4b 2. ~; ~~
IN FLORIDA SCHOOLS
BULLETIN 4D, REVISED
STATE DEPARTMENT OF EDUCATION
THOMAS D. BAILEY,
STATE BOARD OF HEALTH
WILSON T. SOWDER,
State Health Officer
IN FLORIDA SCHOOLS
BULLETIN 4D, REVISED
Sponsored jointly by
STATE DEPARTMENT OF EDUCATION
THOMAS D. BAILEY, Superintendent
STATE BOARD OF HEALTH
WILSON T. SOWDER, State Health Officer
Table of Contents
FOREWORD ....................................... i
ACKNOWLEDGMENTS ........................... iv
1. SCHOOL HEALTH PROGRAM ..................... 1
Developments Affecting School Health Program ..... 2
2. ORGANIZING, ADMINISTERING, AND PLANNING
A SCHOOL HEALTH PROGRAM ................... 5
Building a Sound Foundation for the School Health
Program ...................................... 5
School Personnel and Their Responsibilities in the
School Health Program .......................... 9
Personnel of the County School Office .............. 13
Responsibilities of Health Department Personnel in the
School Health Program ......................... 13
Keeping Abreast of Developments in the Health
Science Field ................................... 17
Resources and Materials .......................... 19
3. HEALTHFUL SCHOOL LIVING .................... 24
School Sites .......................... ...........2 24
School Building ................................... 26
Sanitation ...................................... 30
Safety .......................................... 31
4. SCHOOL HEALTH SERVICES ..................... 35
Health Appraisal .............................. 35
Protection Against Communicable and Infectious
Disease ........................................ 50
Communicable Disease Regulations ................. 54
Emergency Care Following Accidents and Sudden
Illness ......................................... 55
Mental Health Services ............................ 62
Health Counseling ............................ .... 63
School Food Service .............................. 64
5. HEALTH INSTRUCTION .......................... 66
Where Health Learning Occurs .................... 66
Suggestions Concerning Gradation ................. 76
Evaluation of the Health Education Program ........ 82
APPENDIX 1: HEALTH EDUCATION
TERMINOLOGY ................... 85
APPENDIX 2: STATE SERVICES FOR FLORIDA
CHILDREN ....................... 87
APPENDIX 3: LAWS RELATING TO SCHOOL
HEALTH .......................... 89
DURING THE PAST decade, great strides forward have been
made in the improvement of child health. Scientific and
medical discoveries have made it possible to bring new forces to
bear upon the health of the school-age child.
Health experts have long recognized that the key to effective
utilization of medical and health knowledge is education of the
people. One institution of our society which is capable of making
a maximum contribution to health education is the school.
Recognizing its responsibility in this area, the Florida State
Department of Education, in cooperation with the State Board of
Health, has published this bulletin for the information and guid-
ance of all who have responsibilities for the health of children.
The interest of health departments and departments of education
naturally meet because of their common concern with the health
of children of school age and the need for instructing children in
the basic facts which will enable them to live healthy and happy
lives in a clean and wholesome environment. Where this task has
not been accomplished and ignorance and superstition still persist
in the world, modern medical and sanitary science is helpless.
It is the aim of this bulletin to aid the teachers in the public
schools to instruct our children so well in the importance of
healthful living that succeeding generations will not only be more
receptive to the practice of all that is known in the field of health
but will demand its full application. All teachers, principals,
supervisors, superintendents, and other individuals who are re-
sponsible for the education of children are in key positions to
contribute to this effort. It is our hope that this bulletin will pro-
vide substantial assistance for teachers, supervisors, and adminis-
trators who want additional help and support in the building of
their own health programs.
THOMAS D. BAILEY
State Superintendent of Public Instruction
T HE IMPORTANCE OF THE public school in the health pro-
gram cannot be overemphasized. Properly conceived and in-
telligently implemented, the school health program can do much
to ensure strong healthy bodies and emotionally stable young
people. Failure to provide such a program may well contribute to
the physical and functional inadequacy of our people.
Health education and health services are public service areas
in which teachers as well as health personnel play a significant
role not only in providing healthful pupil surroundings but also in
encouraging desirable pupil health practices and normal emotional
adjustments. The efforts of the professions whose primary con-
cern is the improvement of health, the prevention of disease, and
the prolongation of life obtain their maximum benefit when ap-
plied to a citizenry which already has considerable knowledge of
basic health principles.
The importance of organization in the administration of the
school health program becomes more pronounced with the real-
ization that the health of the school-age child is a shared respon-
sibility. Since this responsibility is distributed among parents, the
school, the official health department, medical and dental and
other professional societies, and voluntary agencies, it is desirable
that each group perform its proper role and supplement the other
groups. Since these individuals and groups function within a
variety of governmental and social frameworks, the organization
through which the school health program is planned and admin-
istered must be of such a nature as to guarantee all of them the
opportunity to contribute appropriately and to give direction to
the school health program.
The State Board of Health stands ready to assume its share of
this large responsibility and to provide the kind of leadership that
is rightfully expected of a state health agency. More important, it
stands ready to join hands with all other agencies who share the
responsibility for pupil health in a combined effort to meet the
needs of the children and the community in the most effective
WILSON T. SOWDER
State Health Officer
H HEALTH PROGRAMS IN FLORIDA SCHOOLS represents
a revision of Bulletin 4-D, A Program of Health Services
for Florida Schools. Like its predecessor, this volume is the joint
effort of a large number of dedicated people in both the education
and health professions who have worked long and diligently to
provide an up-to-date guide to the health programs in Florida
public schools. Many of the people who served on the committee
which developed the original bulletin have also helped with this
revision, and a great deal of the credit for its effectiveness must
be attributed to their continuing interest and assistance.
To mention by name each individual who participated in this
work would be impractical, but a few persons who carried a large
share of the responsibility should be singled out for special recog-
Acknowledgment is due Dr. Robert Yoho, Director, Bureau of
Public Health Education, Records and Statistics, Indiana State
Board of Health, for his guidance and valuable assistance with the
development of the first draft of this revision.
Special recognition for professional support and leadership
should go to Dr. L. L. Parks, Director, Bureau of Maternal and
Child Health, Florida State Board of Health, and to Mr. Vincent
Granell, School Health Consultant, Bureau of Maternal and
Child Health, Florida State Board of Helath.
Organizations whose assistance is recognized and acknowl-
edged include the School Health Advisory Committee of the Flor-
ida Medical Association and the Florida State Dental Society.
State Department of Education personnel who contributed
substantially to the development of the guide include Dr. Fred
W. Turner, Director, Division of Instructional Services, and Mr.
Zollie Maynard, Assistant Director, Physical Education, Health,
and Recreation, Division of Instructional Services. Appreciation
is also due Dr. Joseph W. Crenshaw, Assistant Director, General
Education and Curriculum, Division of Instructional Services, for
review of the material and editorial assistance.
Other members of the State Department of Education who
assisted with professional and technical advice, layout, printing,
and distribution are Mr. J. K. Chapman, Mr. Howard Jay Fried-
man, and Mr. W. H. Pierce.
School Health Program
T HE ELEMENTS included in a properly conceived school
health program can be divided into three major areas:
1. healthful school living (environment).
2. health services
3. health instruction.
If each of these phases is to function effectively, the skills and
knowledge of school administrators, teachers, school health co-
ordinators, state and county school lunch supervisors, personnel
of the health department-engineers, nurses, sanitarians, physi-
cians, dentists-and parents will have to be effectively utilized.
Since the school environment is so important to the health
and well-being of the school child, it is essential that those with
special skills, such as the engineer and sanitarian, be involved in
such things as selecting school sites, planning new construction,
or remodeling existing buildings.
It is the purpose of this bulletin to clarify the roles of various
types of personnel and agencies in the provision of an effective
health program for the school child and to point out that mutual
understanding will result in the effective utilization of all com-
munity health resources.
School health programs in Florida have improved consid-
erably during recent years. This improvement is due largely to
the interest and cooperative efforts of school and public health
personnel, professional groups, and community organizations.
Such cooperative effort enables the health program for school-age
children to keep abreast of the advances occurring in the medical
and health sciences and the changing health needs of the com-
The State Board of Health, the State Department of Educa-
tion, and local boards of health and education, all have certain
responsibilities, as well as important contributions to make, to
the school health program. The laws of Florida charge the State
Board of Health and local health boards with primary responsi-
bility for school health services. The State Department of Educa-
tion and local school systems are primarily responsible for the
health education program. The maintenance of a healthful school
environment rests with the local school and public health au-
It is not intended to imply that responsibilities for different
aspects of the school health program are clear-cut and well de-
fined. In fact, the opposite is true. There is a readily recognized
intertwining of responsibility. This commingling of legal respon-
sibility, plus the additional moral obligation of both the school
and the health department, dictates that there be cooperative
planning in the operation of the school health program.
Developments Affecting School Health Program
During the past several years, remarkable advances have been
made in the area of child health. Scientific and medical discoveries
have provided effective new tools, and improvement of tech-
niques and procedures have made it possible to bring these dis-
coveries to bear upon the health of the school-age child. Time
after time, health experts have stated that the key to effective
utilization of medical and health knowledge is education of the
people. The one institution of our society capable of making
maximum contributions to health education of the public is the
Some of the developments in recent years which strengthen
the position of the school and increase its potential contribution
to health improvement are:
A. The unique responsibilities of parents, schools, health
departments, and the health professions for the health of
the school-age child have been clarified. It is understood
that when an agency or group becomes a substitute for
the home, programs are less effective; but when agencies
and groups supplement and reinforce the efforts of the
home, programs are strengthened.
B. Teachers and other school personnel continue to recognize
the contribution of health to total child development.
C. The contributions the classroom teacher can make to all
aspects of school health are better understood, resulting in
programs which are sounder and more effective.
D. New knowledge makes it possible for parents, teachers,
and others to deal more effectively with the mental and
emotional needs of children.
