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Children between the age of 5-17 years are school age
School is defined as an educational institution where
groups of pupils pursue defined studies at defined
levels, receive instructions from one or more teachers,
frequently interact with other officers and employees
such as principal, various supervisors/ instructors, and
maintenance staff etc., usually housed in a single
School health refers to a state of complete physical,
mental, social and spiritual well being and not merely
the absence of disease or infirmity among pupils,
teachers and other school personnel
School health service
Ideally School health services refer to need based
comprehensive services rendered to pupils, teachers and
other personnel in the school to promote and protect
their health, prevent and control diseases and maintain
their health. But practically, it refers to providing need
based comprehensive services to pupils to promote and
protect their health, control diseases and maintain their
1. A healthy child is mentally alert, receptive, will not
miss school due to minor sickness and will have better
performance in his/her studies.
2. Health is not just freedom from sickness or infirmity
but the realization of the full potential of the child
which has physical, mental, social and spiritual
3. Prevention is better than cure; interventions when
health breaks down are costly and time consuming.
4. School health services will help identify any
deviations from normal growth and development, any
health problem so that timely, therapeutic, corrective
and rehabilitative actions can be taken to im-prove and
maintain health and continue studies.
5. While early diagnosis and prompt and adequate treatment
is of great importance, follow up care is equally important
for effective school health services.
6. Rehabilitation of physically and mentally handicapped
children can be done and must receive ad-equate attention.
7. Health knowledge and skills learnt not only will benefit
the child but also it will benefit the school, the parents,
family and community
Introduction to School
It is that phase of community health and family health
service that promotes the well being of the child and his
education for healthful living. School health
programmes can be a powerful influence for shaping
The school health programme refers to all school
activities/procedures that contribute to initiation,
understanding, maintanence and improvement of the
health of pupils and school personnel, including health
services, health education and healthful school living.
Healthful habits as regards personal hygiene, clean
surroundings, nutritious diet, exercise, rest and
recreation if formed at an early stage will remain with
person throughout life and will help to develop healthy
citizens in the full and positive sense of the term. So the
school is the best place for giving health education on
Health Problems of the
The health problems of school children vary from one
place to another, surveys carried out depicts following
2. Infectious diseases
3. Intestinal parasites
4. Diseases of skin, eye and ear and
5. Dental caries.
• Promotion of positive health including awakening of
health consciousness in school children.
• Early detection and prompt treatment and follow-up/
• Prevention and control of communicable and non-communicable
• To make provision and provide a healthy and safe
environment for the all round development of child.
• Awakening health conciousness in children.
The aim of the school health programme is to promote
healthy children so that they can reach optimum growth
and development which will enable them to lead study.
This will be achieved by emphasizing the:
• Protection from disease
• Appropriate medical and dental care including
emergency services of injury and sudden sickness.
On the basis of these above mentioned aims and
objectives three efferents of the school health
programme are identified.
• Health education in schools
• Healthful school living
• School health services
Aspects of School Health
• Health appraisal of school children and school
• Remedial measures and follow-up
• Prevention of communicable diseases
• Healthful school environment
• Nutritional services
• First aid and emergency care
• Mental health
• Dental health
• Eye health
• Health education
• Education of handicapped children
• Proper maintainence and use of school health
1. Health appraisal
The health appraisal should cover not only the students
but also the teachers and other school personnel. Health
appraisal consists of periodic medical examinations and
observation of children by the class teacher.
A. Periodic medical examination: The initial
examination should be thorough and unhastened and
should include a careful history and physical
examination of the child, with tests for vision, hearing
and speech. A routine examination of blood and urine
should be carried out. Clinical examination for
nutritional deficiency and examination of faeces for
Parents should be persuaded to be present at these
examinations. The teacher should help in the medical
inspection by recording the medical history, regular
recording of height and weight, annual testing of vision,
and preparing children for the medical examination by
helping them understand the “how” and “why” of the
B. School personnel: Medical examination should be
given to teachers and other school personnel as they
form part of the environment to which the child is
C. Daily morning inspection: The teacher is in a unique
position to carry out the “daily inspection”, as he is
familiar with the children and can detect changes in the
child’s appearance or behavior that suggest illness or
improper growth and development.
The following clues will help the school teacher in
suspecting children who need medical attention:
Unusually flushed face, Any rash or spots, Symptoms of
acute cold, Coughing and sneezing, Sore throat, Rigid
neck, Nausea and vomiting, Red or watery eyes,
Headache, Chills or fever, Listlessness or sleepiness,
Disinclination to play , Diarrhea, Pains in the body, Skin
conditions like scabies and ringworm, Pediculosis.
