SCHOOL
HEALTH
SERVICES
T
HE health of the child is primarily the family’s responsibility. However, when thechild reaches school age, some health protection service while he is in school has
long been recognized as a community responsibility. The obvious importance of attention
to the health of the school child and the relative ease of access to the child and the
family during this period have been significant factors in the wide-spread establishment of school health services.
The first types of school health service were concerned with controlling the spread
of communicable diseases among young children in crowded urban schools. When
medical inspection for this purpose also revealed many neglected noncommunicable
conditions, a number of cities employed nurses under the Board of Education or the
health department to pass the information on to parents and to obtain treatment.
In the early years of this century serious communicable diseases such as smallpox,
diphtheria, and trachoma were prevalent. The nuisance diseases such as scabies and
pediculosis flourished. Many children did not see a physician from one year to the next.
Under such conditions, almost any medical and nursing services were of benefit to
children. Since then health conditions have changed rapidly. Today there is an increasing
awareness that a different approach and emphasis are needed to discover current health
problems and to make the best use of the valuable opportunities which the school
affords for the health guidance of the child and his family.
EVALUATION OF THE SCHOOL HEALTH PROGRAM
The American Academy of Pediatrics Study of Child Health Services’ indicates that
many of the opportunities to improve child health inherent in health supervision of the
school-age child are used poorly, or not at all. The service, as now offered by many
schools, is too often unrelated to the medical supervision which the child has had before
entering school. It is often equally unrelated to the medical attention he receives during
the periods when he is not under school jurisdiction such as vacations and after school
hours.
Pediatricians play a relatively small part in direct service or as advisors in public school
health programs for the country as a whole. The Study’ showed that, of all physicians
serving in the school, about 20 percent were health officers. Of the majority who were
not health officers, 94 percent were general practitioners and only 4 percent were
pedi-atricians. This means that school health programs lack the advice of the very physicians
whose specialized understanding of child growth and development, and knowledge of
the care and health needs of children, make them the best qualified to assist in planning
a health program for school-age children. There is a possibility of real harm to a child
examined by a physician not familiar enough with normal growth and development.
Children have been falsely labeled as cardiac patients, endocrine cases, or described as
having flat feet or bad tonsils when they were perhaps deviating only slightly from the
average growth pattern. It is important that physicians and school administrators
recog-nize the wisdom of having the advice of local pediatricians in developing school health
SCHOOL HEALTH SERVICES 17
examination procedures and policies. Parents may be given false security by the school
health examination. As commonly practiced, the examination is really nothing more than
a screening test without the use of precision methods as aids to diagnosis. In their health
education efforts, schools should make this very clear. Children as well as their parents
should learn to use and rely upon the services of their bwn physician or clinic for final
diagnosis as well as for treatment of illness.
- A constant problem of many school health services is the difficulty of obtaining
treat-ment for defects and health problems which have been found by the screening
examina-tions in the school. Some of the reasons why parents do nothing about these health
prob-lems are: (1) the family does not really understand what needs to be done and why;
(2) the school diagnosis cannot be verified by the family doctor or community clinic;
(3) the child’s school medical record is lost or contains insufficient information for
effective follow-up by the school nurse or teacher; (4) the family is indifferent, or
unable to pay for diagnosis and treatment; (5) the local practitioner may lack facilities
for treating certain conditions, or there may be no facilities available locally. Clearer
understanding of these and other factors present in individual cases might avoid some
of the frustration and confusion which can interfere with the solution of the follow-up
problem.
It is essential for the official education and health departments to recognize that solving this basic feature of school health service calls for coordinated planning and the
coopera-tion of family physicians, dentists, specialists in child health, parents, and community
health agencies.
AREAS OF NEED
As in other health services, the first prerequisite is a sufficient number of physicians
whose training and background qualify them for this particular position. School health
service today calls less for a medical “inspector” who performs superficial medical
ex-aminations and more for a medical “advisor” on all aspects of the school health program.
A school health program cannot be strong unless the participating physician has genuine
interest in it, and appreciation of the opportunity which he has to improve child health,
and some specialized understanding of child growth and development in addition to
experience in the medical care of children.
As children grow old enough to become a part of the school system and community,
former relationships with their family physician, health conferences, and clinics and
hospitals need not-indeed should not-be severed. Much more coordination and
coopera-tion between these groups and the official education and health departments are needed tc
avoid duplication of activities, procedures which are medically unsound, and
misunder-standings. It is the child who suffers when the various agencies concerned with school
health programs are not working closely together.
SUGGESTIONS FOR LOCAL AND STATE PLANNING
A better understanding of school and educational practices by community physicians
Another obvious opportunity for physicians to assist in the school health program is
in helping to train the school staff to carry out the screening program. Teacher-observation
and selection of children for medical examination is a more effective use of limited
medi-cal personnel in the schools than the use of physicians for routine annual or periodic
examinations as now generally practiced. People who are not medically trained can do
much, with careful instruction, to uncover health problems through observation and the
more refined nondiagnostic tests which are available today. A screening method is, of
course, an adjunct to careful examination. The school is not the place where a complete
diagnostic procedure can be carried out. However, in conjunction with observation, the
tests enable the examiner to have more factual evidence on which to base recommendations.
These tests should be worked out with the cooperation, understanding, and assistance
of private physicians, clinics, hospitals, voluntary agencies, public health department and
all other treatment resources in the community. When cooperation between these groups is
well developed, there is little danger that any child who needs care will fail to get it
for any reason.
Better coordination between education departments and child health groups has been
accomplished in recent years by many communities through the organization of a local
health council. (See pages 4-5.) By supporting and serving on such councils, physicians