E. The procedures under which health instruction is included
in the school curriculum have been refined, resulting in
more appropriate school health education programs.
F. Methods and standards of follow-up of various screening
and examination procedures have become more uniform.
These standards, plus the maintenance of cumulative
health records and their proper utilization, result in more
efficient functioning of school and health department per-
G. There is rather general agreement among the leaders in
health and education that the major objective of the
school health program is the education of the individual
by example and precept, so that he will be capable of
making wise decisions concerning his health and that of
his family and his community.
The School Health Coordinators Plan
This plan for improving school health programs is an out-
growth of the cooperation between the State Department of Edu-
cation and the State Board of Health. The regulations outlined in
Accreditation Standards for Florida Schools require that a faculty
member be designated as school health coordinator. It is recom-
mended that this person serve in an advisory capacity to the
principal and give continuous attention to the school health pro-
Gray Lady Service
Under the supervision of school authorities and with the ap-
proval of local medical authorities, the Gray Lady Service pro-
vides volunteer assistance to school principals and teachers in
caring for sick and injured children during school hours. Now an
approved service, it may be provided by Red Cross chapters on
the request of local school authorities and in accordance with
certain rules and regulations. Gray Ladies are required to pur-
chase the regulation Gray Lady uniform, cap, and insignia and
adhere to the standard uniform requirements for all Red Cross
The increased activity of P-T-A groups in the area of health is
another development affecting school health programs. The more
intense the interest of these groups in school health programs the
more notable is the improvement in school health services, en-
vironment, and instruction.
Medical Advisory Committee on School Health
Through cooperation with local professional health organiza-
tions the way has been opened for the formation of a committee
to act in an advisory capacity to local school personnel in the area
of health. It is advised that health-related activities and programs
within the public schools be instituted by county school boards
only after consultation with the local county health department
and the appropriate local professional health organizations. If the
local professional health organizations fail to appoint such a com-
mittee, the public schools may request the establishment of a
committee. The committee will give the schools advice on health
matters and thereby prevent them from making serious mistakes.
The establishment of this committee is considered a step in the
right direction toward providing medical knowledge for the im-
provement of school health programs.
Organizing, Administering, and Planning
a School Health Program
AN ADEQUATE AMOUNT of organization is necessary to
secure the orderly and successful pursuit of any objective.
When this objective is the health and well-being of the school-age
child, it is extremely important that organization be as productive
and efficient as possible. The significance of organization in the
administration of the school health program becomes more pro-
nounced with the realization that the health of the school-age
child is a shared responsibility. Since this responsibility is distrib-
uted among parents; the school; the official health department;
medical, dental, and other professional societies; and voluntary
agencies, it is desirable that each group perform its proper role
and supplement, not supplant, the other groups.
Since these individuals and groups function within a variety of
governmental and social frameworks, the organization through
which the school health program is planned and administered
must be of such a nature as to guarantee all groups or organiza-
tions the opportunity to contribute appropriately and to give
direction to the school health program.
Building a Sound Foundation for the
School Health Program
Regardless of how great may be the responsibility of the
school and the health department for the school health program,
the program will achieve optimum effectiveness only when it has
the understanding and support of the community. Therefore, it is
essential that proper machinery be established in every county
and every school community for the purpose of assuring public
understanding and support.
The health committee concept is often presented in such a
complicated manner as to create uncertainty and confusion. The
committee may be completely informal, without operating codes,
constitution, or by-laws, and still be highly effective in the devel-
opment and maintenance of an efficient and productive school
health program. Action not organization is the important element
of the committee. The action desired is the voluntary gathering
of lay and professional people, with a similar interest, for the
purpose of studying school health problems, deciding what should
be done, and determining how to bring about the action necessary
to resolve the problems.
The School Health Committee
Each individual school, elementary or secondary, should estab-
lish a school health committee to be concerned with the health
problems and activities peculiar to itself and the locality which it
serves. Members of the committee should be appointed by the
school principal or elected by the faculty, and, as a general rule,
the majority of the members should come from the school staff.
It is highly desirable to include one or more members of the
student body on the committee. (It will be noted that the mem-
bership composition of the school health committee differs from
that of the county school health planning committee, discussed
later in this chapter.) In certain instances, because of problems
confronting the school, individuals other than school personnel
may be added to the committee or asked to serve as consultants.
Certainly, if a special project related to dental health were under
consideration, a representative of the local dental society should
be invited to serve on the school health committee. This same
practice should be followed with other groups and agencies when
activities of particular concern to them are being considered by
the school. This practice of calling in outside consultants for a
specific problem will enable the school to make more intelligent
Each school should consider the establishment of a student
health committee under a faculty advisor. This group can deter-
mine what is needed to improve school health and make recom-
mendations to the school health committee. This is highly desir-
able as it permits the students to assume some responsibility for
planning and instituting improvements which affect them. Cer-
tainly students going back to their classes to discuss with the
group problems and possible solutions has a significant effect on
the student body. The chairman of the committee can be a mem-
ber of the school health committee.
When the regulation requiring that the principal of each school
appoint a faculty member as school health coordinator became a
part of Accreditation Standards for Florida Schools, the precedent
of the coordinator serving as chairman of the school health com-
mittee was established. Considerable thought has been given to
this practice; and although there are advantages to such an ar-
rangement, there is a growing belief that it would be wiser for a
faculty member other than the one designated as coordinator to
serve as chairman of the school health committee. Such an ar-
rangement divides the work load, involves additional people
directly in the program, and makes it possible for the coordinator
as well as the faculty to assume their proper roles in the school
health program. Since the coordinator is in his position by virtue
of being so designated by the principal and has been given respon-
sibilities that are inherently those of the principal, serving as
chairman of the faculty committee for health forces him into a
double role and could actually limit his ability to serve equally
well in each role.
The foregoing recommendation is not intended to imply that
the health coordinator should never serve as chairman of the
school health committee, but is merely a suggestion that con-
sideration might well be given to the advantages and disadvan-
tages of both arrangements before a final decision is reached.
Examples of Activities for School Health Committee
The basic purpose of the school health committee is to assist
the principal or his delegated representative conduct a program
of school health from which the pupils will derive maximum
Examples of activities in which the committee might become in-
A. Developing a health education curriculum especially
adapted to helping with meeting the health needs of the
pupils and community.
B. Determining the need and recommending methods for an
emergency care program.
C. Planning correlation of the educational program with the
D. Suggesting ways by which a health suite might be estab-
lished in the school.
E. Planing ways of helping the nurse with screening programs
and record keeping.
F. Discussing and interpreting daily inspection and obser-
vation procedures with teachers.
G. Studying safety features of the school building and grounds
and recommending needed improvements for accident
H. Discussing opportunities and methods for integrating and
correlating health teaching with other subjects.
I. Planning such special health projects as dental health
week, food habits surveys, sight conservation programs,
J. Providing for in-service health education for teachers.
K. Arranging for participation of custodial personnel in spe-
cial training courses.
L. Discussing opportunities and methods for integrating and
correlating school lunch experiences with health teaching.
The County School Health Planning Committee
Organization of Florida's schools on a county basis and the
fact that local health departments, professional health organiza-
tions, and voluntary health agencies are organized on the same
geographical basis make the establishment of a county school
health planning committee both practical and desirable. Since the
county committee is a planning group concerned with formulat-
ing policies and procedures and with developing uniformity, in
all the schools of the county, its membership should be represent-
ative of all the various health interests of the county.
The county health department, the county school superintend-
ent's office, and the medical and dental societies, as well as other
professional health groups, voluntary health agencies, civic groups
with special health interests, parent organizations, and other
legitimate interests, should have representation on the county
school health planning committee. In addition to these groups,
each of the school health committees within the county should
have membership on the county committee.
The appointment of members to the county school health
planning committee should be the responsibility of the superin-
tendent of schools and the county health officer. Certain situations
may dictate that other knowledgeable individuals be consulted
concerning the composition of the committee.
Examples of Functions for the County School Health
The primary functions of the county school health planning
committee lie generally in the areas of planning, policy determi-
nation, development of procedures, study and determination of
school health needs, and coordination. Some of the more specific
activities of such a committee are:
A. Promoting the development of a school health scope and
sequence curriculum, grades 1-12, for the county.
B. Assisting in the provision of in-service education opportu-
nities for teachers in the field of school health.
C. Developing policies and procedures for the provision of
D. Interpreting problems and policies related to school health.
E. Strengthening the school health committees of the county.
F. Surveying the school health situation throughout the
School Personnel and Their Responsibilities in the
School Health Program
All personnel employed by the school system directly or in-
directly influence the health and well-being of the pupil.
Functions and Responsibilities of Selected Staff Members
A. The Principal
The quality and characteristics of the school health pro-
gram will be determined in large measure by the degree to
which the principal is interested in it, his concept of the
importance of health, and his encouragement of the school
staff, pupils, and the community to exert the necessary
effort to develop and maintain an effective program. The
principal, or the designated school health coordinator,
coordinates the program, serves as liaison with community
health groups and agencies, interprets to school personnel
the health policies of the school and health department,
and generally performs those functions which create a
favorable environment in which the health program may
develop and function.
Specifically the principal should:
1. Appoint a staff member to serve as school health
coordinator as provided for in Accreditation Stand-
ards for Florida Schools.
2. Define the school health coordinator's responsibilities
and status as a member of the staff.
3. Allocate time for health coordination activities.
4. Establish administrative channels for effective func-
tioning of the total staff, the coordinator, and the
school health committee.
B. The School Health Coordinator
A regulation of the Accreditation Standards for Florida
Schools requires that the principal of each school shall
designate a faculty member as school health coordinator.
Experience with the health coordinator plan indicates that
certain special qualifications are needed to enable the
coordinator to function effectively. Since properly qualified
individuals are not available in every school, it is suggested
1. The principal designate a faculty member interested
in health, who is as well qualified as possible in this
field, to serve as school health coordinator.