Children showing any such signs or symptoms should
be reffered to the school medical officer. Teacher
observation of school children is of particular
importance. For this work, the teachers should be
adequately trained during Teacher Training courses and
subsequently by short In-service Training courses.
Special clinics should be conducted exclusively for
school children at the primary health centres in the rural
areas, and in one of the selected schools or dispensaries
for a group of about 5000 children in urban areas.
The clinic days and time should be intimated to all the
concerned schools. Considering the high prevalence of
dental, eye, ear, nose and throat defects in the school
children, special clinics should be secured or provided
for the exclusive use of school children for examination
and treatment of such defects.
In the big cities, the required no of specialists should be
employed in the School health service. There should be
provision for beds in the existing referral hospitals for
the children to be admitted for investigation and
treatment as and when required.
Communicable diseases control through immunization
is the most emphasized school health service function. A
well planned immunization programme should be
drawn up against the common communicable disease.
A record of all immunizations should be maintained as
part of the school health records. When the child leaves
the school, the health record should accompany him.
4. HEALTHFUL SCHOOL
The school building, site and equipment are part of the
environment in which the child grows and develops. A
healthful school environment therefore is necessary for
the best emotional, social and personal health of the
pupils. Schools should serve as demonstration centres of
good sanitation to the community.
The following minimum standards for sanitation of the
school and its environs has been suggested:
Location: the school should normally be centrally
situated with proper approach roads and at a fair
distance from busy places and roads, cinema house,
factories, railway tracks and market places. The school
premises should be properly fenced and kept free from
all the hazards.
Site: the site should be on suitable high land, and not
subject to inundation or dampness and can be properly
drained. The school health committee recommended
that 10 acres of land be provided for higher elementary
schools and 5 acres for primary schools with an
additional one acre of land per 1000 students. In
congested areas, the nearest public park or playground
should be made available to the students.
Structure: Nursery and secondary schools, as far as
possible, be single storied. Exterior walls should have a
minimum thickness of 10 inches and should be heat
Classroom: verandhas should be attached to classrooms.
No classroom should accommodate more than 40
students. Per capita space for students in classroom
should not be less than 10 sq ft.
Furniture: Furniture should suit the age group of
students. It is desirable to provide single desks and
chairs. Desks should be of minus type. Chairs should be
provided with proper back-rests, with facilities for desk-work.
Doors and windows: the windows should be broad with
the bottom sill, at a height of 2’-6” from the floor level;
combined door and window area should be placed on
different walls for cross ventilation; the ventillators
should not be less than 2% of the floor area.
• Colour: inside colour of the classroom should be
white and should be periodically white-washed.
• Lighting: classrooms should have sufficient natural
light, preferably from the left, and should not be from
• Water supply: there should be an independent source
of safe and portable water supply, which should be
continuous, and distributed from the taps.
• Eating facilities: vendors other than those approved
by the school authorities should not be allowed inside
school premises; there should be a separate room
provided for mid-day meals.
• Lavatory: privies and urinals should be provided- one
urinal for 60 students and one latrine for 100 students.
Arrangements should be separately made for boys
A child who is physically weak will be mentally weak,
and cannot be expected to take full advantage of
schooling. The diet of the school child should, therefore
receive first attention. The diet should contain all the
nutrients in proper proportion, adequate for the
maintainence of optimum health. Nutritional disorders
are widely prevalent among school children, particularly
deficiencies relating to proteins; vitamins A, C, thiamine
and riboflavine, calcium and iron.
Mid-day school meal: In order to combat malnutrition
and improve the health of school children. It is now an
accepted procedure in all advanced countries to provide
a good nourishing meal to school children.
The School Health Committee recommended that
school children should be assured of at least one
nourishing meal. Those who can afford it may bring
their lunch packets from home, and during lunch hours
take their meals in school. Otherwise, school should
have some arrangement for providing mid-day meals
through their own cafeteria on a “no profit no loss”
Applied nutrition Programme: UNICEF is assisting in
the implementation of the Applied Nutrition Programme
in the form of implements, seeds, manure and water
supply equipment. Wherever land is available, the
facilities provided by the UNICEF should be utilized in
developing school gardens. The produce may be utilized
in the school feeding programmes as well as for
Specific nutrients: advances in the knowledge of
nutrition have revealed that specific nutrients may be
necessary for the prevention of some nutrient disorders.
Dental caries, endemic goiter, nightblindness, protein
malnutrition, anaemias and a host of other nutrient
disorders are eminently preventable. Use of specific
nutrients is indicated where such nutrient disorders are
problems in a community.
6. FIRST AID & EMERGENCY
The responsibility of giving first-aid and emergency
care to pupils who become sick or injured on school
premises rests with the teacher and therefore all teachers
should receive adequate training during “Teacher
Training Programme” or “In-service Training
programmes” to prepare them to carry out this
The emergencies commonly met within schools are
a)accidents leading to minor or serious injuries, and b)
medical emergencies such as gastroenteritis, colic,
epileptic fits, fainting etc.
