Menoufia University

Faculty of Nursing
Fourth semester

School Health
Under Supervision of

2020-2021
 Acknowledgement
Our deep thanks are submitted first and foremost to
ALLAH who gave us the strength, capability and opportunity to
initiate and complete these assignments.
All respects are due to

Prof. Dr / Nahla Ashour Saafan

Assist. prof / Samia ALI Shaban
Whose stimulating suggestions

And encouragement enabled us all the time to complete this

Assignments.

Master Degree Students

 Table of Contents

.Chapter No Topic Page No.

Chapter 1 Introduction about school health

Chapter 2 School Health Program

Chapter 3 Role of school health nurse

Chapter 4 Needs of school children

Chapter 5 School health problems

Chapter 6 Communicable diseases in school

Chapter 7 Child abuse

Chapter 8 First aid and safety measures in schools

Promoting Healthy Lifestyle In School

Chapter 9
Children
Introduction about school health

Under supervision

Prof. Dr / Nahla Ashour Saafan

Assist. prof / Samia ALI Shaban

Prepared by
Naglaa Fathy

2021-2022

3
Outlines

1- Introduction

2- School age children;

 Definition
 Needs of school age children
 Problems of school age children

3- School health;

 Definition
 Objectives of school health
 Component of school health services

4-Personnel of school Health Services

4
Intended learning outcomes (ILOS)

 Define School age children

 Identify needs of school age children
 Identify Problems of school age children
 Identify objectives of school health
 Identify component of school health services

5
Introduction

Children between the ages of 6-17 years are school age children.
They spent most of their time of the day in the school under the direct
supervision and guidance of their teachers. They are also exposed to
various epidemiological factors in the school which influence their
present and future state of health. Hence, school is the best place for
giving health education and makes a strong foundation to the healthy
nation.

School Health is the comprehensive efforts of developing,

implementing, and evaluating services, both within the school and the
community, that provide each and every student with the resources
needed to thrive within a healthful environment. School Health Services
are primarily meant for preserving and promoting health of the students.
School health services include, but are not limited to: nursing and Other
Health Services; Health Education; Physical Education; Counseling,
Psychological, and Social Services; Nutrition and Appealing School
Lunches.

School age children

School age children: - refer to children between the ages of 6-17 years.

During this stage of development, children are learning to become a part

of the larger world through school, activities, and friends. Children
become more independent, begin to understand cause and effect, and
learn to reflect on their own actions.

6
Needs of school age children:

1) Adequate and proper nutrition

2) Protection from infection

3) Maintenance of health

4) Practicing physical exercise

5) Adequate rest and sleep

6) Treatment of any health problem

7) Meeting their psycho-social needs

8) Providing health education

Health Problems of School Children:

1) Infectious diseases.

2) Parasitic diseases.

3) Malnutrition.

4) Disability

5) Accidents.

6) Psychological and social problems.

School health

Definition of School health: - addresses the health of school children who

considered one of the vulnerable groups due to:

This age group includes children between 6 to 18 years who constitute about
26% of Egyptian population.

1. School children are subjected to infectious diseases.

2. This group undergoes the stresses and strains of growth and

development, physical and mental stress of study.

7
Objectives of school health

The main objectives of this service are the prevention of illness as well as
the promotion of health and well-being of the students through:

 Early detection and care of students with health problems.

 Development of healthy attitudes and healthy behaviors by

students.

 Ensure a healthy environment for children at school.

 Prevention of communicable diseases at school.

Factors considered to make the child comfortable and safe and permit
him to learn most efficiently are:

1) Educational aspect:

a) The hours allowed for school lessons and homework should not
encroach on the child needs for sleep and personal life.

b) Schedule of the day: It is known that difficult subjects should be studied

when the mind is fresh and free of fatigue.

2) Emotional Schools Environment:

Human interrelationship is important during the hours of living in classroom.

8
Components of school health Services

The Eight-Component Model

 Health Education

 Physical Education

 Health Services

 Nutrition Services

 Health Promotion for Staff

 Counseling, Psychological, and Social Services

 Healthful School Environment

 Parent and Community Involvement

The Three-Component Model

 Health Instruction

 Health Services

 Healthful School Environment

Personnel of school Health Services

1-Duties of School Physician:

 Health appraisal.

 Examination of sick, diagnosis and prescription of treatment or referral

to specialists.

 Health education.

 General inspection of the school environment.

 Planning for the prevention and control of infectious diseases.

 Supervising preparation of statistical reports.

9
2- Duties of School Nurse:

 Inspection of the children for cleanliness and general health.

 Participation in the program of health education.

 Performance of first aid measures.

 Assisting physician in physical examination.

 Keeping health records.

 Giving the necessary immunization.

3- Duties of Social Workers: good relations with the school personnel,

pupils, and families can do a lot for social, mental and emotional welfare of
the pupils.

10
 References
1- Schiavo J. (2015). Fast Facts for the School Nurse. Part 1. Bed Baths
to Band-Aids: What the School Nurse Really Does. Second Edition.
Springer Publishing Company, LLC. New York.

2- Rector C. (2018). Community and Public Health Nursing: promoting

the public's Health. Chapter 22. School Age Children and Adolescent.
Ninth Edition. Wolters Kluwer. China.

3- Rector C. (2018). Community and Public Health Nursing: promoting

the public's Health. Chapter 43. Community Health Nurse in the
Schools. Ninth Edition. Wolters Kluwer. China.

4- School Health Services | Healthy Schools | CDC [Internet]. Cdc.gov.

2018 [cited 22 March 2018]. Available from:
https://www.cdc.gov/healthyschools/schoolhealthservices.htm

5- American School Health Association Management of Infectious

Disease in Schools Public Health Medicine Communicable Disease
Group October 2014. Available at: http 18.

11
 Under supervision

Prof.Dr / Nahla Ashour

Assist.prof / Samia Elnagar

Prepared by
C.I/ Amira Ezzat El-sedawy

2022

12
 Outlines:
- Introduction

- Definition of school health program

- Objectives of school health program

- Models of school health program component

• The Three-Component Model

• The Eight-Component Model

- Health Education
- Physical Education
- Health Services
- Nutrition Services
- Health Promotion for Staff
- Counseling, Psychological, and Social Services
- Healthful School Environment
- Parent and Community Involvement
• Full-Service School Model

- Features of Organizing School Health Program

- References

13
Introduction

The school aged children constitute a large sector of population. They are
the parents, workers, leaders and decision makers of tomorrow and their
future success depends on achievement of their educational goals today.
WHO states that “An effective school health program can be one of the
most cost-effective investments a nation can make to simultaneously
improve education and health”.

The school health program was designed to ensure that the school
students are as healthy as possible and to obtain the maximum benefit
from their education with the learning environment safe and conducive
for learning. WHO has recognized the link between health and education
and the potential for schools to play a central role in safeguarding student
health and well-being. Children need to be healthy to learn effectively
and maintaining the health of children today produces healthier adults in
the future.
The school health program is considered an important component of
community health because every citizen must pass through this
institution. All aspects of the total school program contribute to the
understanding, maintenance and improvement of the health of school
children and staff. 'What is very clear, is that education and health for
children are inextricably entwined. A student who is not healthy will not
profit optimally from the educational process.

Definition of school health program:

It is defined as all the strategies, activities, and services offered by, in, or
in association with schools that are designed to promote students'
physical, emotional and social development.

14
Objectives of school health program:

 Promote health and wellness.

 Prevent specific diseases, disorders and injury.
 Prevent high risk social behaviors.
 Assist children and youth who are in need or at risk.
 Support those who are already exhibiting special health care needs.
 Promote positive health and safety behaviors.

Models of school health program:

There are a variety of models that have been used to describe the
components of a school health program. Three of the most common
models are summarized below.

15
 The Three-Component Model.

Originating in the early 1900s and evolving through the 1980s. The three-
component model is considered the traditional model of a school health
program, consisting of the following basic components:

16
 Component Definition
Health Instruction Accomplished through a comprehensive health
education curriculum that focuses on increasing
student understanding of health principles and
modifying health-related risk behaviors.

Health Services Focuses on prevention and early identification of

student health problems.

Healthful School Concerned with the physical and psychosocial

Environment setting and such issues as safety, nutrition, food
services, and a positive learning atmosphere.

 The Eight-Component Model.

In the 1980s, the three-component model was expanded into an eight-

component model—traditionally referred to as a “comprehensive school
health program”—consisting of the following components:

17
The Eight-Component Model
1. Health Education
2. Physical Education
3. Health Services
4. Nutrition Services
5. Health Promotion for Staff
6. Counseling, Psychological, and Social Services
7. Healthful School Environment
8. Parent and Community Involvement
Health Education

Health education is the most important part of the school health program.
It consists of teaching numerous types of health information including

18
safety education, personal hygiene, environmental health and family life.
The goal of health education should be to bring about beneficial changes
in health knowledge, in mind, in practice and also teach children a set of
rules of hygiene. Young children are at a greater risk of various infections
and diseases. Schools have the responsibility to educate their students and
foster among them healthy and hygienic behaviors, through integration of
health and hygiene information messages into the curriculum and training
of teachers on them.

 Education about cleanliness, personal hygiene, and sanitation.

 Preventive information against various non- communicable common
diseases.
 Prevention against communicable diseases.
 Safety education to prevent accidents.
 Guidance and counseling for adolescent students on puberty issues.
 Healthy food (balanced diet) and clean drinking water.
 Hazards of smoking and drug abuse education.
 Sports and physical education.
 Environment education.
 Life skills-based education.
 Well-implemented health education has been shown to improve the
school .achievement.

Requirements:
Message: The message for health education should be easily understood,
concentrated, logic,
tell them what should be done before what should not be done.

Educator: e.g. physician, health visitors, teachers and social workers.

Target: the staff, students and parents.

19
Methods:
a) Personal Approach: Lessons, seminars, group discussion, field
visits.
b) Local media at school as posters.
Participation of school society and personnel in health education activities
Provision of information, knowledge, and skills to the children on
subjects enable them to develop healthy behavior and protect themselves
from diseases and practices which can make them vulnerable to various
hazards in their life.

Physical Education
Is a planned, sequential curriculum that provides cognitive content and
learning experiences in a variety of activity areas such as basic movement
skills, physical fitness, teamwork and individual sports. Quality physical
education should provide planned activities to meet each student’s
optimum physical, mental, emotional and social development. Activities
and sports that students can enjoy and pursue throughout their lifetime
should be designed to meet all students’ abilities. Physical education
involves promoting lifelong physical activity.
Physical education has the following benefits:
• Improves mental and physical health.
• Improves classroom behavior.
• Increased concentration.
• Increased attentiveness in class.
• Increase self-esteem.
• Promotes psychological well-being.
• Reduces stress and anxiety.

20
How to Promote Physical Education in Children:
The following are some of the ways educators can promote
physical education both inside and outside the classroom:
 Incorporate classroom-based physical activities
 Encourage physical activities during recess
 Provide physical education taught by a qualified physical education
(PE) teacher to all students
 Invest in athletic and gym equipment
 Sponsor school sports teams
 Promote interscholastic sports
 Share community sports facilities
 Work with communities to provide after-school physical activity
programs for children and teens

School Health Services

These include either: -
A- Preventive health services: 1- Health appraisal
2- Follow up and health counseling
3- Prevention and control of communicable diseases
4- Early detection and correction of non-communicable
diseases 5- Emergency care and disaster procedures
6- Care of disabled and special education students 7- Health services for
school personnel
B- Curative health services
A- Preventive Health Services :1- Health appraisal
The term appraisal in school health means organized activities to assess or
appraise the complete health status of the student from the physical,
mental, social and emotional conditions. It includes:
a- History taking: Complete history about the student (past, personal,
family, medical…)

21
 b- Health observation by parents, teachers and nurse, it includes:

- Any change in the appearance or behavior.

- Compare the child with other children in the same group.
- Signs of sickness as loss of weight, rapid fatigue.
- Loss of interest, lack of confidence.
- Aggressive behavior, excitability, introversion.
c- Screening tests, which are preliminary appraisal techniques used by
the nurse to identify children who appear to need diagnosis by
health care specialists, they include:
- Hearing and vision test
- Speech defects
- Anthropometric measures (height and weight)
d- Laboratory investigations for urine, stool and blood.
e- Comprehensive medical examination including dental examination.
f- Special surveys, these should be done periodically to detect any
health problem as diabetes, parasitic disease.
2- Follow up and health counseling
It is a way to help the student and family to understand the problems and
identify ways to obtain information needed to solve them, then to discuss
the available solutions and help to choose the one best suited to their
circumstances. The final step is follow up through actions. Physicians,
teachers and nurse together can perform this function. Teachers also
should be trained for counseling techniques and health education.
3- Prevention and control of communicable diseases
School children are vulnerable group, they have bad habits, lack of
cleanliness, they are gathering from different localities, having different
backgrounds and problems. So, they are more liable to the following
infectious diseases:

22
o Respiratory diseases spread by droplet infections common cold,
streptococcal sore throat, measles, chicken pox, and mumps.
o Food and milk borne infection as enteric infection, hepatitis,
parasitic diseases, food poisoning.
o Skin diseases as scabies, ringworm, and impetigo.
o Eye infection as trachoma, conjunctivitis.
o Parasitic diseases as pin worm.

 Measures of prevention
o Healthful environment at school, proper ventilation, safe water
supply, cleanliness, sanitary refuse and sewage disposal, vector
control.
o Immunization: Booster doses of meningitis in 1 st year of primary
school, 1st year of preparatory school and 1st year of secondary
school. Booster doses of DT in 1st and 4th year of primary school.
Booster doses of BCG in 1st and 5th year of primary school
o Vaccination in case of any epidemic.
o Daily observation of all the students for early detection of any
disease. There is a guiding schedule for isolation in different
diseases for the safety of the child and his contacts depending on
the period of communicability,
 Hepatitis A: 21 days Whooping cough: 18 days
 Scarlet fever: 10 days Measles: 14 days
 G measles: 7 days Chicken pox: 14 days
 Mumps: 14 days
o Readmission to school after sickness, the child should be examined
by nurse before readmission school. For some diseases, simple
investigation and examination are not sufficient as in diphtheria
and typhoid, three (-ve) consecutive laboratory bacteriological tests

23
 are needed before readmission to school and written statement
from a physician may be put under observation for the maximum
incubation period. In some diseases, also immunization and
chemoprophylaxis are required as in meningitis.
o Take care of absenteeism number, it is important to know the cause
of absence among the students especially during epidemics.
o Screening for infectious diseases, on the first day of school for
treatment before admission as in scabies and ringworm.
o Searching for the source of infection, may be another student or
worker in the school.
o Food handlers and venders in the school should be examined
yearly and treated.
o Health education for communicable diseases control.

4- Early detection and correction of non-communicable diseases

Non-communicable diseases are common among school children as, eye
defects, acute illnesses as middle ear infection, dental conditions,
malnutrition, parasitic diseases and emotional problems especially in
adolescents.
5- Emergency care and disaster procedures
The school has three responsibilities for emergency care and disaster
control;
 to prevent injuries from happening in school
 to provide safety education
 to develop a plan for handling emergencies, these can
be achieved through;
 immediate care and referral
 notifying parents and authorities
 plan for injuries prevention in the school
building and playground for fire prevention and for
24
 traffic injuries.
 Prepare suitable room for emergency care with
supplies and equipment.
 Train personnel and students in first aid procedures.
6-Care of disabled and special education students
Disabling conditions include mental retardation, speech impairment,
visual impairment, learning disability, emotional disturbance, orthopedic
problems, deaf-blindness, or health impairments from other problems
such as autism. Such impairments need medical, social, emotional and
educational care.