2. The school administrator should provide opportuni-
ties during the school day for the coordinator to im-
prove himself on the job.
3. State and local health department and school officials
provide individual consultation, printed material, and
intensive in-service educational opportunities for the
The school health coordinator is responsible for all the
functions and activities delegated to him by the principal
and generally gives guidance and direction in the develop-
ment and operation of the school health program. He
should give special guidance and service to the school
Some of his duties may be as follows:
1. Serves as the principal's representative in all matters
pertaining to the health of the school-age child,
whether they be of a school or community nature.
2. Guides and counsels student health committees.
3. Evaluates, with the assistance of other school health
activities and problems, such as the program of
health instruction, safety hazards, and safety prac-
tices; environmental factors, such as water supply,
waste disposal, lighting, and ventilation; the school
lunch program; and the working relationships of the
health, science, home economics, physical education,
and recreation programs.
4. Assist teachers and other staff members in securing
sound and appropriate health education materials.
5. Explore ways of making the health services more
meaningful, with special attention being paid to
making them more educational.
6. Make suggestions and recommendations to the prin-
cipal concerning health problems, health needs, and
methods of improvement.
The above list of possible functions of the school health
coordinator is by no means complete. For further sugges-
tions and information see: Handbook: School Health
Coordinators, published by the State Department of Edu-
cation, and Action With Purpose, A Report of an Evalua-
tion Conference on School Health, June 1957, published by
the State Department of Education and the State Board of
C. The Faculty
Teachers have always been considered as the primary
factor in an effective program of school health. Their
knowledge, their continuous contact with, and their con-
stant concern for the individual pupil make this a fact
rather than a platitude.
1. Understand each child as an individual, being aware
of his emotional and physical health, his personality,
his drives, and his needs.
2. Provide a classroom environment that encourages
and supports healthful living.
3. Use the "teachable moment," regardless of subject
area, to educate concerning good health.
4. Continually be alert for signs or other indications
that the pupil may be experiencing some adverse
5. Consult with the parent and the nurse or other
health service personnel when a pupil, or group of
pupils, is confronted with a health problem. The
teacher should request a conference with the parent
and public health nurse at any time such a confer-
ence will benefit any child or clarify a point for the
teacher, the nurse, or the parent.
6. Assist in vision, hearing, and other types of screening
programs approved by the appropriate authority and
utilize the findings for educational purposes as well
as for the selection of individuals for referral to
various health services.
7. Adjust seating arrangement and other aspects of the
physical environment when observation and screen-
ing tests indicate that the individual child will benefit
by such changes.
8. Understand the role of the nurse, the school health
coordinator, the sanitarian, the physician, and other
professional personnel in the school health program.
Thus, proper utilization of their services will be as-
sured. Such understanding by the teacher and an
understanding of the teacher's role and responsibili-
ties by other school and health department personnel
will do much to achieve the team-work necessary to
the operation of the school health program.
D. Other School Personnel
In addition to the principal, the coordinator, and the
teachers, all other members of the school staff have a con-
tribution to make to pupil health. In some instances, these
contributions are tangible and direct. The school secretary,
the maintenance director, the lunchroom manager or
supervisor, and the custodial staff by the very nature of
their responsibilities are in a strategic position to influence
significantly the school health program.
Because of these many sources of influence, it is essential
that coordination of effort be achieved through the school
health committee or some other equally effective instru-
Personnel of the County School Office
The superintendent, the county health coordinator, and special
supervisors have responsibilities and functions similar to those of
local school personnel. These functions and responsibilities differ
primarily in that the county staff accomplishes its purposes and
objectives in school health through devoting time and effort to
planning, policy making, supervision, and consultation, rather
than to being extensively involved in the direct operational
aspects of the school health program.
Responsibilities of Health Department Personnel
in the School Health Program
The health department is legally responsible for certain as-
pects and activities of the school health program. Even if this
were not the case, appreciation of the educational approach and
the realization that school health is a part of total community
health would assure the willingness of nurses, health officers,
sanitarians, health educators, and other health department per-
sonnel to cooperate fully in the development and conduct of the
school health program.
Each member of the health department staff is a specialist in
his particular field and, in addition, is trained and experienced in
General Functions and Responsibilities of Health
No attempt will be made to develop a specific and detailed list
of responsibilities of the health department staff in the school
health program, since such determinations are made primarily at
the local level and are dependent upon needs, problems, staff
availability, and other factors. Through cooperative planning,
however, details can be worked out within the limits of the
policies and philosophy of the health department.
A. The Health Officer
The physician who serves as health officer, like the school
administrator, is the executive officer of his department.
His understanding of the importance of child health, his
interest in school health, and the degree to which he en-
courages his staff to participate in health activities of the
school will determine to a large extent the contribution of
the health department to the school health program.
Generally, the health officer:
1. Interprets public health department policy to school
officials and determines how it fits in with their pre-
conceived ideas of a school health program.
2. Assigns responsibility for school health functions to
members of his staff.
3. Approves procedures and activities engaged in by his
staff, as the members work in the school health
4. Maintains program balance in relation to school
health and other facets of the community health
B. The Public Health Nurse
The nurse, among other things, may do the following:
1. Interpret the medical aspects of the school health
program in accord with the law and the policies of
the health department.
2. Consult with teachers, the principal, parents, and
pupils concerning the health problems and needs of
the individual child. The public health nurse should
encourage a teacher-nurse conference whenever it
will benefit a child and his parents and clarify a point
for either the teacher, the parents, or the nurse.
3. Provide scientific information to the school staff on
health problems. The information should be current
and in accord with the school policies. The county
health department should maintain a current supply
of materials in order for the nurse to be effective in
4. Interpret the health problems of the community to
5. Assist in the development of communicable disease
control projects, screening procedures, and other
activities included in the total school health program.
6. Assist with the development of first aid services and
procedures for emergencies which may occur relating
to health and accidents.
7. Help develop policies and procedures for follow-up
and referral of pupils who have specific health prob-
C. The Sanitarian
The sanitarian is responsible for interpreting the laws and
rules of the state and community in respect to the school
site, building construction and maintenance, and other sani-
tation and environmental factors.
Generally, the sanitarian gives assistance and consultation:
1. In selecting the site for new construction.
2. On the requirements of the state and local health
departments related to remodeling or new-addition
3. To school officials in providing a safe and sanitary
environment: safe water supply, proper waste dis-
posal, proper storage, and sanitary preparation and
serving of food. The sanitarian also engages in a
variety of other activities that promote and encour-
age good health among school-age children.
D. The Public Health Educator
The health educator is the staff member of the health
department especially prepared in proper utilization of edu-
cational methods and community organization. He is
charged by the health officer with the responsibility for
planning and developing a public education program which
will enable individuals of the community to give intelligent
self-direction to their health behavior and practices. The
health educator may contribute effectively to the school
health program by:
1. Serving as a resource person to the teacher.
2. Cooperating with the school health coordinator in
the fulfillment of his responsibilities.
3. Interpreting the health needs of the school to other
health department personnel and vice versa.
E. The Public Health Dentist
Dental disease is a major public health problem, and many
county health departments have dental clinics staffed by
full-time dentists. These dentists give dental treatment to
underprivileged pre-school and elementary school children
and, in some instances, to underprivileged prenatal patients.
Dental emergencies of underprivileged high school stu-
dents may be treated also.
In addition to giving corrective treatment to qualified
patients, the public health dentist is engaged in promoting
and carrying on dental health education programs. These
programs are developed and sustained with the cooperation
and support of P.T.A. groups, civic groups, schools, dental
and medical organizations, and interested individual citi-
zens. Consultative assistance may be obtained on matters
related to the dental health of the community.
Keeping Abreast of Developments in the
Health Science Field
The new discoveries and advances which are continually being
made in public health and medicine make it increasingly impor-
tant for personnel working in these fields or related fields to take
full advantage of the many opportunities that are offered to im-
prove their knowledge and skills.
The in-service program in health education should be devel-
oped cooperatively by colleges and universities and by state and
local departments of education and public health. It is an impor-
tant responsibility of teacher-education institutions to lend sup-
port to in-service programs to help on-the-job participants keep
abreast of new developments and become more effective on the
job. Maintaining such relationships in the field also helps college
staffs become better acquainted with job-level problems.
Well-qualified, skilled leadership in health education is neces-
sary to bring about cooperative action among school administra-
tors, classroom teachers, health educators, public health nurses,
other public health personnel, students, parents, and lay citizens.
Health education leaders must be interested in the health of the
school and the community. They should be well informed in
matters pertaining to and be especially interested in working with
people. Not all teachers with responsibilities for school health
have the necessary preparation; but even if this were not the case,
an adequate and continuing program of in-service education is
necessary in order to provide a program which will meet the ever-
changing needs of the individual and the community.
Highly competent personnel should be used in the in-service
education program. Imaginative and inspirational leadership in
necessary consultation services should be sought. New problems,
new inspirations, and new concepts can be brought to light con-
tinually and should always be built around practical application
in the local school and community. Through in-service education
the participants will achieve greater understanding of all the
community groups having contributions to make to school health.
In addition to teachers the personnel for whom in-service
education in health is provided may include various groups and
combinations of groups, according to the immediate problem and
the specific need. Those who may appropriately participate in in-
service education for health are:
School lunch personnel
School health coordinators
School bus drivers
Custodial and maintenance staff
Medical and nursing supervisory staff
Recreational and coaching staff
Staff of various voluntary and official organizations contribut-
ing to health and welfare
Civic organizations and professional groups.
The types of in-service education are many and varied. Work-
shop experiences or work conferences may be held by local
groups for the purpose of attacking school-community health
problems. One-, two-, or three-day meetings, or a series of eve-
ning meetings, may be held, depending upon the local community
needs and patterns of work.
