Dear Bob:

We had three boys in our day camp last summer, all six to eight years old, who had to be dismissed from our program. This represents an all-time record for us. Not one to be proud of. Each of these boys had trouble with transitions, became upset, and hit when they had to stop one activity and move to another. One boy hit Allison, our head counselor, in the face. Another boy, who had been diagnosed with ADHD and started his meds just before camp, could not make transitions and went into sensory overload. When this happened he shut down and could not communicate until he came out of his overload. In each case, the parents said their schools or other programs dealt with them by letting them go off to a corner by themselves, play alone for the rest of the time, or play alone until they felt like joining in with others. Our program has a number of transitions because it is very scheduled with lots of activities for kids to do each week rather than a free choice format.

Do we have the wrong camp format for children like this? We followed our progression of discipline, including a day at home and a parent conference, and all for naught.

What question(s) could I ask on our application to help these parents decide whether our camp is truly the right choice for their child?

Ann Woods
Roughing It Day Camp

Dear Ann: 

I agree it would be wise to focus on ways to go about getting better information about prospective campers. I suspect a number of other camp professionals share your concerns. A few years ago I created a health form cover letter for parents designed to do exactly that. It starts with an overarching theme: setting things up in a way that best ensures each child has the most positive and successful experience at camp possible. To support a child’s emotional, social, and physical growth, the cover letter talks about the need for the camp to partner with parents to make sure the camp is a fit for their child’s needs. The only way to assess that fit and to make whatever preparations necessary to make the camp experience as successful as possible is to get clear and accurate information.

As a day camp, where you are dealing with children who are younger and still developing their motor control, sensory integration, and self-regulation, I would point out that for some children camp can sometimes be more stressful than school in that it is highly social and has many transitions. For most kids this is a welcome relief from school, but for some children — especially younger or developmentally delayed children — who work very hard to modulate their sensory processing or to regulate their impulses, camp can actually be more work than school. That is because camp is usually a more open environment that has many more transitions and less structure than the typical school.

I would add a question about how their child makes transitions. One key transition to ask about is bedtime. If their child can withdraw from adult company, take a bath, or move into his or her nighttime routine with ease, he or she probably makes other transitions pretty well too. If their child has trouble making other daytime transitions — going off to daycare or school in the morning, for example — then he or she may not be ready for camp. Or at least not ready for your camp.

My cover letter to parents also asks whether a child is on any medication, including any psycho-stimulant or other psychotropic medication, or whether a child is on an individualized educational plan (IEP) in school. I know many camps already ask these questions and lament that they don’t get honest answers from parents. Parents are often reluctant to share this information because they are convinced camp is less stressful than school (it’s all just FUN!), and they worry that their child may be labeled, stigmatized, or perhaps not allowed to come to camp in the first place. If you point out to parents that you understand their reluctance about sharing more sensitive and critical information, and give them assurances as to why you are asking (to set things up in a way that helps their child have a successful experience), then you will get more parents to open up.

You should also consider adding a question about sensory integration and sensory processing on your health questionnaire. Children with poor sensory integration often become frustrated and lash out because they can’t make sense of the world or because they process information much more slowly than the rest of their peer group. These children need a program that can adapt to their needs. Some mainstream camps are adding “chill out time” for kids like this, which is the only way seriously affected ADHD and sensory integration kids could be in a program like yours. They just get too overwhelmed and shut down or lash out without breaks or a shorter day, which is exactly what you described in your e-mail.

Regarding psychotropic medication, I refer you to the advice of my colleague and camp expert Linda Erceg. She suggests that any addition of or change in a psych med should be made at least three months prior to camp (see her sidebar for this column). Many children simply don’t respond well to those meds or can’t achieve a baseline dose in less time than that. You and the parent don’t want to be assessing and dealing with side effects or other medication issues while the child is at camp. Once a child has successfully acclimated to the medication and the positive effects are in place, then you and the parent can consider whether the child is ready for camp.

By the way, I know what I am suggesting here may be perceived by many camp professionals as placing roadblocks in the way of a child registering for camp. For many camp directors this approach is counter-intuitive. The question is do you want to accept a child who simply can’t meet the minimum requirements for participation in your program and therefore risk that the child will experience camp as a failure, and do so at the expense of your staff and the other campers? When 5 percent of your campers take 80-90 percent of your staff’s time, the other campers (and your reputation) suffer. I know situations where one camp has turned a family away only to have another less-discerning camp happily accept their registration (and money). Two days into camp that child is a disaster because the camp that accepted him or her was not careful enough about assessing whether it had the resources and program to effectively meet that child’s needs.

Years ago a saying was coined: “Camp gives kids a world of good!” That world of good can only happen when the needs of each child can be accommodated in a way that doesn’t strain your staff or come at the expense of the other campers. Partnering with parents is the best way to achieve this balanced, nuanced approach.

MESH Medication Guidelines

If a camper needs medication to be successful at school, he or she should stay on the medication while at camp. This complements the American Academy of Pediatrics (AAP) statement.

Campers taking a medication should be on it for three months prior to attending camp. This assures there is both a therapeutic blood level of the medication and that the therapeutic effect is present (i.e., the drug is doing what it’s supposed to do).

Camper parents who have questions about the camp’s protocols regarding medications should be given the name and phone number of the camp professional with whom they can talk (e.g., camp nurse, doctor, etc.)

Provided by Linda Ebner Erceg, RN, MS, PHN


MESH Guidelines Regarding Pre-registration Questions for Parents

There should be a section on the camp health history form that collects information about camper behavior.

Mental, Emotional, Learning and Social Health:See our camp’s parent materials for more information, including the name/phone number of a person to call should questions arise.

  1. This camper has been diagnosed with a condition that impacts learning (e.g. ADHD, sensory processing problem). Yes or No
  2. This camper has a psychiatric diagnosis such as depression, obsessive-compulsive disorder (OCD), panic/anxiety disorder. Yes or No
  3. This camper has an emotional health concern. Yes or No
  4. During the past academic year, this camper saw or is currently seeing a professional to address mental/emotional concerns. Yes or No
    If “yes” was the answer to any of the four statements above, attach a statement from your camper’s professional (e.g., psychiatrist, clinical social worker, physician) that addresses the following three topics:
    1. Describe the concern and the camper’s management plan (including medication) while attending our camp program.
    2. Describe the behaviors that will indicate to our staff that your camper needs professional referral.
    3. Provide a recommendation from that professional for the camper’s participation in our camp program.
  5. This camper has had a significant life event that continues to affect the camper’s life. Yes or No
    If yes, please attach written information about the event (death of a loved one, family change, adoption, new sibling, survived a disaster) its impact upon your camper’s life, and care tips for your camper’s cabin staff. Keep in mind, our staff are generally college students.

Provided by Linda Ebner Erceg, RN, MS, PHN

Bob Ditter is a licensed clinical social worker specializing in child, adolescent, and family therapy. “In the Trenches” is sponsored by American Income Life Insurance.