Most specialists prefer educating this group in the same school with
normal children whenever possible.
o Prepare suitable room for emergency care with supplies
and equipment.
o Train personnel and students in first aid procedures.

7-Health services for school personnel

Good health of the teacher is a pre-requisite for a good educational
program as well as for prevention of spread of diseases. Such as periodic
examination.

B. Curative Health Services

Curative health services include:
o Treatment of any discovered diseases.
o Referral to specialized care.
o Social services and health education activities.
Student health records to provide continuity information on the health
status of each child. It includes: -

- History of illness
- Immunization
25
 - Result of screening test

School Nutrition Programs

Nutritional level affects overall health, and consequently learning among

the children. Nutritional inputs can increase both attendance and quality
of education. Provision of following inputs to schools can be grouped
under nutrition component of school health program.
 Good supplements for malnourished children
 Food as incentive to enhance enrolment and attendance
 Promotion of use of iodized salt
 School feeding or school lunch program for all students in schools
In the developed countries, school lunch or school feeding program are
widely supported.
Nutrition education:
a) Basic nutrients and adequate diet.
b) Importance of breakfast.
c) Avoidance of too many sweets.
d) Good habits in relation to food sanitation.
School feeding program:
The child’s school meal should be balanced. This means that it should contain
some energy-giving staple food, some body building protein and some
protective foods.
3. Management of malnourished children
4. Prevention and control of parasitic infections.
5. Growth monitoring for early detection of malnutrition.

Healthful school Environment

Include both physical and psychological environment of the school

Physical school environment

26
Different items of physical environment to be considered include:

1) Site and area of school

2) Sanitary regulation of school building

3) Sanitary regulation of classroom

4) Food sanitation

5) Sanitary regulation of water supply sewage and refuse disposal

1) Site and Area of school should be:

A) Away from noise bad odor and pollution

B) Easily to be reached by pupils from the entire area that it serves

C) Away from street about 20 meters

2) Sanitary Regulation of school Building:

a) The ground: should not be a past refuse dump area or till the legal
period necessary for stabilization.
b) Building Material: resistant to fire rodents and heavy rain falls.
c) Type of Building: Ordinary houses cannot fulfill the requirements
of school especially regarding the standard of ventilation.
d) The design of the building: - should be in blocks either separated
or joined at right angles in shape of L or F with open spaces in
between with more than one staircase in order to avoid
overcrowding.

3) Sanitary regulation of classroom:

A) Classrooms: - should be rectangular in shape with space area 1.5 m2 /
pupil (usually 8×6 or 7×5).

27
B) Classroom Furniture:

1. The blackboard:

Should have dark surface suspended at a suitable level at the center of the
wall front of the student the distance between it and the first row of desks
should r be less than 1.5 meters.

2. Desks:
1. The back of the student should be kept straight but at the same time
comfortable
2. The height of the seat of the dusk should be suitable with length of
the student legs so that the feet should touch the ground easily.
3. The height of the desk should be suitable for reading and writing.
4. The distance between each two columns of desks should not be less
than 60 (and the side desks should be separated from adjacent walls
by such a distance.

C) Ventilation
 Adequate ventilation can be provided by suitable window area of at
least one – fifth (20%) of the floor area.
 The windows should be dispersed on opposite sides to allow for
cross ventilation and the majorities should be located on the left
side of the students as most of students are right handed.

Health Hazards of Crowded ill – ventilated classes

 Favor spread of droplet infection
 Manifestation of ill ventilated as discomfort fatigue sleepiness
 Deficient educational and health supervision

D) Lighting
A-Natural: This can be achieved by an adequate window area

28
 B-Artificial: means provision and control of light by artificial means
is required for evening school and on dim cloudy days.

Hazards of defective lighting

Inadequate lighting may predispose to visual strain eye fatigue and may
be conjunctivitis

E) Food Sanitation

a) Sanitary regulation of food establishments as kitchen canteen and store

they should fulfill all sanitary requirements.

b) Sanitary regulation of food handlers they should be licensed (valid 2

years) with supervision during work.

c) Food utensil: Containers should be made of safe material and clean.

d) Food stuffs: free from contamination, adulteration and spoilage.

F) Water supply

Safe water supply should be available, drinking fountains should be used

other than ordinary taps to avoid contamination of the nozzle by mouth
and spread of droplet infection

a) Safe sources of water supply.

b) Suitable number of sanitary drinking fountains the minimal number

required is 1 tab for 40 students.

Baths: An adequate number of shower baths is baths is provided in big

school for personal cleanliness after games.

G) Waste Disposal:

a) Refuse: Small baskets should be available in classrooms and

playground.

29
b) Sewage: is directly disposed of the water carriage system of the town
in rural the permeable cesspit can be used.
H) Insect control
The school environment should be free from any breeding places,
application of insecticides usually done as necessary.

Psychological school environment (social)

1- Good relationship between students and teachers and parents. 2- Good
relationship between the children themselves.
3- The school day and homework are properly arranged to prevent
fatigue.

4- activities are valuable for general Social welfare.

5- The influence of teachers on the children.
6- Opportunities for developing talents and skills.
Counseling And Psychological Services
Provide services to students to improve mental, emotional and social
health and include individual and group assessments, interventions and
referrals. Assessment and consultation skills of counselors and
psychologists contribute not only to the health of students but also to the
health of the school environment.
Professionals such as certified school counselors, psychologists and
social workers provide these services. School counseling, psychological
and social services include a wide variety of programs that address the
mental health needs of students. Effective programs focus on:
• Prevention, address problems, facilitate positive learning and
health behavior as well as enhance healthy student development.
• Targeting students in high-risk situations to prevent dropouts.

Health Promotion for Staff

Provides opportunities for school staff to improve their health status

30
through activities such as health assessments, health education and
health-related fitness activities. It also improves morale and produces a
higher level of personal commitment to the school’s overall CSH
program. This personal commitment often transfers into greater
commitment to the health of students.
Health promotion for staff focuses on developing adult health knowledge,
skills and the practice of healthy behaviors. Benefits of this practice
include:
• Enhanced well-being of administrators, teachers and other staff.
• Staff role modeling for the students in their care; a critical
reinforcement to sustaining healthy behaviors in both the adults
and students.
• Increased productivity, decreased absenteeism and positive effects
on health insurance costs.
Family and Community Involvement
An integrated school, parent and community approach for enhancing the
health and well- being of students is another key component of support
for program efforts. Schools actively encourage parent involvement and
engage community resources and services to respond more effectively to
the health-related needs of students.
Family and community involvement benefits students in the following
ways:
• Increases the likelihood of better attendance and better grades.

• Student success improves when teachers and parents work together.

• Reduces in-school suspension rates, inappropriate school behavior

and has a positive impact on academic achievement.

• Increased student interest in co-curricular and after school
community activities have a positive impact on grades and behavior.
• Enhances linkages to community programs that support school
31
 objectives for student success.
 Full-Service School Model.

In recent years, additional models, definitions, and descriptions have

emerged that build on previous models, including the full- service school
model. In addition to quality education, a full-service school model
involves a one-stop, seamless institution, where the school is the center
for providing a wide range of health, mental health, social, and/or family
services.

- Features of Organizing School Health Program:

 In each school, a health council and health committee should be
constituted.
 Health committee should provide leadership and guidance to the
health education program in the school, which will assist the
welfare of community.
 The members of this council should include the head of the school,
the school medical advisor, health coordinator, various teachers,
students and parents’ representatives like school management
committee members.
 Every school should have a counselor, trained teacher of first aid,
nutritionist or a dentist. Medical advisor/doctor should be full time
or part time in the school because students need medical care and
emergency care anytime.
 Health coordinator is most important and responsible person for
well implementation of school health program in school. He/she
may be head of the department, Principal and physical
educationist.

32
 References
• Allender, J. and Spradly, B. (2005). Community Health Nursing:
Promoting and Protecting the Public's Health. 6 th ed. Lippincott
Williams & Wilkins, Philadelphia. P: 664:666.
• Blackboard (2016). How K-12 Schools Are Meeting the Expectations
of Parents for Digital Communications. Retrieved from
cdn2.hubspot.net: https://cdn2.hubspot.net/hubfs/ 273815/ Landing-
Pages_Images-PDFs/Project-Tomorrow_CE-Digital-Trends/Bb_Trend
sinCEReport_Final.pdf
• Cohen S, Halvorson HW, Gosselink CA (2014).Changing physician
behavior to improve disease prevention. Preventive Medicine, 23: 284–
291
• O’Donnell L, Stueve A, San Doval A, et al. (2009). The effectiveness
of the Reach for Healthcommunity youth service program on reducing
early and unprotected sex among urban youth American Journal of
Public Health, 82(2):176–181.
• Stanhope, M. and Lancaster, J. (2002). Foundations of Community
Health Nursing: Community-oriented Practice. Mosby, St louis. P:
481-510.
• UNICEF (2015a). Children in Egypt: a statistical digest, June 2015,
UNICEF Egypt, Cairo,Egypt. Available at:
https://www.unicef.org/egypt/UNICEF_2015_Children_in_Egypt_Stati
stical_Dig est(2).pdf
• UNICEF (2015b). Children in Egypt: a statistical digest, UNICEF
Egypt, Cairo, Egypt. Available at:
https://www.unicef.org/egypt/Ch4.Immunization_and_Health_2015.pd
f

33
• Youth Compendium of Physical Activities for Physical Education
Teachers (2018)

Role of the nurse in school

Under supervision
Prof.Dr / Nahla Ashour

Assist.prof / Samia Elnagar

By

Miss/ Ghada Shaban Nawaya

34
 2022
Out lines
- Introduction
Goal for school nurses -
Definition of school nursing and other terms -
Skills of CHN (Community Health Nurse) -
The school health team -
School nurse role -
-References

35
Introduction
The school nurse has a crucial role in provision of comprehensive health
services to children and youth. Increasing numbers of students enters
schools with chronic health conditions that require management during
the school day. This policy statement describes for pediatricians the role
of the school nurse in serving as a team member in providing preventive
services, early identification of problems, interventions, and referrals to
foster health and educational success.

To optimally care for children, preparation, ongoing education, and

appropriate staffing levels of school nurses are important factors for
success.

Goal for school nurses

The primary goal for school nurses throughout the 20th century followed
the foundation laid by Lina Rogers in 1902:

- Maintain student health and promote school attendance.

Definition of school: Is formal institution designed for transmit the

knowledge and skills for children to become productive member of
society.

School nursing
The National Association of School Nurses defines school nursing as:

A specialized practice of professional nursing that advances the well-

being, academic success, and lifelong achievement of students.

School nurses:

36
 School nurses are specialist community public health nurses (SCPHN)
who work with school-aged children and young people and their families
to improve health and wellbeing outcomes and reduce inequalities and
vulnerabilities.

Healthful school environment:

Is a safe environment to protect students and staff against immediate
injury or disease and promotes activities and attitudes against known risk
factors that might lead to future disease or disability.

Skills of CHN (Community Health Nurse)

1-Communication Skills

Solid communication skills are a basic foundation for any career,

especially school health nurse; it’s one of the most important aspects of her
job.

2. Emotional Stability

Nursing is a stressful job where traumatic situations are common. The

ability to accept suffering and death without letting it get personal is
crucial. Some days can seem like non-stop gloom and doom.

3. Empathy

Great nurses have empathy for the pain and suffering of student. They
are able to feel compassion and provide comfort. But be prepared for the
occasional bout of compassion fatigue; it happens to the greatest of
nurses. Learn how to recognize the symptoms and deal with it efficiently.

4. Flexibility

Being flexible and rolling with the punches is a staple of any career, but
it’s especially important for nurses.

37
 A great nurse must be flexible with regards to working hours and
responsibilities. Nurses, like doctors, are often required to work long
periods of overtime, late or overnight shifts, and weekends.

5. Attention to Detail

Every step in the medical field is one that can have far-reaching
consequences. A great nurse pays excellent attention to detail and is
careful not to skip steps or make errors.

6. Interpersonal Skills

Nurses are the link between doctors and patients. A great nurse has
excellent interpersonal skills and works well in a variety of situations
with different people. They work well with other nurses, doctors, and
other members of the staff.

7. Physical Endurance

Frequent physical tasks, standing for long periods of time, lifting heavy
objects (or people), and performing a number of taxing maneuvers on a
daily basis are staples of nursing life. It’s definitely not a desk job.

Always on the go, a great nurse maintains her energy throughout her
shift, whether she’s in a surgery or checking in on a patient. Staying
strong, eating right, and having a healthy lifestyle outside of nursing is
important too!

8. Problem Solving Skills

A great nurse can think quickly and address problems as or before they
arise. With sick patients, trauma cases, and emergencies, nurses always
need to be on hand to solve a tricky situation. Whether it’s handling the
family, soothing a student, dealing with a doctor, or managing the staff,
having good problem solving skills is a top quality of a great nurse.

38
9. Quick Response

Nurses need to be ready to respond quickly to emergencies and other

situations that arise. Quite often, health care work is simply the response
to sudden incidences, and nurses must always be prepared for the
unexpected.

Staying on their feet, keeping their head cool in a crisis, and a calm
attitude are great qualities in a nurse.

10. Respect

Respect goes a long way. Great nurses respect people and rules. They
remain impartial at all times and are mindful of confidentiality
requirements and different cultures and traditions. Above all, they respect
the wishes of the student him- or herself.

Great nurses respect the hospital staff and each other, understanding that
the student comes first. And nurses who respect others are highly
respected in return

The school health team

1. Administrators of school

2. Medical personnel (Physician and nurse)

3. Social workers

4. Teachers

5. Students

6. Nutritionists

39
 7. Janitorial staff (security)

8. Parents

Duties of School Physician:

1- Health appraisal.

2- Examination of sick, diagnosis and prescription of treatment or referral

to specialists.

3- Health education.

4- General inspection of the school environment.

5- Planning for the prevention and control of infectious diseases.

6- Supervising preparation of statistical reports.

Duties of the Teacher:

1- Observation of children for case finding.

2- Participation in the health education program.

3- Attends the medical examination.

4- Giving a special care for handicapped children.

5- Giving good example for students in his behaviors and practices.

Duties of Social Workers: good relations with the school personnel, pupils,
and families can do a lot for social, mental and emotional welfare of the
pupils.

Duties of the Nutritionists

The Nutritionists procurement, financial administration, menu planning,
recipe development, nutrition education, wellness coordination,

40
catering/vending operations, production facility or warehouse management,
training coordination or more.

School nurse role

The National Association of School Nurses identifies 7 core roles that the
school nurse fulfills to foster child and adolescent health and educational
success. The roles are overarching and are applicable to school nurses at
all levels of practice, in all geographic settings.

1- The school nurse provides direct care to students.

Be school nurse provides care for injuries and acute illness for all
students and long-term management of students with special health care
needs. This include assessment and treatment within the scope of
professional nursing practice, communication with parents, referral to
physicians, and provision or supervision of prescribed nursing care.

2- The school nurse provides leadership for the provision of health

service

As the health care expert within the school, the school nurse assesses the
overall system of care and develops a plan for ensuring that health needs
are met include development of plans for responding to emergencies and
disasters and confidential communication and documentation of student
health information.