The development of joint planning groups in neighborhoods,
towns, counties, states, and the nation represent a type of in-
service education. These organizations may take the form of
school health councils or broader community councils. The groups
participating may include health departments, school systems,
voluntary health agencies, welfare organizations, medical socie-
ties, professional organizations, youth groups, and consumers of
health services, such as labor, business, agriculture, and civic
groups. The planning group needs to represent the local people
and the discussion must include people who have specific knowl-
edge of health programs and problems.
The State Department of Education, the State Board of Health,
and the voluntary health agencies are generous in the amount of
consultant services given to workshops and work conferences,
when additional assistance is needed.
The colleges and universities are pleased to furnish the con-
sultant services of faculty health educators when local communi-
ties request them and as on-campus responsibilities will permit.
This consultant service may come about through individual con-
ferences with school administrators, nurses, and teachers, or as
the result of various types of group consultative situations. City
and county workshops or pre- and post-school planning sessions
offer excellent opportunities for in-service education. Night
classes or Saturday classes in health education and summer course
offerings at the colleges and universities may include courses
especially designed to meet the needs of in-service personnel.
School and public libraries, the State Board of Health library in
Jacksonville, and the State of Florida library in Tallahassee offer
excellent sources for materials.
Since so much of the future success of Florida's school health
programs depends upon the manner in which the health coordi-
nator functions, special consideration should be given to providing
high-quality in-service experiences for those serving in this
Resources and Materials
In every community there are people, places and things which
may be used to make health education an effective experience.
Children learn from all they see, hear, or do, whether this is a
planned experience or one which just happens. Their attitudes
and concepts, which are basic to health practices, will be de-
termined by their total experiences.
People are an important resource for health instruction. The
child, his abilities, his participation, his interests, and his atti-
tudes help to determine the learning situation for himself and his
associates. The teacher brings his experience to the classroom
and may become a valuable resource. Other people in the com-
munity-specialists, parents, and community leaders-may be
used to encourage young people to understand the community in
which they live, its problems, its needs, and its organization for
making improvement possible. In this way, boys and girls have
opportunities to grow in active citizenship and to develop an
understanding of the possibilities for developing a healthful and
safe community for all the people.
Books, magazines, newspapers, films, filmstrips, charts, radio,
television, still pictures, and models offer rich possibilities for
expanding the experiences of boys and girls. Carefully chosen
materials, properly used, can broaden understandings, offer ac-
curate scientific information, and motivate an interest in problem
solving. The use of a variety of media of communication can keep
the learning situation fresh and interesting to the young people.
Places, too, should be considered in choosing desirable in-
structional resources. A visit to the county health unit may offer
children a better opportunity to understand the services and role
of this agency than printed materials or lectures. A field trip to
the dairy, school lunch kitchen, or welfare department might
motivate an interest in reading, seeing motion pictures, and hav-
ing discussion about such important community services. The en-
tire community can be a classroom in which effective teaching
and productive learning occurs.
In recent years, there has been a constant increase in the
variety and improvement of instructional materials available for
use by teachers. It is important that teachers remain well in-
formed concerning the availability of appropriate material and
that the school administration provide budget and facilities to
make such materials available and usable.
Audio-visual materials include such special communication
devices as dramatizations, demonstrations, field trips, radio, re-
cordings, television, motion pictures, and projected still pictures.
Such material is extremely valuable to the good teacher, and
proper use of these devices results in effective learning. However,
skill is required for the proper utilization of visual aids; con-
sequently, they lose much of their value when improperly selected
or used as a substitute for skillful instruction.
It is well to remember that:
1. The showing of a film, viewing educational television, tak-
ing field trips will not assure learning. Careful planning
and preparation for this type of teaching are necessary if
maximum benefit is to be realized.
2. The teacher must select with care the aid to be used at a
specific time and for a specific reason. Each aid has its own
peculiar limitations as well as its special advantages. Selec-
tion depends upon what is to be taught and the outcome
3. Assistance in the selection of audio-visual aids and their
use is available from the state and local health departments,
the state department of education, and the county school
4. The field trip, although classified as a visual aid, is of a
special nature in this category and presents some special
problems. Some school systems have prepared field trip
guide books. Since the guide book is based upon previous
experience, it can be most valuable and helpful to the
teacher. The guide usually includes information on planning
and procedures to be followed, places that may be available
for visitation in the community, and trips appropriate for
different grade levels. Such classification of trips makes
them more meaningful and eliminates duplication of ex-
periences at the different grade levels. It is suggested that
each school prepare a field trip guide. Some suggested field
trip possibilities are contained in the following list.
Suggested Field Trip Possibilities For Various Grade Levels
Dairies and creameries
School Lunch Depart-
Family service agencies
Food freezing plants
School lunch depart-
Home garbage disposal
Home food preserva-
tion and storage
Home water supply
Home safety centers
Home gardening cen-
Sewage disposal plants
Vegetable and meat
City or school incin-
Custodial and correc-
Day homes or special
schools for children
Federal housing au-
Printed material includes textbooks and the great variety of
magazines and pamphlets on almost every subject related to
health which are made available at little or no cost by many dif-
ferent groups and agencies. With the great amount of material
available, the selection of that which can be used effectively and
appropriately becomes extremely significant. In selecting material
to be used, consideration should be given to:
1. The scientific accuracy, current status, and appropriateness
of the content for the age level.
2. The manner of handling content, or the slant given to in-
3. The educational and psychological soundness-interest-
arousing and motivational qualities.
4. The technical qualities-type size and style, layout, paper
stock, quality of illustrations, and use of color.
Selection of Resources
Having discovered the problems needing instructional empha-
sis, the teacher must be concerned with selecting the best ways
and means for accomplishing the desired results. The very nature
and extent of the problems themselves will also point to the best
resources to be employed. Important factors to be considered
are: (1) the child; his knowledge, background, needs, and inter-
ests; (2) the teaching situation; its type, occasion, and time
limits; (3) the specific outcomes desired in terms of understand-
ings, attitudes, and practices.
Each county health department has numerous pamphlets on
various health subjects, which are suitable for both teachers and
Current List-Health Leaflets and Pamphlets available through
the State Board of Health may be obtained by writing to the
Division of Health Education, Florida State Board of Health,
Jacksonville. Two other lists entitled National Sources of Material
and Florida Sources of Material are also available.
Listed below are examples of sources which offer health
materials. These are only examples and should not be considered
a complete list:
Basic Book Collection for Elementary Grades. 7th Edition, Chicago:
American Library Association, 1960.
Basic Book Collection for Junior High Schools. 3rd Edition, Chicago:
American Library Association, 1960.
Basic Book Collection for High Schools. 6th Edition Chicago: American
Library Association, 1958.
Educators Index to Free Materials. Randolph, Wisconsin: Educators
Educators Guide to Free Science Material. 3rd Edition, Randolph,
Wisconsin: Educators Progress Service. 1962.
Elementary Teachers' Guide to Free Curriculum Materials. Randolph,
Wisconsin: Educators Progress Service, 1960 to 1961-62.
Florida School Lunch News, Tallahassee: State Department of Ed-
Free and Inexpensive Learning Materials. Nashville, Tennessee: Divi-
sion of Surveys and Field Services, George Peabody College for
LeFevre, John R. and D. Boydston. Annotated Guide to Free and In-
expensive Health Instruction Materials. Carbondale, Illinois: South-
ern Illinois University Press, 1959.
Library Journal. Recommended Children's Books of 1960-61. New
York: R. R. Bowker Company.
Pepe, T. J. Free and Inexpensive Educational Aids. New York: Dover
School Lunches 1952-1961, A List of References. Library List No. 74.
Washington: National Agricultural Library, United States Depart-
ment of Agriculture.
U. S. Government Publications Monthly Catalog. Washington: Gov-
ernment Printing Office.
Vertical Files Service Catalog. New York: H. W. Wilson Company.
Westcott, Howard E. Guide to Teaching Materials in Elementary
Health Education. San Francisco: Chandler Publications, 1959.
Audio-Visual Catalog, 1962-63. Jacksonville, Florida: Florida State
Board of Health.
Educational Film Guide. New York: H. W. Wilson Company.
Educators Guide to Free Films. Randolph, Wisconsin: Educators Prog-
Educators Guide to Free Filmstrips. Randolph, Wisconsin: Educators
Educators Guide to Free Tapes, Scripts and Transcriptions. Randolph,
Wisconsin: Educators Progress Service.
Filmstrip Guide. New York: H. W. Wilson Company.
Guides to Newer Educational Media. Chicago: American Library As-
Health Film Catalog. New York: Educational Film Library Association.
U. S. Library of Congress. Motion Picture Division. Guide to U. S. Gov-
ernment Motion Pictures. Washington: Government Printing Office.
DeBernardis, A. Use of Instructional Materials. New York, Appleton,
Woefel, Norma. How to Reach Your Teaching Goals with Teaching
Aids. Teaching Aids Laboratory Pamphlet No. 2. Columbus: Ohio
State University Bureau of Educational Research and Service, 1955.
One of the best and most recently prepared discussions of
health education materials and resources is presented concisely
in Chapter 12 of Health Education, 5th Edition, 1961, published
by the National Education Association of the United States, 1201
Sixteenth Street, N.W., Washington, D.C.
Healthful School Living
T HERE IS LITTLE doubt that the influence of environment
on the individual is a strong one. How each person develops
as a member of society and as a human being is affected mark-
edly by his surroundings. The public school plant, therefore,
represents the people's investment in the future. It should be
designed to serve the following general purposes related to health
to improve the health of children and teachers
to provide safety
to develop aesthetic appreciation
to offer opportunity for some of the functional
teaching in health.