The mental health of the child affects his physical health
and the learning process. Juvenile delinquency,
maladjustment and drug addiction are becoming
problems among school children. The school is the most
strategic place for shaping the child’s behavior and
promoting mental health.
The school teacher has both a positive and preventive
role- he should be concerned with helping all children
attain mental health, so that they may develop into
mature, responsible and well adjusted adults.
The school routine should be so planned that there is
enough relaxation between periods of intense work, and
every effort should be made to relieve the tedium of the
class room. No distinction should be made between
race, religion, caste or community; between the rich and
poor; and between the clever and dull.
It is now increasingly realized that there is a great need
for vocational counsellors and psychologists in schools
for guiding the children into careers for which they are
8. DENTAL HEALTH
Children frequently suffer from dental diseases and
defects. A school health programme should have
provision for dental examination, at least once a year. In
the developed countries, dental hygienists are employed
in schools to assist the school dentist with the
examination of the teeth.
They make preliminary inspection of the teeth and do
prophylactic cleansing which is of great value in
preventing gum troubles and in improving personal
appearance. They take part in the teaching of dental
hygiene as they work with the children
Schools should be responsible for the early detection of
refractive errors, treatment of squint and amblyopia, and
detection and treatment of eye infections such as
trachoma. Administration of vitamin A to children A to
children at risk, has shown gratifying results. In other
words, basic eye health services should be provided in
9. EYE HEALTH SERVICE
Schools should be responsible for the early detection of
refractive errors, treatment of squint and amblyopia, and
detection and treatment of eye infections such as
trachoma. Administration of vitamin A to children at
risk, has shown gratifying results. In other words, basic
eye health services should be provided in schools.
10. HEALTH EDUCATION
The most important element of the school health
programme is health education. The goal of health
education should be to bring about desirable changes in
health knowledge, in attitudes and in practice, and not
merely to teach the children a set of rules of hygiene.
Health education in schools should cover the following
1. Personal hygiene
2. Environmental health
3. Family life
Health education in schools is a function of the school
teacher. The health officer and the public health
nurse/health worker/health assistant may furnish
teaching materials and advice, but the teacher is the key
person in the presentation of material to the children. To
do this important work, the teacher should be well
versed in health education techniques, and sincerely
interested in the welfare of the pupils.
11. EDUCATION OF
The ultimate goal is to assist the handicapped child and
his family so that the child will be able to reach his
maximum potential, to lead as normal a life as possible,
to become as independent as possible, and to become a
productive and self-supporting member of society. The
resources for managing handicapped child vary from
country to country. It requires the cooperation of health,
welfare, social and educational agencies.
12. SCHOOL HEALTH
A cumulative health record of each student should be
maintained. Such records should contain
• Identifying data – name, date of birth, parent’s name
and address, etc
• Past health history
• Record of findings of physical examination and
screening tests and record of services provided.
The purpose of maintaining school health records is to
have cumulative information on the health aspects of
school children in order to give continuing intelligent
health supervision. These records will also be useful in
analyzing and evaluating school health programmes and
providing a useful link between the home, school and
ROLE OF NURSE IN
A school health nurse assumes a major part of the health
programme responsibilities and works in collaboration
with others in the school and community.
Nursing services in school ordinarily consist of three
interwining and overlapping areas – health supervision,
health counseling and health education.
• Health supervision includes such activities as health
assessments, vision and hearing screening and health
• Health counseling involves providing interpretation
of health information, guidance and counseling
regarding health behavior and recommendations
regarding individual and group health conditions.
• Health education refers to planning, promoting and
implementing health instructions as well as providing
consultation services in health related matter.
In general, the functions of the school health nurse are
• The establishment and enforcement of the schools
policies and programs for the protection and
promotion of health of pupils.
• The maintenance of a school environment which is
conducive to healthful living.
• The building of those components of the curriculum
which have significance for health.
• The management of the health service including
screening programs and emergency care services.
• The handling of special problems
• Relating the health programme to those of the
Thus, the functions of nurses in schools include using
the nursing process with the school-age population to
maintain or improve the health by nursing actions
including health teaching, creating an environment
conducive to good health, and relating the health of the
school population to families and the community.
Actually, the school health programme is carried out by
the school medical officer with the help of school health
nurse and other paramedical staff and also with the help
of trained teachers in the school.
Table1 : School Health Nursing Service flow
Health Education Health Supervision Health Counselling
Emergency care Follow-up Prevention
Health deficit Consultation, referral Adaptation,
Health appriasals Nursing diagnosis and