3- The school nurse provides screening and referral

Health screenings can decrease the negative effects of health problems on

education by identifying students with potential underlying medical

41
problems early and referring them for treatment as appropriate. Early
identification, referral to the medical home, and use of appropriate
community resources promote optimal outcomes.

4- The school nurse promotes a healthy school environment.

The school nurse provides for the physical and emotional safety of the
school community by monitoring immunizations, ensuring appropriate
exclusion for infectious illnesses, and reporting communicable diseases
as required by law.

5- The school nurse promotes health.

The school nurse provides health education by providing health

information to individual students and groups of students through health
education, science, and other classes. The school nurse assists on health
education curriculum development teams and may also provide programs
for staff, families, and the community

Health education topics: may include nutrition, exercise, smoking

prevention and cessation, oral health, prevention of sexually transmitted
infections and other infectious diseases, substance use and abuse,
immunizations, adolescent pregnancy prevention, parenting, and others.
School nurses also promote health in local school health councils.

6- The school nurse serves in a leadership role for health policies and
programs.

As a health care expert within the school system, the school nurse is a
leader in the development and evaluation of school health policies.
These policies include health promotion and protection, chronic disease
management, coordinated school health programs, school wellness
policies, crisis/disaster management, emergency medical condition

42
management, mental health protection and intervention, acute illness
management, and infectious disease prevention and management.

7- The school nurse is a liaison between school personnel, family,

health care professionals, and the community.

As the case manager for students with health problems, the school nurse
ensures that there is adequate communication and collaboration among
the family, physicians, and providers of community resources. This is a
crucial interface for the pediatrician and the school nurse to ensure
consistent, coordinated care. The school nurse also works with
community organizations and primary care to make the community a
healthy place for all children and families

43
 Reference

1- Allender, J. and Spradley, B. (2015): Community Health Nursing

Promoting and Protecting the Public's Health, 6 thEd.,Lippincott, New
York, pp600-651.

2- American Nurses Association. (2013): The scope of practice for

nursing informatics.Washington, DC: American Nurses Publishing,
NP-90 7.5M 5/94.

3- Graves JR, Corcoran S.( 2012): The Study of Nursing

Informatics .Journal of Nursing Scholarship, 21; 227-231.

4- Kolbe, L. (2015). A framework for school health programs in the 21st

Century. Journal of School Health, 75, 226-228.

5- MOH in Egypt .2012

6- World Health Organization (2005).ComprehensiveSchool Health

Education.Suggested Guidelines for Action.Geneva, Switzerland:
World Health Organization.

7- World Health Organization (2016).The HealthPromotingSchool- an

investment in education health and democracy.Copenhagen: World
Health Organization.

44
Needs of school age children

Under supervision

Prof. Dr / Nahla Ashour Saafan

Assist. prof / Samia ALI Shaban

Prepared by
Naglaa Fathy

2021-2022
45
 Outlines
 Introduction

 Types of school health need:

 physical needs

 Physical activity

 Safety

 Language Development

 Social & Emotional Development

 Intellectual Development

 References.

46
Introduction
School-aged children need a lot of help learning social skills like how
to make friends, trust others, work in a team and resolve conflicts.
Children also need to be taught how to use good manners, ask for help
and negotiate with others. Often, they have to be reminded to carry out
homework responsibilities or household chores.

Learning self-discipline is an ongoing process that improves each

year. Children this age have not had much experience in setting and
achieving goals or in measuring their own strengths and weaknesses.
They need adults to provide experiences that are challenging, yet
achievable.

School-age children need and desire the attention and love of a parent
or adult caregiver. Spending time with family members and peers is one-
way school-age children feel and show love. Children who do not feel
loved have a limited emotional range, have trouble concentrating, and
often act out in antisocial ways.

Needs of school age children

 Physical Development

School-age children most often have smooth and strong motor skills.
However, their coordination (especially eye-hand), endurance, balance,
and physical abilities vary. Fine motor skills may also vary widely. These
skills can affect a child's ability to write neatly, dress appropriately, and
perform certain chores, such as making beds or doing dishes.

47
 There will be big differences in height, weight, and build among
children of this age range. It is important to remember that genetic
background, as well as nutrition may affect a child's growth.
immunization, preventing infectious diseases, adequate rest and sleep,
clothing and shelter. A sense of body image begins developing around
age 6.

For a child to be successful in school they need to be well fed,

sleeping well, feeling safe at home, and have confidence in themselves.
Maslow’s Hierarchy of Needs is a popular theory which focuses on a
series of needs to be successful.

1- Physiological needs are about having the right nutrition and water,
access to fresh air, enough rest and exercise. A healthy diet rich in
calcium, protein and other essential vitamins and minerals, enables
optimal skeletal and physical growth.

2- Safety needs are about security and feeling safe – physically and
emotionally, the need to have shelter/a home and to have stability
in one’s life. being a safe environment and protected from
harm.
3- Belonging and love and are to do with others, the social side
of feeling that you belong, are connected, loved and included.
48
 4- Esteem needs concerns inner self – having feelings of
achievement, being recognized, having power over one’s life and
being a person different from another person.
5- Self-actualization is to do with achieving one’s full potential,
being creative and finding that specialness of oneself.

Physical activity
Physical activity is not only essential for healthy growth and
development, it’s also important to learning. Research shows that
physical activity – whether it’s team sports, bike riding, swimming at the
beach or playground games – has positive effects on the brain and on
school performance.

Sedentary habits in school-age children are linked to a risk for

obesity and heart disease in adults. Children in this age group should get
1 hour of physical activity per day.

The positive effects of physical activity on the brain

49
 Physical activity has a direct impact on the behavior and
development of the brain. An essay by Charles Bausch of Columbia
University summarized how physical activity can improve brain function:

1- The flow of oxygen to the brain is increased

2- The number of brain neurotransmitters is increased, which assists

your ability to focus, concentrate, learn, remember, and handle
stress

3- The number of brain-derived neurotrophies is increased, which

assures the survival of neurons in areas of the brain that are
responsible for learning, memory, and higher thinking.

Safety
Safety is important for school-age children.

 School-age children are highly active. They need physical activity and
peer approval and want to try more daring and adventurous behaviors.

 Children should be taught to play sports in appropriate, safe, supervised

areas, with proper equipment and rules. Bicycles, skateboards, in-line
skates, and other types of recreational sports equipment should fit the
child. They should be used only while following traffic and pedestrian
rules, and while using safety equipment such as knee, elbow, and wrist
pads or braces, and helmets. Sports equipment should not be used at night
or in extreme weather conditions.

 Swimming and water safety lessons may help prevent drowning.

 Safety instruction regarding matches, lighters, barbecues, stoves, and

open fires can prevent major burns.

50
 Wearing seat belts is the most important way to prevent major injury or
death from a motor vehicle accident.

Language Development
Early school-age children should be able to use simple, but complete,
sentences that contain an average of 5 to 7 words. As the child goes
through the elementary school years, grammar and pronunciation become
normal. Children use more complex sentences as they grow. Language
delays may be due to hearing or intelligence problems. In addition,
children who are unable to express themselves well may be more likely to
have aggressive behavior or temper tantrums.

Language development is essential for effective communication

which is the best way to increase interaction between students and
teachers, students and students. It should be constructive effective and
respectful. The child needs open communication from parents and
caregiver.

Social & Emotional Development

Strong, positive relationships help children develop trust, empathy,
compassion, and a sense of right and wrong. Starting from birth, babies
51
 learn who they are by how they are treated. Loving relationships provide
young children with a sense of comfort, safety, and confidence. They
teach young children how to form friendships, communicate emotions
and deal with challenges.

How to promote Social & Emotional Development

 Love your child and show your affection for them and talk with them
throughout the day.

 Encourage your child to try new things. Help them see what they are capable
of. Let your child know you are pleased with their accomplishments.

 Give your child opportunities to play with other children their age. Help them
explore their world and get to know the people in it.

 Show your feelings. Let your child see when you are happy or sad. This helps
them to develop empathy for others.

 Establish daily routines. Your child will feel confident and secure. They will
learn that events can happen in an organized way.

 Acknowledge your child’s feelings. Help them talk about what they feel and
how they are feeling. Comfort your child when they are upset. Hold them and
speak softly and calmly.

Intellectual Development
Cognitive or intellectual development means the growth of a child’s
ability to think and reason. It's about how they organize their minds, ideas
and thoughts to make sense of the world they live in.

The role of the parent is to spend time observing and interacting with
their child and provide opportunities for them to learn and develop by
exposing them to new things by taking them to interesting places or
providing materials at home including a household object, toys, and
52
books. Play with parents, solo play and play with other children is key to
a child developing not only promote cognitive development but physical,
social and language development as well. Play means interacting with
people and objects not watching videos or playing electronic games. Play
also means going outside to explore and engage in physical activity.

How to promote Intellectual Development

 Develop problem-solving skills

Building problem solving skills during the formative years of kids

can be extremely helpful for their lifetime. Encourage them to play
board games, brain games and puzzles. Encourage them to come up
with original ideas, while waiting and listening to them patiently.

 Improve attention spans

Increasing attention span can play a vital role in the cognitive

development in kids. Attention that children pay on a task depends
on whether they are enjoying it or not. Since kids entering school
have to perform more structured, repetitive, and academic tasks
such as writing and reading, you need to make their tasks
interesting for them.

 Improve memory skills

Since memory is a complex process, you can employ a range of

strategies to help your kids recall information. You can teach them
how to remember the sequence of letters of different words, names
of animals using their unique attributes, and names of places with
specific landmarks.

53
References

 American Academy of Pediatrics website. Recommendations for

preventive pediatric health
care. www.aap.org/en-us/Documents/periodicity_schedule.pdf.
Updated March 2020. Accessed January 14, 2021.

 Finkelstein LH, Feigelman S. Middle childhood. In: Kliegman RM,

St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM,
eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA:
Elsevier; 2020:chap 25.

 Marcdante KJ, Kliegman RM. Normal development. In: Marcdante

KJ, Kliegman RM, eds. Nelson Essentials of Pediatrics. 8th ed.
Philadelphia, PA: Elsevier; 2019:chap 7.

 Karin, A.,(2018). The Nemours Foundation; National Network

for Child Care; Meals That Heal for Babies, Toddlers, and
Children; U.S. Food and Drug Administration.

 Health, social care children's development. (2019). Human Growth

& Development. https://redtri.com/how-to-encourage-physical-
emotional-intellectual-development-in-kids/.

54
School Health Problems

Under supervision
Prof.Dr / Nahla Ashour

Assist.prof / Samia Elnagar

55
 Prepared by
C.I/ Amira Ezzat El-sedawy

2022

Outlines:
- Introduction

- Definition of health and health problems

- Common Health Problems of School Children

7) Infectious diseases.

8) Parasitic diseases.

9) Malnutrition.

10) Disability

11) Accidents.

12) Psychological and social problems.

- References

56
Introduction
Childhood is a wonderful phase in one’s life. Children are susceptible to
illnesses as their immune system is still developing. Mild illnesses are a
part of growing up, but a basic awareness of the common health issues
faced by children help to prevent them. School age children experience a
wide range of health problems and at high risk of acquiring
communicable and non-communicable diseases, the situation is alarming
in low and middle-income countries. Schools offer a unique opportunity
to implement effective health services for children. Here we will be
taking a look at common health problems in school children.

Definitions
Health: Is a state of complete physical, mental, social and spiritual well-
being and not merely the absence of disease or infirmity.

Health problems: It is a state in which we are unable to function

normally (state of ill health, unhealthiness)

 The Most Common Health Problems of School Children:

1) Infectious diseases.

2) Parasitic diseases.

3) Malnutrition.

4) Disability.
57
 5) Accidents.

6) Psychological and social problems.

1- Infectious Diseases
They considered as a major health problem in schools.

Forms of Spread:

1. Sporadic: Infrequent scattered cases.

2. Outbreak: Epidemic in a closed community.

Predisposing factors:
 Unsanitary school environment.

 Faulty habits of children and school personnel.

 Lowered body resistance and hyper susceptibility of school children.

 Existing reservoir of infection, especially unapparent cases carriers

among pupils, teachers or food handlers.

Types of Infections:
a. Respiratory infections:

58
 Diseases of respiratory system are the major cause of hospitalization of
young children. Acute respiratory interferes with activities of daily living
and may lead to other serious acute and chronic conditions, such as:

1. Streptococcal pharyngitis, common cold, influenza, mumps and varicella.

2. Measles: Significantly controlled after mandatory vaccine.

3. Diphtheria and pertussis only sporadic cases are reported following mass
active immunization of children.

b. Food borne infections as: typhoid, dysenteries, food poisoning and hepatitis A.

c. Contact Infections:

1. Skin: ring worm, impetigo.

2. Eye: Conjunctivitis, trachoma.

3. Wound sepsis: Streptococcal and staphylococcal infections.

DISEASE MODE OF SIGNS METHODS SCHOOL

59
 TRANSMISSI AND OF CONSIDE
ON SYMPTO CONTROL RATION
MS
CHICKEN • Directcontact • Mildfever, • Prevent
or avoid • Exclude from
POX and inhalation fatigue. exposure to school for 1
Incubation: 14- of • Pustular
rash infected persons. week or until
16 days contaminated with lesions • vaccine
all sores are
air-borne and crusting. (developed dried and
* Reportable droplets. crusted.
disease. 1995) for
• Highly persons 12 • Persons
contagious. months or older with
• Individuals
weakened
should be immune
referred to systems are
physician. more
susceptible.
CONJUNCTIV • Bacteria, • Irritated, • Good
hand • Cool compress
ITIS virus, itching or red washing. for comfort.
Incubation: 24- allergy or eyes with • Possible Rx.
72 hrs chemicals. yellow
discharge. • Refer to
• Direct
and
Viral: 5-12 physician.
days indirect • Matted eyelids.
contact with •

discharge.
• Contamina
ted fingers,
clothing,
other
articles.
FIFTH • Contact with • Lace-like • Goodpersonal • Outbreaks
DISEASE airborne rash on face, hygiene. frequently
Incubation: 4- droplets from arms, legs. • Nospecific occur in
14 days Report nose and Resembles a treatment. spring.
outbreaks only. throat. “slapped • Consult
• Direct contact.
cheek.” personal
• Low-grade physician.
fever. • Risk to those
• Person
is with sickle
contagious cell disease,

60
 prior to anemia,
visible rash. weakened
immune
system.
IMPETIGO • Bacteria(staph, • Cluster of • Antibiotic • Do
not share
Incubation: 2-5 strep). raised bumps therapy towels.
days. Report • Bacteria in
filled with (Bacitracin) for • Early
ID-
outbreaks only. nose may fluids. 24 hours outbreaks
spread to face • Open sores or generally occur late
(auto- lesions eliminates ability summer and
infection). (usually under to spread early fall —
nose and on bacteria. watch for
• Contaminat
ed towels face). • Frequent hand clustering of
and other washing. cases.
toilet • Avoid contact • Consider
articles. with sores or exclusio
lesions. n until
on
antibioti
cs for 24
hours.
INFLUENZA • Inhalation • Fever, muscle • Bed rest, • Offervaccine
(“The Flu”) of aches, cold to all staff
infected fatigue, sore remedies, annually.
droplets. throat, light • Education:
• Highly
headache. exercise. cover mouth,
contagious. • Drinkplenty of nose during
liquids. sneezes and
• Vaccination prior coughs.
to flu season • Frequent hand
(given Sept. to washing.
mid-Nov.
LICE • Direct • Itching and • Medicated • Separation of
Incubation: contact with scratching shampoos or student
days to weeks. infected where lice cream rinses lockers.
person or feed, (permethrin or • Separation
of
Report with infested especially pyrethrin type}.
outbreaks only coat hangers.
be- longings ears and head. • Retreatment
(i.e.: hats, • Proper
• Eggs can be after 7-10 days
combs, treatment,

61
 brushes, detected on is proper
crowded hair shaft. recommended laundering of
clothing to ensure no clothing and
storage). eggs have bedding.
survived. • Education
of
• Concurrent parents and
disinfection. children.
• Remove all nits • Screenfor
(eggs). infestation;
• Screen
family repeat 24
members. hours after
treatment.
• Avoidphysical
• Nosharing of
contact with
infected clothes, hats.
individuals.
MEASLES • Sometimes • Serious rash •Vaccine. • Common in
incubation: 7- airborne. illness with winter and
10 days • Highly
fever, runny spring.
contagious. nose, cough • Immunization
and rash required for
• Direct
contact lasting 4- 7
with nose and days. school-
throat enrolled
secretions. children
(including
pre-
Kindergarten
• Exclude
children
until
physician
approved.
MENINGITIS • Direct
contact • Sudden • Antibiotic • Verify
type of
incubation: 2- with nose and fever, treatment. meningitis.
10 days throat headache, • Preventive • Watchfor
discharge. vomiting, treatment for symptoms
neck pain infected in other
or stiffness. person’s family students/s
and close taff.
contacts.
62
 • Communicate
with staff and
parents about
control
measures.
Prevention of Infectious Diseases at School:
 General Measures:

a) Sanitation of school environment.

b) Health education: - of students, families and teachers about mode of transmission,

precautions, complication and immunization.

c) Health promotion via: adequate nutrition, physical exercise and open air
recreation.