School children represent a cross-section of the home life of
the community, and among them will be found the same health
problems which exist in the community. The construction of the
school building, insofar as environmental sanitation is related to
the transmission of disease and the physical and mental well-be-
ing of teachers and pupils, is of utmost importance from the
standpoint of public health. The school administration is responsi-
ble for providing a healthful physical environment. Administra-
tors and classroom teachers are responsible not only for the best
educational use of the environment but also for keeping the en-
vironment as healthy, safe, and attractive as possible.
Building sites, plans, and later on actual construction should
be reviewed by environmental health specialists in the county
health department as well as the State Board of Health.
While the school administration assumes the major responsi-
bility in the provision of a safe and healthful school environment,
the health department must necessarily share this responsibility.
One phase of a wholesome environment that must not be
overlooked in planning a school site is that of beautification. A
spacious lawn, shrubs, and trees should be provided in front of
and around the buildings. Shrubs and trees should be spaced and
kept trimmed so that they will not obstruct the source of natural
light in any window area.
In addition to the requirements concerning the provision for
playgrounds, it is recommended that a well managed sod should
be maintained on grass areas. Regular cutting, sprinkling, fertiliz-
ing, and seeding are vital factors in good maintenance. Courts and
diamonds should be constructed to provide for a variety of ac-
tivities in a well-balanced play program. All playground equip-
ment should be so located that children will be safeguarded from
moving parts. The equipment should be set in substantial founda-
tions and should be inspected for safety at regular intervals. A
fence enclosing the playground is a desirable safety feature.
Detailed information on requirements for adequate sewage
disposal systems may be found in Chapter IV and Chapter XXXI
of the Florida State Sanitary Code. A copy of the code can be
obtained by writing the State Board of Health in Jacksonville.
The most satisfactory method of disposing of school sewage is by
connection with a municipal sewerage system. If there is no
municipal system, special facilities must be arranged.
Facilities for water supply for all schools should be con-
structed, operated, and maintained in accordance with the regula-
tions of the State Board of Health, Chapter I and XXXI, Florida
State Sanitary Code. The drinking water used in schools is of
great importance from a health standpoint.
The use of common drinking cups is unlawful. Sanitary slant-
jet drinking fountains should be installed in the ratio of 1 to
every 100 pupils and teachers, with not less than two for each
School architecture now emphasizes the needs of children.
The trend today is toward one-story buildings. This type of
structure has had considerable to do with the better schools avail-
able for pupils, teachers, parents, and the community.
The temperature in classrooms is important at all times. Effort
should be made to maintain consistent, comfortable room tem-
perature. Temperatures should be maintained at not less than
700F. except in toilet and activity rooms, such as the gymnasium
anid shops, where a minimum of 650 is acceptable.
Ventilation must serve a number of purposes and comply with
a number of conditions before it can be considered satisfactory:
1. It must bring in fresh air from outside in order to dilute
and remove the products of respiration.
2. It must maintain the air within the room at a proper tem-
perature and humidity level and keep the air of the room
in gentle and continuous motion.
3. It must remove the gases, odors, bacteria, dust, and other
substances that contaminate the air of enclosed spaces.
,4.;,A minimum air space of 200 cubic feet per person should be
.. provided in all occupied rooms.
Ventilation facilities should be constructed, operated, and
maintained in accordance with requirements of the Florida State
Sanitary Code, Chapter XXXI.
Air-conditioning is becoming more and more a part of school
construction. The problems of ventilation are lessened to a large
degree by air conditioning. Some evidence is available that the
teachers and pupils work better in this type of atmosphere. The
question of whether more learning is achieved because of air-
conditioning has not been satisfactorily answered, but this ap-
pears to be the case and deserves intelligent consideration by ad-
The lighting of classrooms is related to the physical well-being
of the children not only as an educational but also as a health fac-
tor. As in temperature, either excessive or inadequate amounts
of light are unsatisfactory for the desirable learning situation.
A. Natural Lighting
Uniformity of brightness has an important bearing on the
usefulness of light as well as the quantity of light, according
to authorities. Brightness ratios in a field of vision in excess
of 10 to 1 have been found to cause fatigue, eye strain, and
other disorders. Lighting and vision authorities have con-
cluded that the goal for brightness ratios in any given field
of vision should be less than 5 to 1, preferably 3 to 1.
B. Artificial Lighting
Artificial lighting should supplement the available daylight
sources, and in no case shall the amount of artificial light
provided for instructional rooms be less than 20 foot-
candles at task level with 30 foot candles being preferable.
C. Other Factors
1. Seating Arrangements. To provide the best working light
in the school child's visual field with a minimum of shad-
ows, the seating arrangements should not be located in
straight rows paralleling the side walls but should be
altered so as to give each child individual consideration
according to his visual or auditory needs. Each desk
should be turned away from the leading edge of the front
window at an angle of 50 degrees. A child seated at a desk
rotated in this manner normally will not have any direct
sky light on the eyes, will have the maximum amount of
light on the working or desk surface, and will have a mini-
mum body shadow on the desk. The desk tops should be
tilted at an angle of 20 degrees with the horizontal to con-
form with a point of minimum stress as worked out by
body mechanics. No desk should be placed in front of the
front window mullion or behind the back window mullion.
Note: Item 1. was developed by the Texas State Department of Health, but the same
holds true in Florida.
Seating is one of the important problems in the school from
the standpoint of health. For general purposes, in most
schools, it is found that the chair and table type is the most
desirable, as it is possible to rearrange this equipment for
many different types of groups or activities and to move
the furniture out of the room to make way for an area of
The furniture should be of the proper size or adjustable so
that when a child is seated his feet are able to rest on the
floor without his knees touching the bottom of the desk.
Frequent adjustment of all seating equipment should be
made in keeping with the changing needs of the children.
Special Service Rooms
A. Health Suite
Wherever possible, rooms with special facilities should be
designated for the health services within the school plan.
These rooms should be located away from the noisy areas
of the schools, such as gymnasiums and shops, and should
preferably join the administrative unit. Where only one
room can be established for the use of health personnel, it
must necessarily serve for a clinic room, teacher-nurse con-
ferences, administration of first aid, health examinations,
and isolation of pupils who are suspected of having con-
tagious diseases. Where more room can be arranged for
health purposes, separate rooms for clinic purposes and iso-
lation should be maintained. Lavatory and toilet facilities
should be easily accessible. Minimum equipment within
the health suite should be a cot, a lavatory, cabinet space
for first-aid supplies, a table and chairs, a sanitary waste
container, and platform scales. Other highly desirable
pieces of equipment for such a health room would be a
two-compartment sink with a closed cabinet, additional
tables and chairs, a sterilizer, a file for records, screens
for isolation purposes, a footstool, bulletin boards, and a
desk for the health personnel. A quantity of paper sheets
and pillow cases should be on hand for the cots in order
that fresh linen may be available for each use.
Planned space with suitable connections for water and
electricity should be made for mobile health services.
B. Teachers' Lounge
A teachers' lounge contributes to the health and emotional
well-being of the teachers. It is generally recommended
that the administration do everything within its power to
provide such a facility. Policies appropriate to the com-
munity should be maintained by the group using this room.
The room should be large enough to provide for chairs,
sofa, bookcases, magazine racks, and space for personal be-
longings of the professional staff. There should be toilet and
lavatory facilities provided as a part of the teachers'
C. School Lunch Department
A school lunch department is essential to every good
school. It should be located on the first floor and be ac-
cessible from a service driveway, from the rest of the
school building, and from the outside for evening and va-
cation use by the public without opening the entire school.
The required capacity of lunch facilities is based on the
school enrollment. The necessary space in new buildings
can be determined accurately only by a functional layout.
School lunch buildings, equipment, and food handling prac-
tices should conform to the standards set forth in Florida
State Sanitary Code.
In the construction of a gymnasium, it should be remem-
bered that the primary purpose of the building is to pro-
vide a place for carrying on a balanced health, physical
education, and recreational program not for entertaining
the public. Health education classes should be scheduled
away from the gymnasium. The floor area should be ex-
tensive enough to meet the needs of a highly enriched
physical activity program. Shower, drying, and dressing
rooms should meet state recommendations as to size and
facilities. To provide realistic educational health experi-
ences in physical activity should be the primary objec-
tive of this structure.
E. Toilet Rooms
Indoor flush toilets should be provided for public schools.
At least one toilet room for each sex is required on each
floor, and the entrance to them should be well separated
and clearly marked.
Primary grades (1-2) should be provided with toilet and
handwashing facilities within or immediately adjacent to
the classroom, and such toilet rooms are considered ade-
quate without urinals through the fourth grade.
Toilets should be easily accessible from playgrounds
Toilet rooms should be located within the building to
provide cross ventilation and a maximum of direct sun-
light within the room.
Handwashing facilities, soap, and towels are essentials
in rest rooms in all schools. Hot water is recommended,
and mirrors are very desirable in the schools' toilet
A janitor's sink should be provided near each toilet
room so that the custodial staff will have a place to
wash their mops and other cleaning equipment.
While certain standards are set and inspections are made by
Health Department sanitarians, the primary responsibility for the
maintenance of a clean and sanitary school plant rests upon the
custodial staff. The school administrator again is responsible for
all actions and conditions taking place or existing within the
TUntrained personnel should not be held accountable for un-
sanitary conditions in a school building. Intelligence and proper
training in satisfactory methods are necessary if the building is to
be sanitary. The custodian should use supplies and utilities as
efficiently as possible. He is responsible for keeping the school
buildings, its fixtures, furniture, and equipment clean so the
students can appreciate a clean and tidy environment.
Garbage cans should be kept tightly covered at all times and
should be periodically cleaned and washed. Disposal is best ac-
complished by utilizing municipal or commercial pick-:up and
disposal services. Where such services are not available, care
should be taken to dispose of waste materials in a manner ap-
proved by the county health department in order that unsanitary
conditions causing odors, smoke nuisance, and pest problems not
Insect and rodent control in and around the school is an im-
portant part of sanitation. The service of the county health de-
partment may be needed for control measures beyond the im-
mediate environs of the school. This service may be obtained on
application to the county health officers.
