools are happy for an OA/TOF child to have a little bottle of fizzy water or lemonade in the classroom cupboard and school dining hall should it be needed for mild stickies, but this is with agreement between the parents and school. Again this drink will need to be clearly labelled, kept in date and replaced if used, as the parents responsibility. At senior school, pupils are often allowed to keep a small can or bottle of fizzy drink in their bag.

The school nursing service should be involved in any additional training that is required for staff.

Packed Lunch or School Dinners?

When your child is settling into school it may be beneficial to start them on a packed lunch so you can monitor how much they eat and include foods you know they can manage easily.

Your child should be known to the lunchtime staff. If funding is available your child may be overseen by a particular lunchtime supervisor, although often this supervision may be shared between another child who has additional needs also. If the school does not have funding for this, it is useful that your child knows which lunchtime supervisor they can approach if they get into difficulties.

OA/TOF children do need to be allowed additional time to eat. This may mean going to the lunch hall early. To avoid being singled out as ‘ different’ discuss with your child how to respond to other children’s questions. For example, ‘I have a tricky throat and have had lots of operations to fix it. I need a bit more time to eat as sometimes I get food stuck.’

If your child is allowed to choose someone to go down to the dinner hall with early they quickly become extremely popular!

If your school allows children to have a packed lunch on some days and school dinners on others, this is ideal as you can look through the menu together and pick TOF friendly food.

Make sure the dinner staff know extra gravy, ketchup, sauce and drinks will be required when serving the food. It is helpful for your child to take an additional water bottle to school to ensure they have enough fluid to help them eat at lunch time as well as drink during the day.

Snack time in school requires some planning and thinking ahead.

Under the Government Fruit Scheme, all children from Reception to Year 2 receive a free piece of fruit each day. The school will usually know a week in advance which fruit they will be offering children. It is useful to provide an alternative snack for the school to keep in the cupboard like sundried/ yoghurt coated raisins or fruit winders for days when it’s not a manageable fruit. Snack time is a sociable time for children to sit together and drink and eat, so ensuring your child can participate is important.

You may wish to ask that your child is sat next to the teacher or teaching assistant during snack times so they can easily see if your child is managing OK.

For secondary school aged children, lunch passes to allow the pupil to go down to the canteen five minutes early are useful, as lunch breaks tend to be much shorter. Toilet passes are also useful to request due to drinking more when eating.

School Attendance

For a child with OA/TOF there can be numerous outpatients appointments to attend. There can sometimes also be unexpected hospital admissions.

It is useful to find out who is the school’s Attendance Officer and make contact to explain your child’s condition, particularly if your child is experiencing a challenging period.

Ensure all absences are authorised by making a copy of the outpatient appointment letter and sending this to the Attendance Officer in advance of the appointment. Do ensure you have also have proof of hospital admissions and advised recuperation times from your child’s medical team.

Talking about OA/TOF in the classroom

Joe - Born with OA/TOF


When Joe was 8, he thought it was important to teach his classmates about his experiences with OA/TOF and why it makes him special. So, he decided to make a wonderful presentation to tell them all about it. Joe did a fantastic job of explaining about his condition and his classmates learned a lot too! Please feel free to download the presentation and adapt it, if you feel it might help your chid explain OA/TOF to their class.

European Lung Foundation

Healthy Lungs for Life (for Schools)

The European Lung Foundation (ELF) have produced a series of resources for use in schools. They are available for ages 5-7, 7-11 and 11-14 and are in-line with the needs set out in the curriculum. Parents may find it useful to signpost these to school.