 Special Measures:

1-For students:

A- Active Immunization at School Entry against:

Age Vaccine Dosage

5-6 years OPV, DT Booster dose

BCG Revaccination

Measles, mumps and rubella Booster dose

Meningococcal vaccine Single dose 0.5 ml SC

8 years DT booster dose 0.5 ml, IM

9 years Meningococcal Single dose 0.5 ml SC

vaccine

63
School children at Tetanus toxoid Booster dose, when
any age when injured, with risk of infection
indicated

B) Chemoprophylaxis:

1. Rifampicin for contact in meningococcal meningitis.

2. Long acting penicillin for rheumatic fever.

3. Erythromycin for pertussis.

2- For School Personnel:

a. Pre-employment and periodic medical examination for infections.

b. Health education for healthy habit.

c. Supervision during work.

 Control Measures:
For Cases

(1) Case finding through: -

-Daily inspection of pupils in the morning before entering the classrooms.

Pupils showing suspicious manifestations e.g., running nose or eyes,
cough, fever or presence of rash such pupils are excluded from the
classrooms until the doctor come and examine them.

-Examination of the absentee’s records.

(2) Notification.

(3) Isolation.

(4) Proper treatment, follow up.

(5) Release.

64
For Contacts: Identification, examination, prophylaxis and health education.

The steps to be taken during an epidemic or outbreak at school:

1 - General measure.

2 - Special measure as mentioned before.

3 - Emergency measures as class or school closure if needed (very rare) and the
determining factors control the closure of the school are:

a) The character of the disease.

b) The extent of spread of infection.

c) The likelihood that, if the schools are closed, the children may equally come in
contact as if they attend school.

d) The value of leaving children under observation when school stays open.

The general rule is that, so long an efficient school health services are available, it is
recommended to have school open for health supervision.

Epidemiological investigation to trace the sources and channels of infections: -

The steps commonly used are as follow:

1-Verification of the diagnosis (define cases).

2- Verification of the epidemic spread by:

a. Case study.

b. Search for mild or unapparent cases.

c. Comparison with previous incidence.

3- Identification of the affected persons as regard:

a. Time (when, epidemic curve).

b. Place (where, map spot).

c. Person (who, personal characteristics).

65
4- Definition and investigation of the population at risk.

5- Formulation of a hypothesis as to source and spread of epidemic.

6- Test Hypothesis: through case-control study.

7- Reporting and recommendations.

2- Parasitic Diseases
Parasites of more prevalence:

1- Enterobius vermicularis: The most prevalent (easy spread by hand to mouth

infection).

2- Ascaris and Hymenolepis nana.

3- Giardia lamblia: an important etiological agent of recurrent diarrhoeal

disease.

4- E. histolytica, Taenia saginata, Ancylostoma and Schistosoma in endemic

areas.

Prevention and Control:

1. General measures

 Sanitation of school environment.

 Health education of students, families and teachers about modes

of transmission, complication and immunization and
precautions.

 Health promotion via adequate nutrition, physical exercise and

open air

2. Case finding on health appraisal (urine and stool examination).

3. Treatment and re-examination of cases.

3- Malnutrition Problem

66
Important forms of malnutrition among school children are:

1- Protein deficiency disorder:-which take the form of impairment of growth at this

age (wasting and stunted growth).

2- Iron deficiency anemia.

3- Riboflavin deficiency (B2 deficiency):- causing angular stomatitis and cheilosis

4- Vitamin A deficiency (anti-infection vitamin):-giving skin and ocular manifestation

and decrease resistance to infections.

5- Dental caries.

6- Over nutrition.

Types of Malnutrition:

1. Primary deficiency: - due to inadequate dietary supply and nutrition ignorance

of

child and family.

2. Secondary deficiency: - which interferes with the availability and utilization of

the nutrients, e.g. diarrhoeal diseases and chronic bleeding, intestinal

parasitic diseases and malabsorbton disorders.

Assessment of Nutritional Status includes:

1- Dietary history and intake data.

1- Anthropometric data, e.g. height and height for weight.

3- History and clinical examination.

4- Biochemical data.

6- Assessment of ecological factors, e.g. prevalence of infectious diseases, food

habits, socioeconomic factors.

Methods of Improvement:
67
 1) School feeding program.

2) Nutrition education of children and their families.

3) Prevention and control of parasitic infestation.

4) Periodic examination for detection and management of deficiency.

4- Accidents
Causes and factors related to the causation:

1. Bad environmental condition of school

2. Overcrowding

3. Unsuitable site of school

4. Desire to win in the competition.

Prevention and control:

1. Fulfillment of safety measures at school and its surroundings.

2. Supervision of children during their play.

3. Providing first aid.

4. Ambulance services.

5. Notification of the parents.

5- Handicapping
Handicapping is physical, mental and/or social disability that interferes with
normal life and activities.

68
 I. Physically handicapped:

• Visual disabilities

• Auditory disabilities: It may be conductive, perceptive or

psychogenic deafness.

• Cardiac handicaps.

• Asthmatic handicaps.

• Speech handicaps.

• Musculoskeletal disorders.

II. Mentally Handicapped

Mildly retarded Moderately retarded Severely retarded

• I.Q. ( 50%- 70%) • I.Q. ( 20 -50%) • I.Q. ( < 20%)

• The mental age: 8- • Age: 4 - 8 years. • less than 4 years.

12 years . • Trainable, non- • Non-educable, non-
• Educable and educable. trainable, not able to
trainable. They can help themselves.
live independently

69
III. Socially Handicapped:

The different social factors e.g., Poverty, maternal deprivation may cause
socially handicapped child who is more prone to secondary handicap and
child abuse.

 Other Common Health Problems at School Age

• Diabetes Mellitus

About 50% of children diagnosed with type 1 diabetes mellitus are

diagnosed before age 10 years. Children being treated with insulin
receive their injection at least one hour before coming to the school,
hypoglycemia may occur. Teacher should be aware for the condition.
Orange juice produces recovery in few minutes.

• Disorders of Oral Cavity: Good dental hygiene should be

taught to all children.

o Caries and cavities

o Abscess.

o Gingivitis.

 Disorders of Eye Vision: Teachers should observe their students

closely this can be helpful in early detection of disorders such as
myopia and Conjunctivitis.

 Ear infection:

Cause: When a virus or bacteria gets into the space behind the
eardrum. It causes pus to build up. The pressure on the eardrum
causes pain.

70
 Symptoms: Ear pain, fever, trouble swallowing or sleeping,
tugging at ear in younger children.

Treatment: Many doctors take a “wait and see” approach before

recommending antibiotics. Antibiotics can’t help an ear
infection caused by a virus. They often don’t help very much
before the infection clears up on its own. Medicine can be given
for pain at home.

6- Psychological and social problems

 Anxiety disorders. Anxiety disorders in children are persistent

fears, worries or anxiety that disrupt their ability to participate
in play, school or typical age-appropriate social situations.
 Attention-deficit/hyperactivity disorder (ADHD). Compared
with most children of the same age, children with ADHD have
difficulty with attention, impulsive behaviors, hyperactivity or
some combination of these problems.
 Autism spectrum disorder (ASD). Autism spectrum disorder
is a neurological condition that appears in early childhood —
usually before age 3. Although the severity of ASD varies, a
child with this disorder has difficulty communicating and
interacting with others.
 Eating disorders. Unsafe eating and dieting habits. Eating
disorders such as anorexia nervosa, bulimia nervosa and binge-

71
 eating disorder can result in emotional and social dysfunction
and life-threatening physical complications.
 Depression and other mood disorders. Depression is
persistent feelings of sadness and loss of interest that disrupt a
child's ability to function in school and interact with others.
Bipolar disorder results in extreme mood swings between
depression and extreme emotional or behavioral highs that may
be unguarded, risky or unsafe.
 Post-traumatic stress disorder (PTSD). PTSD is prolonged
emotional distress, anxiety, distressing memories, nightmares
and disruptive behaviors in response to violence, abuse, injury
or other traumatic events.

 Warning signs that a child may have psychological problems

include:

 Persistent sadness that lasts two weeks or more.

 Withdrawing from or avoiding social interactions.
 Hurting oneself or talking about hurting oneself.
 Talking about death or suicide.
 Outbursts or extreme irritability.
 Out-of-control behavior that can be harmful.
 Drastic changes in mood, behavior or personality.
 Changes in eating habits.
 Loss of weight.
 Difficulty sleeping.
 Frequent headaches or stomachaches.
 Difficulty concentrating.
 Changes in academic performance.

 Management of psychological problems

72
 Complete medical examination
 Medical history
 History of physical or emotional trauma
 Family history of physical and mental health
 Review of symptoms and general concerns with parents
 Academic history
 Timeline of child's developmental progress
 Interview with parents
 Conversations with and observations of the child
 Provide education about the illness.
 Consider family counseling that treats all members as partners
in the treatment plan.
 Ask your child's mental health professional for advice on how
to respond to your child and handle difficult behavior.
 Enroll in parent training programs, particularly those designed
for parents of children with a mental illness.
 teach stress management techniques to help you respond
calmly.
 Praise your child's strengths and abilities.
 Work with your child's school to secure necessary support.

73
References
Pradhan, Nousheen & Karmaliani, Rozina & Gulzar, Saleema. (2020).
Health Problems among School age Children and Proposed Model
for School Health Promotion.

Buzgar, Ramona & Dumulescu, Daniela & Opre, Adrian. (2013).

Emotional and Social Problems in Primary School Children: A
National Screening Program. Procedia - Social and Behavioral
Sciences. 78. 250–254. 10.1016/j.sbspro.2013.04.289.

Oh, H. Y. (2018). Management of infectious diseases in schools. Taehan

Kanho. The Korean Nurse, 7(4), 10-29 passim.

Services, H. (2022). Managing Communicable Diseases in Schools.

1(March). http://www.michigan.gov/mde/0,4615,7-140-
28753_64839_38684_29233_29803-241996--,00.html

74
 Under supervision

Prof.Dr / Nahla Ashour

Assist.prof / Samia Elnagar

By

Miss/ Ghada Shaban Nawaya

75
 2022
Out line
1- Introduction

2- Definition of communicable diseases and other terms

3- Causes of Communicable Diseases

4- Chain of Disease Transmission

5- Time Courses of Infectious

6- Exclusion from School for Health Reasons

7- A symptoms that will be exclude the student from school

8- Examples of communicable diseases

9- What should be done if an outbreak is suspecting

10- Management of suspected outbreaks of communicable diseases

11- Prevention of infectious diseases and the role of school nurse

12- Reference

76
Introduction
Children are more at risk of contracting communicable diseases because of their age,
their personal hygiene and because of close contact with other children. Some
childhood diseases can be very dangerous or fatal to children. Schools are common
sites for transmission of infectious diseases and it can play a major role in helping to
reduce or prevent the incidence of illness among children and adults in our
communities. Encouraging good hand hygiene, following cleaning recommendations,
and adhering to the most up to-date mask requirements and recommendations
contribute to a safe and healthy learning environment for children. When schools
report illness to their local health department (LHD), public health specialists can
assist schools with disease prevention and control guidance.

Definition of diseases
The diseases can be simply defined as a disturbance in the normal functioning of the
body, among which few affects only to the particular organ system and some affect
the entire body of an organism. There are numerous diseases which vary in their
signs, symptoms, and causes.

Communicable Diseases
These are illnesses due to specific infectious agents or its toxic products, which arise
through transmission of that agent, or its toxic products from an infected person,
animal or inanimate reservoir to a susceptible host, either directly or Communicable
Disease Control 9 indirectly, through an intermediate plant or animal host, vector or
inanimate environment.

OR
77
A disease, which spreads from one person to another person, is termed as the
communicable disease. It is also referred to as infectious diseases or transmissible
diseases.

Causes of Communicable Diseases

The agents causing communicable diseases include

1- Virus

These microbes are small infectious agents which are present in food, air and in the
water. They penetrate very easily into the body through the mouth, nose, cuts,
injuries, scratches on the skin from the environment (from the soil, water, and air) and
other infectious agents and causes severe infections which may also lead to the
person’s death. Viral infections can be easily transmitted from person to person.

AIDS, Polio, Measles, Influenza are a few examples of infections caused by a virus.

2- Bacteria

There are millions and billions of beneficial and harmful bacteria present all around
us. Few among them are present both inside and outside the body always, by
protecting our body from the disease-causing microbes. These bacteria are called
beneficial bacteria.

78
The other group of bacteria, cause harm by entering into the body. These bacteria
generally, engulf, reproduce kill the protective bacteria and cause harm to the host
cells by releasing toxins.

Tuberculosis, Whooping cough, Typhoid and Cholera, are few examples of infections
caused by bacteria.

3- Protozoa

They are single-celled, microscopic, eukaryotic organisms. Malaria and other immune
system disorders are few examples of infections caused by the protozoan.

4- Fungi

They are threadlike parasites, which cannot synthesize their food and feeds on other
organic material in which they live in. Ringworm, Athlete’s foot are a few examples
of infections caused by fungi.

79
Chain of Disease Transmission: This refers to a logical sequence of factors or links
of a chain that are essential to the development of the infectious agent and
propagation of disease. The six factors involved in the

A. Infectious agent (etiology or causative agent

B. Reservoir

C. Portal of exit

D. Mode of transmission

E. Portal of entry

F. Susceptible host

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A- Infectious agent:

An organism that is capable of producing infection or infectious disease such as

Virus, Bacteria, protozoa and Fungi.

B- Reservoir of infection:

Any person, animal, arthropod plant, soil or substance (or combination of these) in
which an infectious agent normally lives and multiplies, on which it depends
primarily for survival and where it reproduces itself in such a manner that it can be
transmitted to a susceptible host.