The teaching staff can render assistance to the custodial staff
by helping children establish habits of good housekeeping
throughout the day. Administrators should set up work schedules
for the custodians and standards of cleanliness to be maintained.
A complete list of duties and activities of the custodial staff
should be outlined.
Florida school administrators are constantly on the alert to
make their schools as responsive to the needs of youth as possi-
ble. They conclude that time and space will not permit the full
realization of all youth's needs, but those which relate to sur-
vival must be emphasized in a fundamental manner.
Since accidents are the leading cause of death of pre-school
and school-age children, it is apparent that a more intensive and
effective educational program is required if children are to be
spared crippling disabilities and death as a result of accidents.
Although records indicate that deaths resulting from accidents
which occur in the school are relatively few, the fact remains
that many serious accidents, which might have been prevented,
can and do occur in the school. Therefore, it is imperative that
the best possible safety features and procedures be included in
the design, construction, maintenance, and use of school facilities.
All schools should establish policies relating to the movement
of pupils in the building and the movement of vehicular traffic
on the grounds. Careful thought should be given to designating
bus loading zones and to all operational procedures related
thereto. A plan should also be developed with regard to the
orderly reporting and handling of all school accidents.
School Safety Patrol
School boys, and sometimes girls, are used in many schools to
assist children across dangerous street intersections. The boys
should not direct traffic from the street but work from the curb
with flags. The flags should be placed on poles which the boys
can extend into the street to stop traffic when children are ready
to cross the street. A faculty sponsor should be appointed to give
this group guidance. Sometimes a police officer is assigned as
sponsor or co-sponsor. Time should be given to the proper train-
ing of the school-boy patrols so that they will be effective in their
work and cause a minimum of slow-up in traffic. The student
body should realize the importance of the work of the patrols and
follow their direction. The patrol not only is instrumental in re-
ducing accidents but it also has a definite educational value
through training young people to become good leaders and fol-
Attention should be given to provide stop signs, designated
safety zones, and police patrol during congested periods. A haz-
ard often overlooked by the school administration is that caused
by the lack of sidewalks. It is the responsibility of the adminis-
tration, working in cooperation with city and county officials,
to arrange details which will provide the necessary facilities ad-
jacent to the school for children who walk to and from school.
In the construction and maintenance of any new school build-
ing and in the maintenance of any existing school building,
special attention should be given to protecting and safeguarding
the students from fire hazards. All school buildings two or more
stories in height which do not have fireproof or fire resistant
stairways and corridors and adequate exits should be provided
with at least one adequate and easily accessible fire escape for
each 250 pupils enrolled in the school (Section 235.26, Florida
Any school plant with six or more classrooms not protected
by the services of a public fire department must be provided
with chemical fire extinguishers approved by the National Board
of Fire Underwriters and conforming to Subsection 21b, Section
235.26 Florida Statutes, 1951. Fire extinguishers should be promi-
nently exposed to view and always accessible. The principal of
each school should see that each extinguisher is recharged an-
nually. It is desirable that as many of the school personnel as
possible know how to use effectively a fire extinguisher.
There should be placed in a hall or corridor of each school
plant an alarm consisting of a bell or gong, arranged or equipped
so as to be accessible at least at one convenient station or place
upon each floor and of sufficient size and volume of tone to be
distinctly heard in each room when sounded (Subsection 21c,
Section 235.26, Florida Statutes, 1951).
It is the responsibility of the school administration to secure
routine inspections of the site, building and equipment, water
and waste facilities, food service, and other environmental health
factors. If hazards are found they should be corrected immedi-
ately. Inspection service may be provided by the county health
Supervision of Play Activity
At all times that children are on the school grounds, adequate
supervision must be provided. It is very important that proper
organization and supervision of play activities before school, dur-
ing free periods, and after school be recognized as a definite re-
sponsibility. A physical education period should provide instruc-
tion related to the safe use of all facilities located on the school
In order to operate effectively in an emergency situation, it
is well to be prepared for such emergencies with written school
health policies. The emergency care plan should be developed by
the principal, the school health coordinator, the medical advisor,
the nurse, and other school staff members and be made available
for handling illness and injury. It should contain directions con-
cerning emergency care of a sick or injured child; referral
sources; and other items which would be required in case of an
emergency. Arrangements for providing for first aid kits should
be made in accordance with the section on First Aid in the
Handbook for School Health Coordinators, published in 1960 by
The Florida State Department of Education, Tallahassee.
The Human Environment
Although the physical resources of the school environment are
important aspects of the child's school life, the relationships he
builds with the human resources in the school are the truly in-
fluential factors in his willingness to accept the school health
Every adult in the school-custodian, school lunch worker,
teacher, or administrator-is responsible for maintaining con-
stantly a warm and friendly atmosphere which helps the child
feel that he is known and accepted as a human being.
Unless this positive human environment is achieved as an
integral part of the school program, the school experience can
devastate a child, filling him with resentment and hostility which
is then often demonstrated in negative behavior.
School Health Services
T HE COUNTY SCHOOL BOARD and the local health depart-
ment share a joint responsibility by school statutes for the
school health program. In addition, they and other groups, such as
physicians, dentists, workers in voluntary health agencies, and
other professional health personnel, have a moral responsibility
for the health and well-being of all children.
As a result of discussions, decisions, and recommendations of
county school health planning committees and school health com-
mittees, school health services may vary somewhat from county
to county and from school to school within a county. However,
in most instances, school health services will encompass and in-
clude activities directed toward:
1. the determination of health needs
2. follow-up and interpretation of these needs
3. care of emergency illness or injury
4. disease prevention and control
5. accident prevention.
School health services, properly conceived and carefully de-
veloped, contribute to the realization of educational aims, mini-
mize problems of school attendance, facilitate adaptation of
school programs to individual abilities and needs, and help chil-
dren obtain the health care needed.
The purposes of an adequate health appraisal of the school
child are threefold. The appraisal should serve:
1. To provide accurate information for the teacher, nurse,
parent, or other interested person responsible for the
child's physical or emotional well-being.
2. To identify the child who needs treatment or referral to a
physician, a dentist, or personnel of related health profes-
sions or agencies
3. To identify the children with non-remedial defects who re-
quire an adapted program such as children with epilepsy,
speech defects, cerebral palsy, and heart disease.
A. Teacher Observation
1. The teacher's contact with the child enables him to
observe behavior and other conditions daily which
might otherwise pass unnoticed by others during a
short association with the child.
2. Daily observations by the teacher will help to dis-
cover some of the following:
a. Conditions which may indicate visual disturb-
(1) Crust on lids and lashes
(2) Red eyelids
(4) Swollen lids
(5) Watery eyes
(6) Apparent lack of coordination in eye move-
(7) Any of the following types of behavior:
Attempting to brush away blur.
Blinking continually or frequently while
Showing signs of nervousness, irritability
when doing close work, frequent crying or
fits of temper.
Holding the book too far away or too close
Squinting to see the blackboard or holding
the body tense when looking at a distant ob-
Showing inattention to wall charts or maps.
Rubbing eyes frequently.
Showing inattention to reading lesson.
Thrusting head at unusual angle.
Complaining of frequent headaches.
Demonstrating poor alignment in penman-
Exhibiting reversal tendencies in reading.
Confusing letters in reading and spelling,
such as mistaking an o for an a, e for c, m for
n, n for r, f for t.
Making apparent guesses for a quick recog-
nition of parts of words in easy reading ma-
b. The teacher should test vision and refer those
children with symptoms of eye defects to the
public health nurse who will call the attention of
the parents to the defects and suggest that satis-
factory remedial measures be taken.
(1) Every child's visual acuity should be tested
at least once a year. For a number of years,
the Florida State Board of Health has advo-
cated vision screening of children in schools,
employing the Snellen test as an adjunct to
teacher observation in the detection of chil-
dren with possible vision problems. Vision
screening in schools is usually done accord-
ing to policies governing the testing program
of the county school system and the county
health department. Such vision screening
represents but one aspect of the total school
(2) Vision screening, as well as other types of
screening tests, are not diagnostic and every
effort must be made to maintain this distinc-
tion since the school is an educational institu-
tion and must not become a clinic or a hos-
pital-type operation. In the school situation,
health services, including all types of screen-
ing testing, is educationally-oriented rather
(3) Schools in Florida have access to some type
of screening device for vision through their
local health department. Some schools use
the Snellen Chart or a lighted Snellen, and
some use screening instruments.
(4) Directions for using the Snellen test are in-
cluded here and, when requested, the nurse
will demonstrate to the teacher the proce-
dure to be followed.
Directions for Using The Snellen Vision Test (Wall Chart)
If a child wears glasses, test first without
glasses and then with glasses.
Test both eyes together, then the right, then
With children suspected of impaired vision,
begin at the top of the chart. With other
children, begin with the 50-foot line and
proceed with test to include the 2-foot line.
Keep unused portion of the line covered,
using a "window card." Expose one symbol at
A young child may indicate with his hand
which way the "E" points; older children
may prefer to state directions. Alphabet type
chart is also used.
Move promptly and rhythmically from one
symbol to another at a speed with which the
child seems to keep pace easily.
Show one vertical and one horizontal symbol
on a line and move to the next line. Reading
three out of four symbols is usually con-
sidered evidence that the child sees the line
Record vision of each eye. Record as though
it were a fraction. Numerator is distance child
is from chart (20 ft), and the denominator is
the last line read accurately. (This should not
be interpreted as percentage of vision. 20/30
visual acuity does not indicate % of normal
In routine vision testing, the Snellen Chart should
be hung where it receives adequate light but not in
a glaring light. The child should be twenty feet from
the chart so that his eyes are at a level with chart.
A reduced Snellen Chart should also be used to test
vision at the reading distance. The child should hold
the chart in his hand about fourteen inches from his
eyes, and vision should be checked and recorded as
with the wall chart.
