It is very hard for children who are ill without a diagnosis because the schools start chasing them and child protection issues or other legal issues can come into play. But then there are implicit threats of child protection when choice is exercised or even where doctors disagree (the parents get the blame).
Indeed.
In England, regular non attendance at school will trigger the involvement of the educational welfare officer (EWO) attached to the child's school, the school's special educational needs officer (SEN), the Community Paediatrician service (this is in addition to the child's hospital paediatrician). In some cases, social services may become involved. The child and family may also be offered psychological assessment.
Many agencies (the multidisciplinary team) will become involved with the child's medical care and the delivery of education. So a diagnosis is essential. Unlike adults, who can take time off work when ill, a child/young person must continue to receive education or be exempt by the paediatrician until able to cope with short periods of tuition - even if this is less than an hour a day.
It can be very difficult to get the LEA to agree to provide a home tutor because of the expense. Some children may be pressured by the Community Paediatrician service to attend (what were known as) Pupil Referral Units - totally inappropriate for the needs of most children/young people with ME.
In order for home tuition to be obtained from the LEA (Local Education Authority), letters in support of home tuition are required from the hospital consultant/EWO or other clinician involved. Once home tuition has been put in place, letters of approval for the continuation of home tuition are required periodically to satisfy the LEA.
If a young person is able to sit some GCSE examinations, either in school or at home, special provisions will need to be applied for from the exam boards by the school/LEA tutor for additional time, rest breaks, amanuensis if required and provision of an invigilator, if the exams are being taken at home; so a diagnosis and the support of the school/LEA and possibly letters from the medical team will be required by the exam boards.
Some families with children or young people with ME will elect to take the child out of the mainstream educational system and home educate - that in itself will likely raise a red flag on the child's medical file.
In 2003, I had a letter published in the print edition of the BMJ which set out just how many agencies can end up involved in the medical care and education of a child with long-term illness.
https://www.ncbi.nlm.nih.gov/pubmed/12596800
BMJ. 2003 Feb 22;326(7386):449.
Copying letters to patients. Copying letters can help avoid communications nightmare.
Chapman S.
As I said in the BMJ:
"...For parents of young people who are unable to access mainstream education because of long term illnesses such as myalgic encephalomyelitis/chronic fatigue syndrome the difficulties in maintaining effective liaison between school, special educational needs coordinator, educational welfare officer, home tuition coordinator, general practitioner, hospital consultant, community paediatrician, and local education authority can be serious. In addition, some families also deal with social services and child and adolescent mental health services, as well as having input from the Connexions Service. For many it can be a communications nightmare on top of an already challenging situation. Anything that helps to improve liaison, such as receiving copies of hospital letters, is to be welcomed, and I would advise all parents to ask for copies of these letters if they do not already receive them."
I know too many families who have had problems with social services, have had child protection involvement or whose sick children have been placed on the "at risk" register or threatened with placement on the "at risk" register, where there have been disputes between clinicians and other agencies or between clinicians and the family over the child's diagnosis.
Caveat: Our experiences of the system were between 1999-2003