C- Portal of exit (mode of escape from the reservoir):

This is the site through which the agent escapes from the reservoir. Examples include

GIT: typhoid fever, bacillary dysentery, amoebic

Respiratory: tuberculosis, common cold…...

Skin and mucus membranes: Syphilis

D- Mode of transmission (mechanism of transmission of infection):

Refers to the mechanisms by which an infectious agent is transferred from one person
to another or from a reservoir to a new host. Transmission may be direct or indirect.

1. Direct transmission: Consists of essentially immediate transfer of infectious

agents from an infected host or reservoir to an appropriate portal of entry.

-Direct Vertical Such as: Trans placental transmission of syphilis, HIV, etc.

- Direct horizontal direct touching, biting, kissing, sexual intercourse, droplet spread
onto the conjunctiva or onto mucus membrane of eye, nose or mouth during sneezing
coughing, spitting or talking; usually limited to a distance of about one meter or less.

2. Indirect transmission

A -Vehicle-borne transmission:

-Indirect contact through contaminated inanimate objects (fomites) like: Bedding,

toys, soiled clothes, cooking or eating utensils, surgical instruments.

-Biological products like blood, serum, plasma or IV-fluids or any substance serving
as intermediate means by which an infectious agent is transported and introduced into
a susceptible host through a suitable portal of entry.

81
 Contaminated food and water -

B- Vector-borne transmission: Occurs when the infectious agent is conveyed by an

arthropod (insect) to a susceptible host.

C- Air-borne transmission: Dissemination of microbial agent by air to a suitable

portal of entry, usually the respiratory tract.

Two types of particles are implicated in this kind of spread: dusts and droplet
nuclei.

Dust: small infectious particles of widely varying size that may arise from soil,
clothes, bedding or contaminated floors and be resuspended by air currents.

Droplet nuclei: Small residues resulting from evaporation of fluid (droplets emitted
by an infected host). They usually remain suspended in the air for long periods of
time.

Mode of transmission Process Examples of communicable

Contact transmission
Droplet transmission
Air-borne transmission
diseases
Through direct body
contact with the infected Hand, foot and mouth disease
persons, e.g. playing
together with direct skin  Acute conjunctivitis
contacts; or indirect  Head lice
through contact with
 Scabies
objects contaminated by
infective agents, e.g.  Chickenpox
sharing towels, combs
and clothes
Inhale or contact of Influenza
droplets expelled from  Common cold
the sick during sneezing,
coughing, spitting and  Acute bronchiolitis
speaking, or through  Pneumonia
subsequent touching of
 Severe acute respiratory
mucous membranes of
syndrome (SARS)
the mouth, nose and the
eyes, with hands  Scarlet fever
contaminated with
infective agents
The infective agents

82
 float in the air for some Chickenpox#
time and enter the body  Measles
through the respiratory
tract  Pulmonary tuberculosis
Food-borne / water-borne Through ingestion of
transmission contaminated food or Viral gastroenteritis
water, or use of
contaminated eating  Food poisoning
utensils  Cholera
 Bacillary dysentery
 Hepatitis A
 Hepatitis E
Vector-borne transmission Through vectors, usually Mosquito-borne
insects. The infective  Dengue fever
agent parasite and breed
in the bodies of the  Malaria
insects.  Japanese encephalitis
Blood / body fluid Through blood  Hepatitis B
transmission transfusion, tattooing, Acquired
ear piercing or sexual immunodeficiency syndrome
intercourse (AIDS)
Time Courses of Infectious
Diseases Incubation period: It is the interval of time between infection of the host
and the first appearance of symptoms and signs of the disease.

Prodromal period: It is the interval between the onset of symptoms of an infectious

disease and the appearance of characteristic manifestations. For example, in a measles
patient, fever and coryza occur in the first three and characteristics skin

lesions appear on the fourth day.

Period of communicability: The period during which that particular

communicable disease (infectious agent) is transmitted from the infected
person to the susceptible host

83
Exclusion from School for Health Reasons
-To protect all students and staff from communicable diseases, students
infected with certain diseases are not allowed to attend school while they
are contagious. The student may return to school after they are symptom
and fever free for 24 hours, have been diagnosed and treated The school
nurse will notify parents that the student must be excluded for medical
reasons

- A student with any of the following symptoms will be excluded

from school

 Temperature of 38 (100.4) degrees or more. Student must be fever

free for 24 hours, without medication, before re-entry.
 Pain and/or swelling at angle of jaw.
 Undetermined rash over any part of the body.
 Undiagnosed scaly patches on the body or scalp.
 Nausea, vomiting or diarrhea. Student must be symptom free for 24
hours without medication before re-entry.
 Red, draining eyes.
 Intense itching with signs and symptoms of secondary infection.
 Open, draining lesions.
 Jaundice

Diseases that must be reported:

• Chickenpox (varicella);

• Diphtheria;

• Haemophilus influenzae type b (Hib);

• Hepatitis A;

• Hepatitis B;

84
 • Invasive pneumococcal disease;

• Pertussis;

• Polio;

• Measles;

• Mumps;

• Rubella; and tetanus.

DISEASE INCUBAT TRANSMISSION SYMPTOMS CONTAGI EXCLUSIO School nurse role

ION OUS N
PERIOD PERIOD
Chickenpox 10 - 21 • From person to Mild fever, 1 - 2 days YES • Clean and sanitize
(Varicella) days person by direct itchy fluid-filled before rash items and surfaces in
until rash
contact with blisters blisters that may onset until the facility In
has crusted
• Through breathing first show up on all blisters consultation with DC
over and no
in airborne virus the face, chest are crusted Health • Notify
new lesions
particles that come and back then over parents/guardians of
or blisters
from the blisters spread to the (usually 5 - classmates (e.g. day
appear for
that get in the air rest of the body 7 days) school, after care) and
24 hours
when an infected teachers/caregivers •
person breathes, Check their vaccination
coughs, sneezes, or status and recommend
talks vaccination if needed -
Consider exclusion of
unimmunized
individuals - On
appearance of
symptoms, exclude
from school
Hepatitis A 15 - 50 • Fecal-oral spread Fatigue, poor In the 2 YES -- until • Clean and sanitize
days (through contact appetite, fever, weeks 1 week after items and surfaces in
(usually 28 with items or nausea, before onset of the facility •
days) surfaces vomiting, onset of illness or Recommend proper
contaminated with abdominal pain, symptoms jaundice hand washing,
feces from an joint pain, to 1 week especially after
infected person) • jaundice after onset toileting or changing
Through (yellowing of of jaundice diaper and before
consumption of skin or whites of handling food Notify
contaminated food eyes), and dark parents/guardians of
or water brown urine classmates (e.g. day
school, after care) •
Check vaccination
status of classmates
and recommend
vaccination for non-
immunized contacts
within 2 weeks of
exposure - Assess the

85
 need for using vaccine
or immune globulin for
contacts
Measles 7 - 21 days • Through Fever (lasting 4 days YES -- until • Clean and sanitize
Rubella (most breathing in couple of days), prior rash 4 days after items and surfaces in
common is airborne virus cough, onset to 4 onset of the the facility • Notify
14 days particles that stay in conjunctivitis, days rash parents/guardians of
after the air when an runny nose, rash afterwards children and
exposure infected person on the face and teachers/caregivers of
coughs, sneezes, or upper neck that the entire school •
talks can spread to Check vaccination
other areas of status of any individual
the body who was in the same
space or area with the
case) and recommend
vaccination if needed -
Exclude unimmunized
contacts until
immunized or until 21
days from last day of
potential exposure to
the case if
immunization refused •
On appearance of
symptoms in exposed
individual, exclude
from school
Meningitis Varies by .Through contact Fever, Until 24 YES -- until • Notify
(Bacterial) causative with respiratory headache, and hours after 24 hours parents/guardians of
agent but droplets (when an stiff neck, can treatment after classmates (e.g. day
usually 3 - infected person sometimes has begun antibiotics school, after care) and
7 days sneezes or coughs) cause nausea, treatment teachers/caregivers •
or when sharing vomiting, has begun Clean and sanitize
eating utensils, • increased items and surfaces in
Through eating sensitivity to the facility especially
contaminated food light and eating and drinking
confusion utensils • Recommend
that people avoid
contact with infected
individual Check
vaccination status of
classmates; recommend
post-exposure
prophylaxis and
vaccination if needed

86
DISEASE INCUBAT TRANSMIS SYMPTOMS CONTAGIOU EXCLUSION School nurse role
ION SION S PERIOD and
PERIOD recommendation

Mumps 12 - 25 • Through Fever, 2 days before YES -- until 5 • Clean and

days contact with headache, par otitis days after par sanitize items and
(usually respiratory muscle aches, (swelling of otitis onset surfaces in the
16-18 days droplets par otitis salivary glands) facility • Notify
(when an (swollen and to 5 days after parents/guardians
infected tender salivary par otitis of classmates (e.g.
person glands) day school, after
sneezes or care) • Check
coughs) vaccination status
of classmates and
recommend
vaccination if
needed. This does
not prevent
infection if child is
already exposed
but can stop future
spread. - Exclude
unimmunized
classmates until
immunized, or
until 25 days if
immunization
refused

Pertussis 5 - 21 days • Through In early stage Until after 5 YES -- until 5 • Clean and
(Whoopin (usually 7 - contact with people days of days after sanitize items and
g cough) 10 days) respiratory experience treatment or 3 treatment or 3 surfaces in the
droplets cold-like weeks after weeks after facility • Notify
(when an symptoms, cough onset cough onset (if parents/guardians
infected runny nose, untreated) of classmates (e.g.
person mild cough or day school, after
sneezes or low-grade care) and
coughs) fever. Within 2 teachers/caregivers
weeks, people • Check their
experience vaccination status
rapid coughs and recommend

87
 with a high- post-exposure
pitched whoop prophylaxis, and
and vomiting vaccination if
needed - Consider
excluding any
exposed
individuals who
are coughing until
appropriate
evaluation and
treatment •
Monitor exposed
staff and
classmates for
coughing, and
exclude until
evaluated

Influenza 1 - 4 days Through Fever, chills, 1 day before to NONE Notify

(Flu ) (2 days on contact with cough, sore about 5-7 days parents/guardians
average) respiratory throat, runny after symptoms of classmates (e.g.
droplets and stuffy nose, onset date day school, after
(when an muscles or body care) •
infected aches, Recommend
person talks, headaches, and proper hand
sneezes, or tiredness, washing •
coughs) • children may Recommend
Through sometime practice of proper
direct experience covering
contact with vomiting and techniques when
items or diarrhea coughing or
surfaces sneezing •
contaminate Recommend
d with vaccination
respiratory against flu during
droplets flu season • Clean
and sanitize items
and surfaces in the
facility, especially
mouthed

88
 toys/items

Corona 2 days Respiratory  Fever. Exclude students • Notify

virus prior to the and airborne or staff with a parents/guardians
 Cough that
infection onset of or direct positive PCR test of affected patient
becomes
(covid 19) symptoms contact with or another and classmates
productive.
(or date of the infected approved test per (e.g. day school,
test individual  Chest pain. the DHEC after care) •
specimen or objects  New loss of website (testing Recommend that
collection taste or recommendations parent consult a
if no smell. will be updated healthcare
symptoms) as they become provider for
 Changes in
to the end available and treatment •
the skin,
of the may impact Recommend
such as
exclusion exclusion – refer proper hand
discolored
period to guidance washing especially
areas on the
documents for before handling
feet and
response to food or eating and
hands.
cases, link after using the
 Sore throat. below) toilet proper
covering
 Nausea,
techniques when
vomiting,
coughing or
belly pain
sneezing •
or diarrhea.
Recommend
 Chills. vaccination. Clean
and sanitize items
and surfaces in the
facility, especially
mouthed
toys/items

Outbreak
If children or staff is developed similar symptoms one after another and
the incidence is higher than usual, occurrence of outbreak is suspected.

Examples two or more students in the same class (or had studied in the
same setting in case of kindergarten or child care centers) develop
89
symptoms of hand, foot and mouth disease in succession within a short
time, and three or more students in the same class develop symptoms of
respiratory tract infections

To judge whether there is outbreak in schools/centers, the daily

information on cases of communicable diseases has to be monitored.
Some examples are cited below for reference. School/center staff should
keep a closer watch if the following happens:

 Children studying in the same room or on the same floor develop

similar symptoms in clusters within a short period of time.
 Children and staff concurrently develop similar symptoms in
clusters, such as symptoms of influenza (fever, cough and sore
throat). This may mean cross-infection is occurring within
schools/centers.
 Two or more people develop similar symptoms after eating
common food or meals. This may mean food poisoning outbreak
and the pathogen may be the bacteria, virus or toxin contained in
the food.
 A single case sometimes may warrant outbreak investigation. A
disease newly emerged or posing major impact on the overall
public health system is one of such cases.

What should be done if an outbreak is suspected?

Early detection of the occurrence of communicable disease is essential
to prevent the disease spread. For such purpose, staff shall be
responsible for keeping a close watch on the occurrence and outbreak
of communicable diseases, particularly the statutory notifiable
diseases such as Malaria, Measles, Meningococcal infection
(invasive), Middle East Respiratory Syndrome and Mumps.

90
 They should report promptly as soon as possible so that timely
preventive measures can be implemented.

General the management of suspected outbreaks of

communicable diseases
School/center staff should follow the steps below in managing a
suspected outbreak:

 Take care of the sick first. Isolate the sick properly.

 Inform the parents/guardians of the sick child to take him/her to

seek early medical consultation or to the nearby Accident and
Emergency Department if necessary.

 Inform the relevant departments according to the established

procedures after settling down the patient.

 Supply relevant information to CHP to facilitate

epidemiological investigation.

 Keep records of children's and staff's personal particulars and

medical histories properly. Seek consent in advance from
parents/guardians of children before the start of school year for
releasing such information to CHP or other relevant
departments when necessary.

 Sick children or staff should avoid participating in group

activities.

 Minimize contact between children and staff of different floors

to avoid cross-infection, and arrange the same team of staff to
take care of a fixed group of children as far as possible when
preparing the shift roster.

91
  Assist CHP officers in monitoring the outbreak to ensure the
effectiveness of preventive measures. The surveillance period
for common communicable diseases is usually twofold of the
longest incubation period from the onset of the last case.

 Inform all parents of the suspected or confirmed communicable

disease outbreak and remind them that sick children should stay
at home.

 Maintain close communication with parents on the condition of

the children and report to CHP if the affected children have
been admitted to hospitals.

Environmental disinfection during outbreak

Disinfect furniture, floor and toilets with appropriate disinfectant (e.g.
mixing 1 part of 5.25% bleach with 49 parts of water for non-metallic
surface or using 70% alcohol for metallic surface); leave for 30 minutes
before rinsing with water and mopping dry; pay special attention to
disinfection of toilets, surfaces that are frequently touched such as door
knobs and handrails.

 Use highly absorbent materials to clean up surfaces contaminated

by vomitus or excreta preliminarily before performing the above
disinfection procedures.

School closure
CHP may consider advising the affected schools/centers to suspend
classes for a period of time, based on factors such as the number of
children affected, the number of children with severe illness and number
of hospitalizations, the progression of the outbreak and whether it is

92
responsive to control measures, etc. School/center staff should provide
the necessary arrangement.