The teacher should record any symptoms of eye
straining noted during the testing such as:
Thrusting head forward
Watering of eyes
Frowning or scowling
Closing one eye during test when both eyes
are tested together
The teacher should refer to the nurse those older
pupils who have visual acuity of 20/30 or less in
either eye and younger children (ten years old or
younger) who have visual acuity of 20/40 or less in
c. Symptoms often associated with hearing difficul-
(1) Discharging ears
(3) Turning head to hear
(4) Asking others to repeat conversation
(6) Excessive noisiness
(7) Inability to repeat accurately things heard
(8) Picking at ears
(9) Talking in a monotone
(10) Emotional problems
Early discovery of defective hearing is extremely
important. The more common means for detecting
hearing problems are:
(1) Use of the audiometer.
(2) The whisper test.
The teacher is 20 ft. to the side of the child
to be tested. Right ear is tested first. Teacher
whispers one syllable words which child re-
peats if he hears them. If a teacher has to
come four or more feet closer for the child to
hear words or numbers, the child should be
referred to the public health nurse.
(3) The watch-tick test.
This test is similar to whisper test except for
the use of a watch instead of words.
A child may lose a considerable amount of
hearing ability without being aware of the
loss, and medical aid may not be sought for
him until it is too late. The problem is one of
prevention, examination, diagnosis, treatment,
Obviously the school must play an important role
in solving the problems of speech defects, retardation,
and emotional maladjustments associated with de-
d. Dental Inspection
(1) Children should be prepared in advance for
dental examination and treatment in order to
allay fear and to create the right atmosphere
for using the situation as an educational ex-
perience. This should be done regardless of
whether the child is examined by his family
dentist or at the local clinic.
(2) Teachers, nurses, other specialists, and par-
ents should confer about special care for
children with dental defects and marked
(3) Teachers should follow up the examination
to encourage dental corrections and to deter-
mine if corrective dental service has been
received after dental examinations.
(4) The teacher and nurse should become famil-
iar and use the guide Design for Teaching
Dental Health, Bulletin #7, State Depart-
ment of Education.
Children having the following should be referred
to the public health nurse for further examination:
(1) Prematurely loose baby teeth
(2) Decayed temporary or permanent teeth
(3) Highly reddened, irritated, bleeding gums
(4) Any sore in mouth that does not heal in two
(5) Permanent teeth out of alignment
(6) Speech defects
(7) Broken down tooth roots
(8) Repeated absence from school due to tooth-
(9) Poor mouth hygiene
e. Throat and nose. Children having any of the fol-
lowing should be referred for further examina-
tion to -the public health nurse.
(1) Repeated attacks of sore throat
(2) Earache or discharging ears
(3) Obvious chronic mouth breathing
(4) Visibly enlarged neck glands
(5) Recurrent colds
(6) Chronic nasal discharge
(7) Frequent nose bleeds
(8) Nasal speech
f. Posture. The teacher should watch children for
signs of slumping and careless habits of walking,
standing, and sitting. Children with abnormal
posture habits should be referred to the public
g. Nutritional problems. It is desirable that a teacher
learn to recognize signs and symptoms of mal-
nutrition, such as an unusual pallor or the pale
sallow complexion of the child with hookworm so
that he can detect any problems existing in the
classroom. Changing eating habits is a difficult and
slow process, but children's habits can be im-
proved. Because of this fact, nutrition should be
an integral part of the school curriculum. (See
discussion under school lunch.)
h. Teachers should refer children for further exami-
nation if any of the following signs are noted:
(1) Abnormal nervousness or irritability
(2) Repeated absence because of sickness
(3) Evidence of abnormal fatigue
(4) Infections of scalp or skin
(5) Lack of general cleanliness
(6) Continual withdrawal from the group
(7) Retarded mental or physical development
B. School Health Records (MCH 304)
1. In planning the health appraisal part of a school
health program, the need for records becomes
apparent. School Health Record (MCH 304), ap-
proved jointly by the State Board of Health and the
Department of Education, is recommended.
2. School health records should be filed and kept in the
school at all times. It is advisable for these records
to be kept in a locked permanent file in the classroom
in the elementary school so that the teacher will have
easy access to them for the purpose of making neces-
sary notations as significant changes or conditions
develop in individual pupils.
3. Records should not be removed from the school.
Records should, however, be transferred with the
child's cumulative folder when he transfers from
one grade to another or from one school to another.
4. These records should be retained permanently and
treated as highly confidential, since they contain in-
formation on the child's personal history. The
teacher, principal, public health nurse, parents, the
health officer and through him the private physician
or dentist or authorized personnel in related health
professions, are the only persons who should have
access to these records. Other persons desiring access
to the health records should be required to obtain
permission from both the county superintendent of
schools and the county health officer as well as the
principal of the school.
5. The principal's responsibility in record keeping is:
a. To obtain a supply of health records, form MCH
304, for the school by requisitioning them from the
local health department.
b. To arrange for and ensure permanent filing and
preservation of health records of all children in
c. To obtain health records, whenever possible, of all
d. To encourage and guide teachers regarding keep-
ing, using, and filing health records.
6. The teacher's responsibility in record keeping is:
a. To see that the record is properly filed for ready
reference and to see that it contains up-to-date
b. To initiate a record for each new pupil, filling in
information and data such as family history and
immunization history on MCH 304 form. This is
done for pre-school children or children entering
school for the first time.
c. To record on form MCH 304 the findings of any
screening tests. Parents, Gray Ladies, and in some
cases high school students may assist the teacher
d. To record significant illnesses or injuries for each
pupil as they occur.
e. To make school health records available to the
public health nurse so that she can enter thereon
pertinent information gained during the follow-up
program and record her comments and observa-
tions on each child.
A new form of the school record, MCH 304-B,
came into existence when the new school stat-
ute (322.111) Driver Education for Minors was
passed. This statute requires a physical examina-
tion before enrolling in a driver education course.
The regular form, School Record, MCH 304, is
still available and will continue to be used. The
new form MCH 304-B is a supplemental form used
only for a physical examination.
(See a sample of the MCH 304 Form and a sample
of the MCH 304-B Form and instructions which
are reproduced on the following pages.)
INSTRUCTIONS FOR SCHOOL RECORD MCH 304-B
To provide a means for recording medical examinations for the
following: preschool, High School Driver Education course, athletes or
other special school examinations. This form may be used for physical
examinations for teachers.
EXPLANATIONS AND DEFINITIONS
This is a medical examination record developed by the State Board
of Health, the State Department of Education and the School Health
Medical Advisory Committee to these two agencies for use in Florida
public schools. The proper use of the record will permit machine proc-
essing of the recorded data, providing statewide descriptive informa-
tion with regard to the physical health status of Florida school children.
In order to accomplish this, all items must be checked as indicated. ( V )
Please note that this record requires a minimum expenditure of
time on the part of the teacher and physician in order to record the
information. Information is recorded simply by inserting appropriate
digits, or by making a check mark in the code boxes corresponding to
the descriptive characteristics. For example:
E. Student Age
Col 14 15
Code 0 7
C e 0 '7 shows that the child is seven years of age.
Columns 1 and 2 should show the month of the year; for example,
March should be shown by putting a 3 in column 2; October would be
shown by putting 1 in column 1 and 0 in column 2. The same would
apply for recording the year, using the last two digits of the year. The
county number is listed alphabetically; for example, Alachua would be
1 and Washington would be 67. Columns 7, 8, 9 and 10 are for recording
the county school number. The other column numbers are self-explan-
atory for sex, birth registration and cultural group.
Part I. "History of Immunizations"-See instructions on reverse
side of form. Individual's immunity status as of the time of examina-
tion should be given. In the case of measles vaccine, it should show
any disease experience or vaccination, if done. If a vaccine is given on
the date of examination, it should be recorded with the date.
Part J. "Physical Examination"-In order to code material on IBM
records, it should be indicated whether condition is normal or abnor-
mal; and if the latter, indicate degree of abnormality, such as fair or
Item 42. Refers to physical exercise and a temporary restriction
may mean for only one week or two weeks. Permanent restriction is
Item 43. Refers only to the recommendations of the physician as to
applicant's physical ability to drive a car.
There is no place for nurses' comments on this record since it is to
be used entirely to report the physical condition of the child. Other
forms are provided for this purpose.
The student, parent and teacher should fill out items 1 through 18.
Then the form will be taken to the physician who will complete Parts I
and J. Part I, that is Items 19 through 26, may be completed by the
health department or the persons who have the immunization record of
After the record is complete, it will be turned over to the school to
be kept by the classroom teacher or in the principal's office depending
upon the individual school plan.
