#InklusionStattAusgrenzung: Inclusion not Exclusion – Calling for the Deployment of School Nurses

More and more children and young people are living with mental health conditions and chronic illnesses. They frequently need nursing or medical care – including at school. School nurses resp. School Health Specialists could take on the provision of this support. They relieve the strain on teaching staff, parents and students, improve the inclusion of children who are chronically ill or have disabilities, and increase health literacy in schools. But in the current school system, there is no funding for medically qualified staff. To boost public awareness of the need for school nurses, around World Children’s Day on September 20, a number of organizations are launching an online campaign – #InklusionStattAusgrenzung (inclusion not exclusion). The campaign is organized by the German Diabetes Association (DDG) in collaboration with its working group Pediatric Diabetology (AGPD), diabetesDE – Germany’s diabetes charity, the German Association for Social Pediatrics and Adolescent Medicine (DGSPJ), the Alliance for Chronic and Rare Diseases (ACHSE),, the Pediatric Nursing Association (BeKD) and the German Society of Pediatrics and Adolescent Medicine (DGKJ).


15 percent of children are living with chronic physical or mental conditions such as behavioral disorders, allergies or diabetes mellitus. “Teachers are increasingly overburdened. They are not trained or responsible when it comes to medical matters,” says Professor Dr. med. Andreas Neu, former president of the DDG and acting medical director at the Clinic for Children’s and Adolescent Medicine at the Tübingen University Hospital. Model projects, other countries’ experiences and studies show that nurses play a key role in taking the burden away from the school system, parents and children. “On the one hand, they can practice simple primary medical care for things like grazed knees and nose bleeds, and promote health education. On the other hand, they provide valuable and skilled assistance for children with daily support needs, thus relieving the strain on families and teachers, while also preventing discrimination against chronically-ill children,” Neu explains.


Having medically trained staff in schools particularly benefits children who require special help in their everyday activities because of their chronic illness. Research shows that currently almost a quarter of school children require additional medical or therapeutic support. “With Type 1 diabetes, the insulin regime and physical exercise need to be precisely balanced to avoid health complications such as life-threatening hypoglycemia,” explains Dr. Med. Thomas Kapellen PD of the AGPD. Despite the growing use of technology in treatment, primary school children are generally overburdened with the demands of their illness. “They can’t manage their diabetes fully independently because they can’t see the complex interrelationships by themselves – just like their teachers.” When chronic illnesses and their individual demands are not integrated into day-to-day schooling, there’s a high risk that the affected children will experience exclusion from school. “In the worst case scenario, contrary to their abilities, they have to forfeit the chance to go to a mainstream school, purely because nobody feels responsible for their healthcare needs,” Kapellen reflects. 

To enable their children to attend a mainstream school, it is often the mothers who step up to fill the gap, according to the AMBA study (Everyday Burdens of Mothers of Children with Type 1 Diabetes: Effects on Employment and Need for Support in Everyday Life). “We supported the AMBA study, which documented that 39 percent of mothers of children with Type 1 diabetes reduce their working hours. 10 percent even gave up work altogether after receiving their child’s diabetes diagnosis, to help provide care in kindergarten and school. We can’t allow a diabetes diagnosis to go hand-in-hand with mothers facing an interrupted career and risk of poverty. School nurses would change that,” says Dr. med. Jens Kröger, diabetologist and Chairman of diabetesDE – Germany’s diabetes charity.


Despite the obvious advantages of having health professionals in schools, there is still no clear commitment from politicians, who remain unwilling to employ medical staff in German schools to better integrate children with chronic illnesses into mainstream education. For this reason, DDG and its working group Pediatric Diabetology, alongside diabetesDE, DGSPJ, ACHSE, BeKD, and DGKJ, launched an online campaign to raise awareness of the problem. By following the hashtag #InklusionStattAusgrenzung (inclusion not exclusion) on XLinkedIn and Facebook, anyone can follow and support the campaign. Please contact the relevant press offices to request materials.

The key demands of the #InklusionStattAusgrenzung campaign:

Inclusion not exclusion!

School health specialists promote inclusion of chronically-ill children in schools.

Turning point in schools!

School health specialists relieve the strain on parents, teachers and educators in everyday school life.

Chronic illness? I can handle that!

School health specialists support children and young people in managing their illness independently.

School for everyone!

Chronically-ill children have a right to schooling – regardless of their illness.

DDG in the social networks:





  1. Informationen zum Modellprojekt Schulgesundheitsfachkräfte der AWO: Mehr Gesundheit im Schulalltag | Schulgesundheitsfachkräfte (
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  3.  A. D-Hindenberg et Al.: Long-term Occupational Consequences for Families of Children with Type 1 Diabetes: The mothers take the burden, Diabetes Care 2021:44:2656-2663
  4. H. Sassmann: Wer ist gestresst, wann, warum und wie sehr? Elterliche Belastungen und Bedürfnisse in der Betreuung von Kindern mit Typ-1-Diabetes, Poster DDG 0522
  5. KiGGS-Studie:
  6. Presseunterlagen zur Pressekonferenz „Inklusion statt Ausgrenzung: Warum wir Kinder mit chronischen Krankheiten wie Diabetes an deutschen Grundschulen nicht allein lassen dürfen!“:
  7. DDG Positionspapier Schulgesundheitsfachkräfte:
  8. Alltagsbelastungen der Mütter von Kindern mit Typ 1 Diabetes: Auswirkungen auf Berufstätigkeit und Bedarf an Unterstützungsleistungen im Alltag (AMBA-Studie):