Prevention of infectious diseases

General prevention measures of communicable diseases:

Sanitary environment: Air sanitation, Sanitary water supply, Food

sanitation, Sanitary disposal of sewage, insect control.

Personal hygiene

Since many communicable diseases are transmitted through contact or

droplet, performing hand hygiene properly and maintaining respiratory
hygiene are two prerequisites for the prevention of such diseases.
School/center staff should not only observe their personal hygiene
practices but also supervise and provide support for the children to
develop the good practices.

Hand hygiene
Hand hygiene is a basic infection control measure to prevent the spread
of communicable diseases. The common hand hygiene practices include
hand washing and proper use of alcohol-based hand rub.

It is the most effective way of preventing transmission of communicable

diseases.

93
Respiratory hygiene
 Staff should observe themselves and instruct the children to
maintain respiratory hygiene practices in accordance to the
following advice:

 Do not spit.

 Cover both the nose and mouth with a handkerchief or tissue paper
when coughing or sneezing.

 Wrap up sputum with tissue paper and discard it into garbage bins
with lids

94
  Wash hands immediately after contacting respiratory secretions or
touching objects contaminated with respiratory secretions.

 Put on a surgical mask for those with respiratory infection

symptoms.

Food hygiene
 Do not buy ready-to-eat food and drinks that are displayed with
raw products.

 Do not buy food which look, smells or tastes abnormal.

 Do not buy unpasteurized products like raw milk.

 Wash hands properly before and after eating.

 Eat a balance diet in accordance with the food pyramid.

 Do not wrap food with newspaper, unclean paper or coloured

plastic bags.

95
School lunch boxes
 Choose and monitor food suppliers carefully; order lunchboxes
from premises with a valid Food Factory License issued by the
Food and Environmental Hygiene.

 Hot foods should be kept at above 60 degrees Celsius while cold

foods should be kept at 4 degrees Celsius or below.

 Proper cleaning with detergents and clean water and dry it

carefully.

Environmental hygiene
 Since infective agents can survive in the environment for a period
of time, it is essential to observe proper environmental hygiene,
Toilet and bathroom hygiene,

 Cover garbage bins with lids, cleaning utensils with detergents and
clean water.

96
  Different types of disinfectants can be used to clean the
environment. Household bleach, which normally contains 5.25%
hypochlorite solution, is the most convenient and effective
disinfectant.

 Use highly absorbent materials to clean up surfaces contaminated

by vomitus or excreta preliminarily before performing the above
disinfection procedures.

Kitchen hygiene
 Keep the kitchen clean.

 Wash the exhaust fan and range hood regularly.

 Store utensils in a clean cupboard.

 Keep worktops in the kitchen clean.

 Keep the floor dry after cleaning to prevent slip.

 Do not store personal items such as clothes or shoes in the kitchen.

 Cover garbage bins properly to avoid breeding of mosquitoes,

cockroaches, flies and rodents

Vaccination
 Vaccination the children according to the childhood immunization
programed.

 Diseases which can be prevented by vaccination include measles,

mumps, rubella, poliomyelitis, whooping cough, diphtheria,
tetanus, tuberculosis and hepatitis B

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Role of school nurse
 Promulgate to staff the latest information and guidelines on
prevention of communicable diseases and in reminding children
and parents of such information and guidelines. Be responsible for
assisting new recruits to become familiarized with control
measures for communicable diseases.

 Arrange infection control training for staff.

 Implement and monitor measures as suggested in the guidelines for

preventing communicable diseases in schools/centers. They include
measures on personal, environmental and food hygiene.

98
  Monitor the disinfection of items used and the proper disposal of
contaminated clothing and other wastes.

 Provide essential personal protective gear as well as in supervising

and monitoring staff's proper use and disposal of such gear after
use.

 Watch for symptoms of communicable diseases among children

and staff in the schools/centers. If an outbreak of communicable
disease is suspected, assist the person-in-charge in reporting and
providing information to infection control Centre for Health
Protection,

 Assist investigation and take effective infection control measures

to prevent the spread of such disease.

 Evaluate the risk of communicable disease outbreak in

schools/centers. Consult the person-in-charge, staff and the DH on
a regular basis and develop preventive measures for communicable
diseases so as to reduce the chance of spreading such diseases in

99
References

 Susan, S. Aronson, Timothy, R. Shope, (2017). Managing

infectious disease in child care and schools: A quick refere
 nce guide, 4th Edition. Elk Grove Village, IL: American Academy
of Pediatrics. 22-B Public Health and Medicine - Chapter 22-B2
Communicable and Reportable Diseases. DCMR § 209 (2016)
Centers for Disease Control and Prevention - communicable
diseases resources
 American Academy of Pediatrics. Model Childcare Health Policies
Rosemont, PA: Healthy Childcare Pennsylvania. American
Academy of Pediatrics.2018. Red Book: 2018 Report of the
Committee on Infectious Diseases (31st ed.). (D. W. Kimberlin, M.
T. Brady, M. A. Jackson, & S. S. Long, Eds.) Itasca, IL: American
Academy of Pediatrics
 Lopez, A. S., & Marin, M. (2008). Strategies for the control and
investigation of varicella outbreaks 2008. Retrieved May 28, 2013,
from Centers for Diseae Control and Prevention, National Center
for Immunization and Respiratory Diseases:
http://www.cdc.gov/chickenpox/outbreaks/downloads/manual.pdf
 Centre for Food Safety, Food and Environmental Hygiene
Department
 http://www.cfs.gov.hk/english/multimedia/multimedia_pub/files/
5keys_pos-Overall.pdf

100
 Child Abuse

Under supervision

Prof. Dr / Nahla Ashour Saafan

Assist. prof / Samia ALI Shaban

Prepared by
Naglaa Fathy

2021-2022
101
Outlines
 Introduction

 Definition of child abuse

 Types of Child Abuse

 Signs and symptoms of child abuse

 Preventive measures of child abuse

 References

102
Introduction
Any intentional harm or mistreatment to a child under 18 years old is
considered child abuse. Child abuse takes many forms, which often occur
at the same time. Child abuse and neglect are serious public health
problems and adverse childhood experiences (ACEs). They can have
long-term impacts on health, opportunity, and wellbeing.

When your child is in school, the school is responsible for keeping them
safe from harm and abuse. The school should create a safe learning
environment, identify pupils who are suffering or at risk of harm and take
suitable action. The school also needs to train staff in child protection.
Abusers can be:

 A person in a position of trust, such as a teacher

 Other staff members

 Pupils at the school

Children’s rights include the right to health, education, family life, play
and recreation, an adequate standard of living and to be protected from
abuse and harm. Children’s rights cover their developmental and age-
appropriate needs that change over time as a child grows up.

Definition of child abuse:

The World Health Organization (WHO) defines child abuse and child
maltreatment as "all forms of physical and/or emotional ill-treatment,
sexual abuse, neglect or negligent treatment or commercial or other
exploitation, resulting in actual or potential harm to the child's health,
survival, development or dignity in the context of a relationship of
responsibility, trust or power.

103
The WHO also says, Violence against children includes all forms of
violence against people under 18 years old, whether perpetrated by
parents or other caregivers, peers, romantic partners, or strangers.

Types of Child Abuse:

Physical abuse

Physical abuse is a nonaccidental physical injury to a child caused by a

parent, caregiver, or other person responsible for a child and can include
punching, beating, kicking, biting, shaking, throwing, stabbing, choking,
hitting (with a hand, stick, strap, or other object), burning, or otherwise
causing physical harm.

Physical discipline, such as spanking or paddling, is not considered

abuse as long as it is reasonable and causes no bodily injury to the child.
Injuries from physical abuse could range from minor bruises to severe
fractures or death.

104
Signs of Physical Abuse

 Has unexplained injuries, such as burns, bites, bruises, broken

bones, or black eyes

 Has fading bruises or other noticeable marks after an absence from

school

 Seems scared, anxious, depressed, withdrawn, or aggressive

 Seems frightened of his or her parents and protests or cries when it

is time to go home

 Shrinks at the approach of adults

 Shows changes in eating and sleeping habits

 Reports injury by a parent or another adult caregiver

Neglect

Neglect is the failure of a parent or other caregiver to provide for a child’s

basic needs.

Neglect generally includes the following categories:

 Physical (e.g., failure to provide necessary food or shelter, lack of

appropriate supervision).

 Medical (e.g., failure to provide necessary medical or mental health

treatment, withholding medically indicated treatment from children
with life-threatening conditions).

 Educational (e.g., failure to educate a child or attend to special

education needs).

 Emotional (e.g., inattention to a child’s emotional needs, failure to

provide psychological care, permitting a child to use alcohol or
other drugs).

105
Signs of Neglect

 Is frequently absent from school

 Begs or steals food or money

 Lacks needed medical care (including immunizations), dental care,

or glasses

 Is consistently dirty and has severe body odor

 Lacks sufficient clothing for the weather

 States that there is no one at home to provide care.

Sexual abuse
Sexual abuse includes activities by a parent or other caregiver such
as fondling a child’s genitals, penetration, incest, rape, sodomy,
indecent exposure, and exploitation through prostitution or the
production of pornographic materials. Using a child for the purpose
of sexual needs or desires, may include:

 Touching

 Fondling

 Oral stimulation

 Penetration of genital or anal opening.

Signs of Sexual Abuse

 Has difficulty walking or sitting

 Experiences bleeding, bruising, or swelling in their private parts

 Suddenly refuses to go to school

 Reports nightmares or bedwetting

 Experiences a sudden change in appetite

106
  Demonstrates bizarre, or unusual sexual knowledge or behavior

 Becomes pregnant or contracts a sexually transmitted disease,

particularly if under age 14.

 Reports sexual abuse by a parent or another adult caregiver.

Emotional abuse
Emotional abuse (or psychological abuse) is a pattern of behavior that
impairs a child’s emotional development or sense of self-worth. This may
include constant criticism, threats, or rejection as well as withholding
love, support, or guidance. Emotional abuse is often difficult to prove,
and, therefore, child protective services may not be able to intervene
without evidence of harm or mental injury to the child.

Signs of Emotional Maltreatment

 Shows extremes in behavior, such as being overly compliant or

demanding, extremely passive, or aggressive.

 Is either inappropriately adult (e.g., parenting other children) or

inappropriately infantile (e.g., frequently rocking or head-banging).

 Is delayed in physical or emotional development.

 Shows signs of depression or suicidal thoughts.

 Reports an inability to develop emotional bonds with others.

107
Preventive measures of child abuse

 Know what child abuse is. Physical and sexual abuse clearly
constitutes maltreatment, but so does neglect - the failure of parents
or other caregivers to provide a child with basic needs such as
food, clothing, and care.
 Know the signs. Unexplained injuries are not the only signs of
abuse. Depression, fear of a certain person or place, anxiety,
difficulty trusting others or making friends, sudden changes in
eating or sleeping patterns, inappropriate sexual behavior, poor
hygiene, secrecy and hostility are often signs of family problems
and may indicate a child is being neglected or physically, sexually,
or emotionally abused.
 Report abuse. Be prepared by saving the Child Abuse Hotline
number, 800-331-1585. Then, be watchful and alert. If you suspect
a child is being harmed or see evidence of abuse, or if a child tells
you about abuse, make a report to the hotline or your local police.
 Educate yourself and others. Talking to family, friends,
coworkers, and neighbors in our community can be effective in
preventing child abuse and neglect. By encouraging others who
may be struggling to seek assistance, you could help reduce the
stress that often leads to abuse and neglect. Alternatives include
parent education classes, after school activities (Boys & Girls
Clubs), mentoring programs (Big Brothers/ Big Sisters), and
childcare.
 Teach children their rights. When children are taught, they have
the right to be safe, they are less likely to think abuse is their fault
and more likely to report an offender.

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 Examine your behavior. Abuse is not just physical. Both words
and actions can inflict deep, lasting wounds. Be a nurturing parent
and use your actions to show children and other adults that
conflicts can be settled without hitting or yelling.
 Discipline your children thoughtfully. Never discipline your
child when you are upset, frustrated or angry. Use privileges to
encourage good behavior, and time-outs to help your child regain
control. Remember, time out for a parent is also necessary at
times.
 Support prevention programs. Too often, intervention occurs
only after abuse is reported. Greater investments in programs that
have proven to stop abuse before it occurs are necessary. Be a
voice in support of these efforts by advocating for services that
assist the needs of families in our community such as family
counseling and home visitation programs.
 Invest in kids. Encourage leaders in our community to support
children and families. Ask your local and national lawmakers to
implement legislation that will provide better support to existing
programs and services charged to protect our children from abuse
and neglect.
 Volunteer your time. Get involved in our community. Child abuse
prevention is everybody’s business! There are many child abuse
prevention resource agencies in Tulare County that need help, i.e.
foster care, court appointed advocates, victim advocates or
mentoring.
 Be respectful: Giving respect to each other can help in better trust
building and bonding between teacher and students.
 Encourage child: Reassure the children that they did nothing
wrong. It takes a lot for a child to come forward about abuse.

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 Reassure child that take what is said seriously, and that it is not the
child’s fault.

References

110
 McCoy, M.L.; Keen, S.M. (2019). "Introduction". Child Abuse and
Neglect (2 ed.). New York: Psychology Press. pp. 3–22. ISBN 978-
1-84872-529-4. OCLC 863824493. Archived from the original on
23 February 2017.Retrieved 4 February 2016.

 Rector,Ch.,PhD,RN,PHN,(2018).Community and Public Health

Nursing.(9Th ed.).China.pp.776-791.

 "Definitions of Child Abuse and Neglect in Federal

Law". childwelfare.gov. Children’s Bureau, Administration for
Children and Families, U.S. Department of Health and Human
Services. Archived from the original on 16 May 2016.Retrieved 20
February 2016.

111
First aid and safety measures
in schools

Under supervision
Prof.Dr / Nahla Ashour

Assist.prof / Samia Elnagar

Prepared by
C.I/ Amira Ezzat El-sedawy

2022

112
Outlines: -
- Introduction
- Definition of first aid
- Aim of first aid
- Importance of first aid in schools
- Role of First Aider
- Qualities of an Excellent First Aider
- First aid Kit in school
- Primary things to be noted while giving first aid
- Definition of school safety
- Why school safety rules
- School safety rules for emergencies
- Top 10 safety measures schools should adopt
- Common conditions of first aid
 Allergic reactions.
 Asthma.
 Animal bite & Human bite.
 Chocking.
 Shock.
 Fracture.
 Bleeding, & Nosebleed.
 Amputation of body parts.
 Fainting.
 Convulsion.
 Burns.
 Poisoning.
- References

113
Introduction
Health of school children is an issue of growing concern, as school-age
children are generally at higher risk of being involved in accidents and
sustaining injuries. Although many of these injuries are likely to be
relatively minor, in some cases a could sustain a serious or life-
threatening injury on school. knowledge about first aid promotes a safer
and healthier environment. The concept of first aid was developed first
time in 1858 in Germany during the war. First aid, by its name itself, is
the first/immediate/primary assistance and care given to the injured/ill
person. As first aid offers a range of benefits, therefore, it is a must for
the teachers and students to get a proper first aid training so that they can
contribute to preserving lives. Without an initial medical assistance, a
mild injury might turn into a serious one. Moreover, serious injuries when
not treated on time can be fatal. To ensure the safety of all the staff
members and students, it is important to have first aid in the schools. It is
vital to make everyone aware of the basic methods they should apply
after an accident occurs.

What is first aid?

First aid is the initial, immediate help or

treatment that is given to someone who
suffers an injury or illness to prevent
further deterioration, until receiving
professional medical treatment. (It is
lifesaving procedure)

In the case of minor injuries and illnesses, first aid may be sufficient. In
more serious or life-threatening situations, first aid should be given until
medical treatment is available. Correctly administered first aid can be the
difference between life and death.
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The commonly found abbreviation of first aid is:
F: First A: Arrangement

I: Investigation I: Immediately

R: Relief D: Disposal

S: Symptom

T: Treatment

Aims of First Aid:

The aim of first aid is also known as

the three Ps:

 Preserve life.

 Prevent the situation from

worsening or further injury.

 Promote recovery.

Importance of first aid in schools

Promotes the sense of safety

Teachers and students with good knowledge of the first aid are likely to
be more alert and active. They make sure they are not vulnerable to any
accident or injuries. First aid promotes the sense of safety. It makes them
capable of managing incidents and assessing casualties. The more they
are aware of the accidents, illness and treatments, the more they become
conscious.

Quick treatment

First aid is the initial treatment given to a victim. Some injuries do not
require professional assistance. They can be treated with simple methods

115
such as applying an ice pack etc. First aiders can help the affected person
feel better and relieve pain by performing simple procedures.

Prevents victim’s condition from becoming worse

Although first aid is a temporary treatment, it still plays a great role in

preventing the situation from getting serious or worse. Well-trained first
aiders apply the right methods to keep the situation under control. They
put every effort to help victim cope with the illness or pain until
professional help arrives.

Helps preserve life

People equipped with first aid skills can handle emergencies in an

efficient manner. Their quick response and right methods of treatment
can help save lives. A trained person is more composed and confident in
critical situations. He/she knows the best possible ways to help the
victims regain their consciousness.

Makes people feel secure

People who get first aid training to learn the treatment methods are likely
to feel secure. They know they can treat themselves easily in case an
accident occurs. Moreover, they are also trusted by their friends or loved
ones. Having a well-trained first aider around help them relax and stay
calm in the event of an emergency.

It reduces the likelihood of an accident occurring

Knowledge of first aid can make it easier for staff members to identify
potential hazards. It also highlights the importance of conducting a risk
assessment and how to effectively implement any actions or
recommendations from the risk assessment. This can reduce the
likelihood of accidents occurring on school.

116
Duties of a First Aider
First aid is generally performed by someone with first aid training (First
aider).

Qualities of an Excellent First Aider:

- Should have a helping attitude.

- Should be polite and gentle.

- Should have the quality of getting/asking help from others, in any

necessary cases.

- Must be alert that first aider is not a doctor.

117
 - Should be a good observer (site of injury, talk to the patient, know
the level of consciousness of the patient).

- Should be able to manage the situation, local resources efficiently

at the site of injury

- Should be prompt, brave and quick.

- Should be calm in nature and able to control emotions.

First aid Kit in school

All schools should be equipped with the First Aid Kit containing:

 Thermometer

 Syriges
 Roller Bandage
 Gauze Pad
 Cotton

 Adhesive tape

 Gauze
 Alcohol

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  Betadine
 Splints
 Tourniquet
 Kidney Tray
 Eye Pad
 Scissors
 Ice Bag Sample
 Hot Water Bottle

 Antiseptic wipes and swabs

 Wet wipes

 Absorbent compresses

 Antibiotic cream/ointment

 Burn ointment

 Mask for breathing (rescue breathing/CPR)

 Chemical cold pack

 Eye shield and eye wash

 gloves

 First aid reference guide that includes local hospital/ambulance

phone numbers.

Remember that this is a suggested list of contents only. Equivalent or

additional items are acceptable. In addition, the contents of first aid
containers should be examined frequently, well arranged and restocked
after use. Care should be taken to dispose of items safely once they reach
their expiry date and kept in safe place.

Primary Things to Be Noted While Giving First Aid:

 A- Airway
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  B- Breathing

 C- Circulation (stop bleeding)

 D- Disability

 E- Exposure environment (the condition/environment where

patient is found)

School Safety
"School Safety" has been defined as: Creating safe environment for
children, starting from their homes to their schools and back. This
includes safety from any kind of abuse, violence, injury, psycho-social
issue, disaster, etc.

Why School safety rules?

Children are the most likely to get into accidents all the time, be it on a
playground or inside the classroom. School safety should be one of the
top priorities of the management. Having safety rules to tackle
emergencies in schools not only makes your school safe but it also
teaches kids to be prepared and careful.

School safety rules for emergencies

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121
1. Inspecting School Routes:

Most of the mishaps occur when students go to schools. It is due to the

negligence in safety of school routes. Many footpaths are in adverse
conditions, that forces students to take roads to walk and get themselves
in trouble.

Lack of speed breakers and proper signboards, etc., are a couple of key
factors adding to these mishaps. A route safety audit can be conducted
regularly by the local government and school management to mark out
the obstacles and difficulties faced by the children.

2. Inspecting School Infrastructure:

Another significant concern is the school infrastructure. Numerous

students have faced fatal accidents because of weak foundation at the

122
schools. We should hold on to start the development or maintenance of
rooftops until they breakdown and create problems.

Additionally, the arrangement for safe drinking water is essential for

students, not an enhancement. School authorities need to be sharp about
analyzing the school infrastructure and facilities to make a superior and
safe learning environment.

3. Inspecting School Environment:

Deep analysis of school ambiance is essential. Sometimes a stray animal

may attack students or tree branch may fall off when they are playing
outside, floor, roof, stairs, etc. It may result in some severe
casualties. School authorities should make sure that the environment is
safe and secure for students. There must be some volunteers ready for
rescue if any trouble occurs.

4. Inspecting School Bus:

One of the most crucial times is when students travel to and from school
on a bus. School authorities should do a regular audit of inside and out of
the buses.

They must check if the tires are in proper condition if the brakes are
working fine. Along with it, they should check the engine’s working
condition and coolant level, so that it reduces the risk of catching fire.
Also, the driver should be a good one.

5. Awareness of Road Safety:

Carelessness in passing on necessary road safety education to students

can put their life at risk. It is the responsibility of school authorities to
make students aware of the traffic safety rules since they are at the
primary level.

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6. Displaying Emergency Numbers:

There should be emergency numbers evident on the school buses so that

other travelers could see it in case any mishap occurs. The contact
numbers include local police station, ambulance service, etc. Also, for
more safety, identity cards can be issued to the students with the
emergency contact of their parents/guardians.

7. First Aid and Inter-school Clinic Service:

It will be a significant step if schools equip emergency clinics inside the

place. Also, the authorities should keep first aid kits with all the necessary
ointments and medicines ready. Injuries can happen at any time, and
delay in proper aid can result in some severe after-effect.

8. Deploying Police:

Another best approach to increasing the safety of the students is posting

police personnel in the school premises. It will ensure the safety of
children while they are crossing roads and will inspire them to follow the
proper traffic rules.

9. Check for Unattended Safety Issues:

The parents and the school authorities may not be aware most of the time,
but there are times when children are abused, bullied, and discriminated
in the school premises.

Small children often don’t share the incidents with anyone. It’s the
responsibility of school authorities to take the necessary steps to ensure
that no one misbehaves with the students.

Additionally, teachers must make them aware of the difference between a

right touch and a bad touch, so that they know when to report the actions.

124
10. School Safety Committee:

It’s always a best practice to constitute a safety committee in the school

to confirm the safety of all the students. The leading members of the
committee should include the principal, parent-teacher association,
student and staff representatives, and all members.

Common Conditions of First Aid:

 Allergic reactions.

 Asthma.

 Animal bite & Human bite.

 Chocking.

 Shock.

 Fracture.

 Bleeding, & Nosebleed.

 Amputation of body parts.

 Fainting.

 Convulsion.

 Burns.

 Poisoning.

Allergies
Allergies can be caused by foods, dust, plants, pollen, animal dander,
latex, mold, insects, mites, medications, and chemicals.

Students with known allergies should have an Individual Health Care

Plan for taking medications and dealing with symptoms and emergencies.
125
First Aid:

• Monitor student for any signs and symptoms as:

- Runny nose.

- Itchy or watery eyes.

- Itchy throat.

- Coughing or wheezing.

- Rashes and tissue swelling

• Note what triggers the allergy. Try to determine how the student was
exposed to the allergen.

• Stop exposure if possible.

• Have student sit in any position that is comfortable and allows them to
breathe more easily.

• Calm and reassure the student.

• Watch the student’s breathing carefully.

• Notify the student’s parent or legal guardian as soon as possible.

Severe Allergic Reaction (Anaphylaxis).

If a student has a known history of Anaphylaxis or severe allergic

reaction and has known or suspected exposure to an allergen.

• give epinephrine immediately and call ambulance.

• monitor for:

- Swelling of the face, lips, tongue, mouth, and airway.

- Wheezing and shortness of breath.

- Tightness in the chest.

126
 - Dizziness.

- Blue or gray color around the lips.

- Nausea and vomiting.

• If unresponsive, lay the student on his or her left side to reduce the risk
of blocking the airway. Check for breathing, and if not breathing, start
CPR (30 chest compression & 2 breath) until the student starts breathing
or until the emergency medical team arrives.

• If the student is being transported to a medical facility, inform the

student’s parent or legal guardian.

ASTHMA
note: Asthma is a lung disease that causes repeated episodes of
breathing problems. Symptoms of asthma can be mild, severe, or
fatal. Asthma is potentially life threatening.

Signs and symptoms

- Breathing problems.

- Wheezing (high-pitched, whistling sound)

- Coughing

- Tightness in chest

- Shortness of breath

First Aid:

1. Place student in comfortable position, usually sitting, leaning forward

and ask him to breath slowly.

2. Calm and reassure the student.

3. If individual is known to school personnel as having

asthma, return to the written emergency action plan on
127
 file and proceed with physician's recommendations.

4. If the student has medication and is able to take it, assist

the student to inhale medication slowly and fully.

5. If symptoms don’t resolve in 20 minutes or any of the following

conditions exist, call ambulance:

 Difficulty breathing (significant use of neck and chest

muscles for breathing or poor air movement).

 Shortness of breath or inability to speak more than 3–5-word

sentences.

 Breathing rate of less than 12 or greater than 30 times a

minute.

 Individual with decreased level of consciousness.

 Bluish lips or nail beds.

6. Inform the student’s parent or legal guardian about the attack.

ANIMAL BITE

First Aid:

1. Wear gloves. Use Standard Precautions.

2. Remove rings and bracelets from bitten extremity.

3. Cleanse wound thoroughly with soap and water for 5 minutes.

4. Cover wound with clean bandage (preferably sterile).

5. Determine individual's tetanus immunization status.

6. If injury not severe, call parent and recommend contact with health
provider.

7. Call Animal Control.

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 8. Report all animal bites to the local health department.

HUMAN BITE

First Aid:

1. Wear gloves. Use Standard Precautions.

2. Remove rings and bracelets from bitten extremity.

3. Cleanse wound thoroughly with soap and water for 5 minutes.

4. Cover wound with clean bandage (preferably sterile).

5. Determine individual's tetanus immunization status.

6. Assess Hepatitis B vaccination status of involved individual.

7. Call parent and recommend contact with health provider.

Choking
Choking is very common and extremely
scary, but people rarely die because of it.

How do you know if someone is

choking?

They will be unable to speak or cry, not be

able to breathe and might be clutching
their throat.

If they can cough or speak, this means that

they can breathe. They should just be
encouraged to cough.

First Aid:

1. Stay calm and in clean area if the child cough, encourage him to
cough to remove the object.

129
2. If this doesn’t work, bend child forward, supporting his/ her chest
with one hand.

3. With the other hand, use your palm to give 5 back blows between
the shoulder blades.

4. Check to see if child has stopped choking before giving another

blow.

5. If is still choking after 5 back blows, call an ambulance.

6. Then give abdominal thrusts (formerly known as the Heimlich

manoeuvre):

Stand behind child and put one hand in a fist under their rib cage.
Use the other hand to pull up and under in a J-shaped motion, to
dislodge the obstruction.

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 7. Perform abdominal thrusts up to 5 times, checking each time
to see if they have stopped choking.

8. If they are still choking, swap between five back blows and
five abdominal thrusts until an ambulance arrives.

9. If they lose consciousness, be ready to start CPR.

10. If the student is being transported to a medical facility,

inform the student’s parent or legal guardian and have
them meet the student at the facility.

Shock
Shock may develop when a person is suddenly injured, bleeding,
or ill. Even mild injuries or witnessing a traumatic injury or illness
can lead to shock.

First Aid:

• Treat as a medical emergency—call ambulance.

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 • Do not move them if they have a head, neck, or back injury.

• Otherwise, have them lie down.

• Keep them dry and warm.

• Give nothing by mouth.

• Deal with any bleeding, injury or other problem.

• Keep them calm.

Fracture
First Aid:

 Stop any bleeding. Apply pressure to the wound with a sterile

bandage, a clean cloth or a clean piece of clothing.
 Immobilize the injured area. Don't try to realign the bone or
push a bone that's sticking out back in. If you've been trained in
how to splint and professional help isn't readily available, apply
a splint to the area above and below the fracture sites. Padding
the splints can help reduce discomfort.
 Apply ice packs to limit swelling and help relieve pain. Don't
apply ice directly to the skin. Wrap the ice in a towel, piece of
cloth or some other material.
 Treat for shock. If the person feels faint or is breathing in
short, rapid breaths, lay the person down with the head slightly
lower than the trunk and, if possible, elevate the legs.

With closed fractures (and also with soft tissue injuries such as
sprains and strains) – you should initially do the following:

(PRICE) – Treatment for soft tissue injuries and closed fractures

 Protect the injury (stop using the injured limb, pad to protect).

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  Rest the injury.

 Ice – apply a wrapped ice pack.

 Comfortable support – apply a supportive bandage.

 Elevate – to reduce swelling

Bleeding
First Aid:

• Put on non-latex disposable gloves and follow standard precautions for

exposure to blood and body fluids.

• Have the student lie down. Watch for signs of shock.

• When bleeding is hard to control, apply direct pressure to the open

wound with a clean dressing until the emergency medical team arrives or for
at least five minutes. Do not remove the dressing but add more if needed.

First Aid for Minor Cuts:

• Have the student apply direct pressure with a clean dressing or cloth
for at least one to two minutes or until the bleeding has stopped.

• Once bleeding has stopped on a minor cut, slowly remove the dressing
and wash the wound with soap and water.

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• Apply a sterile dressing or band-aid.

• Inform the student’s parent or legal guardian. If the bleeding is the

result of an injury, advise them to check on the student’s last tetanus shot.
Advise them to have the student seen by their healthcare provider if the
wound will not stay closed or may need stitches.

• Clean and disinfect any surfaces that came in contact with blood

Nosebleeds

First Aid:

• Put on non-latex disposable gloves and follow standard precautions for

exposure to blood and body fluids.

• Keep the student sitting up.

• Gently pinch the soft parts of the nose together and gently press the
nose against the bones of the face. If possible, have student do this. Have the
student lean forward Do not tilt the head back.

• Hold for a full five minutes and breath from mouth—do not peek to
see if the bleeding has stopped.

• If available, place a cold pack or ice bag wrapped in a cloth on the

nose and cheeks.

• After five minutes, release the pinch slowly. Reapply pressure for
longer than five minutes if bleeding starts again.

• Have the student sit quietly until the bleeding stops. Tell him or her to
avoid blowing or touching the nose.

• If bleed doesn’t stop after 30-minute, transport child to medical

facility.

• Inform the student’s parent or legal guardian.

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• Clean and disinfect any surfaces that came in contact with blood.

Amputation of any Body Part

First Aid:

• Put on non-latex disposable gloves.

• follow standard precautions for exposure to blood and body fluids.

• Have the student lie down.

• Apply direct pressure to the wound for at least five minutes to help
stop the bleeding.

• Watch for signs of shock.

• If the finger or other body part is still attached, keep it in a normal

position as you apply pressure.

• Use sterile dressings over the wound while you apply pressure. If
blood seeps through, add more dressings—do not remove them.

• If bleeding is hard to control, keep pressure on the wound, and also

use your fingers to squeeze the pressure point on the inside of the upper arm
just above the elbow.

• If the injury is on the lower body, press the palm of your hand on the
pressure point at the top of the leg near the groin.

• If the finger or body part is detached, wrap it in clean gauze, put it

in a plastic bag and put the bag on ice. The part should not be frozen or
submerged in ice or water.

• Give it to the emergency medical team when they arrive.

• If the student is being transported to a medical facility, inform the

student’s parent or legal guardian and have them meet the student at the
facility.

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• Clean and disinfect any surfaces that came in contact with blood.

Fainting
First Aid:

• If possible, try to prevent someone who is fainting from hitting the

ground.

• Lay the person down on the ground, face up, and elevate his/her
feet 8–12 inches.

• Loosen any constrictive clothing.

• Apply a cool, wet compress to the person's forehead.

• Attempt to keep the person from standing up until fully recovered.

• If the person vomits while he/she is unconscious, quickly turn

him/her to allow the fluid to drain while protecting the person's airway.

 Do not attempt to give an unconscious person anything by mouth.

 Do not shake or slap a person who has fainted to attempt to make

him/her regain consciousness.

If the person was injured while fainting, give first aid for any injuries
(e.g., bumps, bruises, or cuts) accordingly. Bleeding should be stopped
with direct pressure.

Convulsion

First Aid:

• Follow the student’s Individual Health Plan if there is a history of

seizures.

• Move toys and furniture out of the way so the student won’t get
injured.

• Protect the student’s head with a towel, blanket, or clothing. Or

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slide your palm under the head to protect it. Be careful not to put yourself
in danger.

• Loosen tight clothing.

• Note about how long the seizure lasts. Note the body parts that are
affected. Your detailed description can be important for the healthcare
provider.

• Let the student rest while lying on their side after the seizure.

• Stay calm and try to offer privacy where possible.

• Do not try to restrain the student or stop the convulsions.

• NEVER put anything into the student’s mouth.

• Inform the student’s parent or legal guardian.

Burns
The severity of a burn involves three factors: size, location and depth.

First Aid:

• Protect the burned person from further harm. If can do so safely,

make sure the person is helping is not in contact with the source of the
burn.

• Remove clothing from the burned areas, except clothing stuck to the
skin.

• Run cool (not cold) water over the burn until the pain eases.

• Lightly apply a gauze bandage or a clean, soft cloth or towel.

• If your child is awake and alert, offer ibuprofen or acetaminophen for

pain.

• Do not put any ointments, butter, or other treatments on the burn —

these can make it worse.
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• Do not break any blisters that have formed.

• Watch for signs of shock. Manage the condition.

Get Emergency Medical Care if:

• The burned area is large (cover the area with a clean, soft cloth or
towel).

• The burns came from a fire, an electrical wire or socket, or chemicals.

• The burn is on the face, hands, feet, joints, or genitals.

• The burn looks infected while it is healing. Signs of infection include

swelling, pus, or increasing redness or red streaking of the skin near the burn
area.

Poisoning
Poisoning is injury or death due to swallowing, inhaling, touching or
injecting various drugs, chemicals, venoms, gases or any poisonous
substance. Children are particularly sensitive to even small amounts of
certain drugs and chemicals.

Treat someone who may have been poisoned depends on:

 The person's symptoms

 The person's age
 Type and amount of the substance that caused poisoning

Signs and symptoms of poisoning may include:

 Burns or redness around the mouth and lips

 Breath that smells like chemicals, such as gasoline or paint thinner
 Vomiting
 Difficulty breathing
 Drowsiness

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 Confusion or other altered mental status

First Aid

 Swallowed poison. Remove anything remaining in the person's

mouth. If the suspected poison is a household cleaner or other chemical,
read the container's label and follow instructions for accidental poisoning.
 Poison on the skin. Remove any contaminated clothing using
gloves. Rinse the skin for 15 to 20 minutes in a shower or with a hose.
 Poison in the eye. Gently flush the eye with cool or lukewarm
water for 20 minutes or until help arrives.
 Inhaled poison. Get the person into fresh air as soon as possible.
 Give milk or water to dilute down the poison.
 If the person vomits, turn head to the side to prevent choking.
Observe the amount and color of vomits.
 Monitor vital signs and prevent shock.
 Begin CPR if the person shows no signs of life, such as moving,
breathing or coughing.
 Call Poison Help for additional instructions.
 Have somebody gather pill bottles, packages or containers with
labels, and any other information about the poison to send along with the
ambulance team.

References

Lee, H. C., Jang, P., & Kim, J. H. (2021). School safety education status and the
awareness and practice of safety among middle school students: 「 First aid,
disaster safety, traffic safety, and daily life safety 」 . The Korean Journal of

139
 Emergency Medical Services, 25(2), 129-143.

Hosapatna, M., Bhat, N., Belle, J., Priyadarshini, S., & Ankolekar, V. H.
(2019). Knowledge and Training of Primary School Teachers in First
Aid-A Questionnaire Based Study. The Kurume Medical Journal, 66(2),
101-106.

Mahachandra, M., Purba, J. K., Septiana, R., Eridani, D., & Windasari, I. P.
APPLICATION DEVELOPMENT OF INSPECTION OF FIRE PROTECTION
EQUIPMENT, FIRST AID KIT AND INCIDENT REPORTING CASE STUDY.
In 7th International Conference on Public Health 2020 (pp. 184-187). Sebelas
Maret University.

Galindo Neto, N. M., Carvalho, G. C. N., Castro, R. C. M. B., Caetano, J. Á.,

Santos, E. C. B. D., Silva, T. M. D., & Vasconcelos, E. M. R. D. (2018). Teachers’
experiences about first aid at school. Revista brasileira de enfermagem, 71, 1678-
1684

Charlton NP, Pellegrino JL, Kule A, et al. 2019 American Heart

Association and American Red Cross Focused Update for First Aid:
Presyncope: An Update to the American Heart Association and American
Red Cross Guidelines for First Aid.Circulation. 2019;140(24):e931-e938.
doi:10.1161/CIR

National Center for Education Statistics. (2021). Report on Indicators of

School Crime and Safety: 2020 (NCES 2021-092), Safety and Security
Practices at Public Schools

"Role of a First Aider - First Aid - St John Ambulance". www.sja.org.uk.

Retrieved May 4, 2022

140
Promoting Healthy Lifestyle in

School Children
141
 Under supervision

Prof.Dr / Nahla Ashour

Assist.prof / Samia Elnagar

By

Miss/ Ghada Shaban Nawaya

2020

Out lines
Introduction -

Definition of some concepts-

- Types of Lifestyle

Import ants of Health promotion in a school setting-

Components of health promotion in a school -

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- Simple Steps to a Health Promoting School

Advantages of a health-promoting school-

Reference-

Introduction
The rise in childhood obesity and illnesses such as the early onset of Type
2 diabetes and heart disease has highlighted the dangers of unhealthy
lifestyles. Schools have an important role to encourage children to make
healthy life choices. Educating children on the benefits of healthy eating
and regular exercise can bring about both immediate and long term
improvements to their quality of life.

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The World Health Organization has emphasized that 60% of the quality
of an individual’s life depends on his or her behavior and lifestyle.

Lifestyle is a social practice and ways of living adopted by individuals

that reflect personal, group and socio-economic identities. Although
lifestyle reflect individual identity, they are primarily a reflection of the
norms and values of the group to which the individual belongs.

Healthy lifestyle: is expressed into positive health behaviors being

practiced so to be healthy as well as to prevent diseases.

Healthy lifestyle behaviors: are important characteristics in health

promotion and may suppress markers of illness. Individuals who
embraced healthy lifestyle behaviors can withstand health risks linked to
disability and disease in later life.

School health promotion could be defined as any activity undertaken to

improve and/or protect the health of the whole school community.

A Health Promoting School (HPS) is a place where all members of the

school community work, learn, live and play together to promote the
health and well-being of learners, staff, parents and the wider community.

A Health Promoting School is a school that is constantly strengthening

its own capacity as a health setting for living, learning and working
(World Health Organization 1996). It does not replace existing programs
in the school or the community, rather, facilitates working together on
specific, mutually acceptable goals.

Types of Lifestyle
Healthy lifestyles which are essential for increasing quality and years of
healthy life are the healthy ones, for example managing stress, eating
balance diet, engaging in regular exercise, avoiding destructive habits
(drug abuse, alcohol abuse) adopting good personal health behavior,
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practicing sex abstinence, adopting good safety habits, getting
immunized, getting plenty of rest and sleep, developing good stress and
time management skills, knowing where to go for health – related
assistance, being informed about common health issues etc.

Unhealthy lifestyle are those activities that do not bring promotion in the
life of an individual rather it contributes to early death and disability;
Examples are, not participating in regular physical exercise, improper
nutrition, improper management of stress, use and abuse of drugs,
promiscuity, poor safety habits, poor personal health behavior, lack of
medical advice, unskilled consumption, and not protecting environment.

Import ants of Health promotion in a school setting

• Healthy children are more likely to learn effectively;

• Education plays an important role in health and economic outcomes

throughout life;

• promoting the health of school staff can lead to more effective teachers,
greater work satisfaction and reduced absenteeism;

• Actively promoting health in schools can aid schools and policy-

makers in reaching their educational, social and economic targets.

Healthy lifestyles can be promoted through the following:

1-Adequate/ balance diet

Healthy eating means eating moderately, that is moderate amount of

feeding and adequate amount of the six classes of food. Healthy eating
allows the body to reach its maximum genetic potentials. However
healthy eating helps to prevent diseases. Excessive cholesterol should be
minimized to avert the risk of arteriosclerosis.

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2- Moderate regular exercise

Exercise plays an important role in the promotion of a healthy lifestyle.

Physical education (PE) is a curricular component in schools that offers
students the opportunity to acquire PE-related knowledge and skills
contributing to integral human development. It is not only brings physical
benefits but psychological too. All children are encouraged to actively
participate in Physical Education and swimming lessons. A variety of
activities including Football, Netball and other activities are available for
children to join. Additional information is available in the school’s PE
Policy.

Most classes

3- Mental and spiritual factors

Positive mental and spiritual factors also play important roles in

maintaining a healthy lifestyle. To maintain a healthy mental outlook,
entertainment on television, video, magazine etc should be chosen wisely.
Our eyes should be averted from that which is “good for nothing”.

Entertainment that incites us to do what is bad should be avoided. Our

thinking ability should be fortified through a study of God’s word and by
seeking divine love, joy, peace and fulfillment.

4- Regular medical checkups

Having regular check-ups so that any disease that develops can be

detected and treated early is very important in maintaining healthy
lifestyles. Individuals should expose themselves to varsities of tests and
medical examinations as may be directed by the doctor. One can stay

healthier throughout life by making positive lifestyle change. And school

146
children screening (eg:100 million seha, Malnutrition Diseases Anemia,
obesity and dwarfism detection and treatment )

5- Positive lifestyle and effective management of stress.

Effective management of stress can be carried out through the following;

music therapy, communication therapy, psychological/cognitive (e.g.,
self-esteem and lower levels of anxiety) Pharmaco-therapy etc.

Health promotion in a school has six components:

1- Healthy School Policies

These are clearly defined in documents or in accepted practices that

promote health and wellbeing. Many policies promote health and well-
being e.g., policies that enable healthy food practices to occur at school;
policies which discourage bullying.

2-The School’s Physical Environment

The physical environment refers to the buildings, grounds and equipment

in and surrounding the school such as: the building design and location;
the provision of natural light and adequate shade; the creation of space for
physical activity and facilities for learning and healthy eating.

3-The School’s Social Environment

The social environment of the school is a combination of the quality of

the relationships among and between staff and students .It improves social
skills of children such as cooperation, proactivity, and establishment of
friendships.

4-Individual Health Skills and Action Competencies

This refers to both the formal and informal curriculum and associated
activities, where students gain age-related knowledge, understandings,
skills and experiences, which enable them to build competencies in taking

147
action to improve the health and well-being of them and other in their
community and that enhances their learning outcomes

5- Community Links

Community links are the connections between the school and the
students’ families, plus the connection between the school and key local
groups and individuals. Appropriate consultation and participation with
these stakeholders enhances the health promoting school and provides

6-Health Services

These are the local and regional school-based or school-linked services,

which have a responsibility for child and adolescent health care and
promotion through the provision of direct services to students including
these with special needs.

The Five Simple Steps to a Health Promoting School

The process of becoming a Health Promoting School can be initiated

through a series of simple and manageable steps.

 Introduce the concept to the school.

 Carry out a needs assessment – analyses the causes of problems
and priorities the needs.
 Audit available human and financial resources.
 Draw up a plan of action based on priorities and resources and
implement the plan.
 Monitor and evaluate process.

Advantages of a health-promoting school

The health-promoting school concept offers the following advantages.

148
 It utilizes a holistic model of health which includes the
interrelationships between the physical, mental, social and
environmental aspects of health.
 It involves families by encouraging their participation in the
development of health skills and knowledge of their children. It
addresses the significance of the physical environment (e.g.
buildings, sanitation, fresh water, play areas) in contributing to the
health of children.
 It recognizes the importance of 'the social ethos of the school in
supporting a positive learning environment and one in which
healthy relationships and the emotional well-being of students are
strengthened.
 It links regional and local health services with the school to
address specific health concerns which affect schoolchildren (e.g.
worm infestations, sight and hearing problems, malaria,
psychosocial stress).
 It focuses on active student participation in the formal curriculum
to develop a range of life-long health-related skills and knowledge.
It enhances equity in education and health in raising the health
competencies of girls and women in the community.
 It provides a positive and supportive working environment for
school staff. It enables the school and the local community to
collaborate in health initiatives which benefit school students, their
families and community members

149
Reference

 Bandeira, A. D. S., Ravagnani, F. C. D. P., Barbosa Filho, V. C., de

Oliveira, V. J. M., de Camargo, E. M., Tenório, M. C. M., ... &
Silva, K. S. (2022). Mapping recommended strategies to promote
active and healthy lifestyles through physical education classes: a
scoping review. International Journal of Behavioral Nutrition and
Physical Activity, 19(1), 1-20.

150
 https://healtheducationresources.unesco.org/library/documents/
promotion-healthy-lifestyles-primary-schools

 Sawyer SM, Afifi RA, Bearinger LH, Blakemore SJ, Dick B, Ezeh
AC, Patton GC. Adolescence: A foundation for future health.
Lancet 2012;379:1630-40.

 Tamanal JM, Park KE, Kim CH. The relationship of perceived

stress and lifestyle choices among Filipino adolescents. Int Res J
Public Environ Health. 2017;4:205–12

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 All Respects to you,
our kind, patient and
great doctor.

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