nl- maY C --- -
nAoPrm rAl 1n9K E
DAEO IRH.. ...BRHREITRD:YS __NO __LCEO IT
DATE OF BIRTH BIRTH REGISTERED: YES NO-PLACE OF BIRTH
IMMUNIZATIONS CLINICAL & LAB TESTS DISEASE EXPERIENCE
DATE DATE DATE DATE DATE DATE TYPE RESULT DISEASE YEAR
DIPHTHERIA Pertunis Tetanus
SKIN & SCALP
MOUTH & THROAT
DATE SIGNIFICANT FACTS AND PHYSICIANS' NOTES (WORKER SHOULD INITIAL EACH ENTRY)
CODE: 0- Satisfactory; 1, 2, 3 Slightly, Moderatedly, Markedly Unsatisfactory; X Needs Attention; No Information; 00 Corretion
Record approved by State Department of Education and State Board of Health School Record MCH 304
Iul A &A
VISIT SERVICES RENDERED, HOME VISITATION & PARENT CONFERENCES
DATE A INFORMATION SECURED, ADVICE GIVEN, PLAN FOR CORRECTION
S E 'Worker Should Initial Each Entry)
S z i,
TESTS GIVEN BY TEACHER
VISION W/O GLASSES R L R L R L R L R L R L R L R L R L R L
VISION WITH GLASSES R L R L R L R L R L R L R L R L R L R L
HEARING R L R L R L RL R L L R L R L R L R L
TEACHER'S OBSERVATION DURING SCHOOL YEAR
TEACHER'S NAME OR INITIAL
GRADE WHEN OBSERVED
FREQUENT STYES, CRUSTED LIDS, INFL
EYES FREQUENT HEADACHES
SQUINTS AT BLACKBOARD AND BOOK
EARACHES AND DISCHARGING EARS
FAILS TO HEAR QUESTIONS
NOSE & PERSISTENT MOUTH BREATHER
THROAT FREQUENT SORE THROAT OR COLDS
MOUTH OBVIOUS NEED FOR CARE
SKIN & SKIN ERUPTIONS
GENERAL POOR MUSCULAR COORDINATION
CONDITION BAD POSTURE
APPEARANCE SPEECH DEFECT
NERVOUSNESS OR RESTLESSNESS
TOO LITTLE GROUP PARTICIPATION
HEALTH LACK OF EMOTIONAL CONTROL
HABITS EXCESSIVE USE OF TOILET
POOR FOOD HABITS
CtOI: Sofisftaetr y; 1. 2, 3 Sightly, Modrotedly, Mork*dly Untisfaoctry; X Needs Attention; o information; 00 Correctio n
RECORD OF STUDENT MEDICAL EXAMINATION
TEACHER AND PHYSICIAN PLEASE READ CAREFULLY: All student and school identification information is to be recorded by
the teacher or parent PRIOR to the physical examination. The physician is to check appropriately all items 19 through 45 and
note pertinent comments on the reverse side of the record.
-C C A. Date Mo. Yr. B. County No. C. School C C D. Student Number: E. Student Age
0 --- 00
L D Col 1 2 3 4 C 5 6 7 8 9 10 L D Col 10 11 12 13 Col 14 15
Code Code Code Code
H. Cultural Group
16 1 F. Mole 17 1 G. Birth is Registered 18 1 Anglo-Saxon
2 Female 2 Birth NOT registered 2 Indian 4 Negro
3 Unknown 3 Latin 5 Other
I. HISTORY OF IMMUNIZATIONS AND SKIN TESTS
(For Definition of Standards, See Other Side)
19 1 Satis. Diphtheri- Dates 23 1 Satis. Polio Dates
2 Unsatis. Tetanus 2 Unsatis.
20 1 Sati. Diphthria 24 1 Sats. Typhoid
2 Unsatis. Tetanus 2 Unsatis.
71 1 Satis. T25 1 Yes B Te
2 Unsatis. 2 No
22 1 Satis. 26 1 Satis.
m Smallpox Measles
2 Unsatis. 2 Unsatis.
J. PHYSICAL EXAMINATION
(Significant Medical History, Findings, Recommendations)
27 1 NUTRITION, Normal
28 1 ORTHOPEDIC, Handicap
2 Defect, No Handicap
3 No Defect Found
29 1 SKIN AND SCALP, Normal
30 1 EARS, Normal
2 Hearing Loss
3 Other Abnormality
71 1 EYES, Normal
2 Poor Vision
3 Other Pathology
32 1 NOSE, Normal
Record Approved by State Department of Education and State Board of Health
SCHOOL RECORD MCH 304-B
7 ? I
*f a- a-
33 1 TEETH, Good
34 1 MOUTH and THROAT, Normal
35 1 LYMPHATICS, Normal
36 1 HEART, Normal
37 1 LUNGS, Normal
38 1 ABDOMEN, Normal
39 1 GENITALIA, Normal
40 1 SPEECH, Normal
41 1 No History of SEIZURES
2 History of Seizures, Specify
42 1 PHYSICAL ED., No Restriction
2 Temporary Restriction, Specify
3 Permanent Restriction, Specify
43 1 DRIVING, No Medical Restriction
2 Restriction, Specify
3 Not Applicable
44 1 FOLLOW-UP Indicated
2 Follow-Up Not Indicated
45 1 Examination Conducted by Private Physician
2 Exam. Conducted by Public Health Physician
Physician's Signature and Address
46 1 Follow-up Recommendations have been complied with
"Satisfactory" means that immunization has been completed and all indicated boosters are up-to-date at time
of examination. Accepted standards require boosters of DPT combination(or single vaccines)every 3:4 years,
polio vaccine at least every 2 years, and smallpox revaccination every 3-5 years. Typhoid vaccine booster
every 1-2 years. For tuberculin tests, check yes or no and date. For measles, indicate disease experience or
Physical Examination Continued
C. Special Testing and Health Screening
1. Pre-school examinations
a. The school should develop a plan for locating
pre-school children who will be entering school
the following year. When possible, such a plan
should also concern itself with younger children,
two and three years of age.
b. The school should encourage parents to have
children examined by their family physician,
dentist, and opthalmologist or optometrist well in
advance of the opening of school, so that defects
may be corrected prior to the child's entrance into
school. Findings of these examinations should be
entered on the school health record (MCH 304).
Indigent children may have these examinations
through the county health department or what
ever other method the county proposes.
c. The school should seek assistance of the P-T.A.
and other appropriate groups in encouraging
parents to place children under early, continuous
2. Screening of school children
a. Screening may be defined as a selected process of
health appraisal to determine the children who
need further attention or examination. Periodic
screening of children is primarily the responsibil-
ity of teachers, with the assistance of nurses and
certain special technicians.
Screening by the teacher has a multiple purpose.
It not only notes apparent physical defects which
may need correction but also helps the teacher to
understand the child more completely. Screening
may serve to guide the teacher in making any
indicated adjustments to help the child.
b. Any variation in height and weight patterns of an
individual child may indicate a health problem.
(1) It is suggested that teachers investigate the
possibility of using the Meredith Physical
Growth Record of the Wetzel Grid which may
be obtained from the American Medical As-
(2) In order that height and weight measure-
ments may be reliable, an adequate number
of beam type scales should be provided, at
least one in each school.
(3) Periodic weighing of all children should take
place at least annually. It is advisable that
elementary school children (because of rapid
growth and changes at these ages) be weighed
and measured at least three times a year, or
every three months.
(4) During the growth period a child should show
some gain in weight and height each year.
When these factors are measured, the teacher
should record them on the School Health
Record Form, noting the date.
(5) Referrals should be made to the public health
D. Medical Examinations
1. Pre-examination suggestions
a. Parents should place children under continuous
medical supervision from birth. It is recom-
mended, therefore, that these examinations be
arranged privately rather than through the health
department, except in cases of medical indigency.
b. Screening should be conducted by the teacher and
nurse if deemed necessary prior to the physician's
medical examination. The medical examination
should be given only after a teacher-nurse con-
ference regarding the findings of the preliminary
screening. Such conferences provide the medical
examiner with information that helps him deter-
mine his course of action. They may point out
conditions that would pass unnoticed otherwise,
and such information may serve to help all con-
cerned to better understand the child and his
c. Sufficient preparation should be made so that the
examination will be an educational health experi-
ence for the child and parent.
d. The parent should be notified in writing by the
teacher of the day, time, and place of the examina-
tion of the child and should be encouraged to be
present during the examination.
e. If the parent is not present at the time of the
examination and defects are found, notice for re-
ferral should be prepared by the health depart-
ment and be sent to the parent.
2. Examination of entrants and transfers
All children entering a school for the first time (in
the first or any other grade) should be examined. It
is preferable that this be done by a private physician,
dentist, and personnel of related health professions
and that findings of such examinations be entered on
the School Health Record Form MCH 304.
3. Periodic examination
One examination is recommended at the time of en-
try into school, one at the beginning of adolescence,
and one before leaving school. The Accreditation
Standards for Florida Schools suggests that all
children have a physical examination at the first-
grade, seventh-grade, and tenth-grade levels and the
results recorded on MCH 304. Pupils who have
serious defects or abnormalities, who have suffered
from serious or repeated illnesses, or who engage in
vigorous athletic programs require more frequent
examinations. The students doing poor school work
may benefit by a thorough physical examination to
determine if their deficiency is physical. The physi-
cian is the best judge of the need for repeated exami-
nations and of the frequency with which they should
be given. Additional examinations, even annual ex-
aminations, may be arranged if money, time, and
personnel permit; but quality medical procedures
and careful judgment should not be sacrificed for
frequent and complete coverage of the entire school.
Medical examinations should be comprehensive to
command medical respect, informative to guide
school personnel in the proper counseling of the stu-
dent, and personalized to form a desirable educa-
Annual medical examinations, with chest X-ray of
administrators, teachers, clerical personnel, bus
drivers, school lunchroom personnel, and custodial
personnel should be required. The physical condition
of all who come in contact with children is important
and all precautions should be exercised to protect
Protection Against Communicable
And Infectious Disease
A. Exclusion and Readmission Policies
1. It is possible to endanger the health of the school
child through overemphasizing school attendance,
therefore school policy should not set too great a
value on perfect attendance. Parents should be en-
couraged to make careful observation of their chil-
dren before sending them to school in order to help
prevent exposing a group to a child who might be in
the first stages of a communicable disease.
2. Exclusion of Sick Pupils
a. The teacher is responsible for recognizing a child
who shows any signs or symptoms of illness and
for referring the child to the principal, nurse, or
proper authority for exclusion from school. Cases
of communicable diseases should be reported im-
mediately to the county health department.
b. The teacher should be continuously alert to note
any child who deviates from his normal health
and behavior. The teacher should take particular
care in observing children for early signs of a
c. It is an approved state policy that no treatment
shall be given by the teachers with the exception
of first aid for injuries. (If, in certain locations,
exceptions for minor and specific procedures are
made, these must have the approval of the local
medical society, county health officer, and school
d. Any child considered by the teacher to be sick
should be isolated-placed apart from all other
children until arrangements can be made to send
the child home. A sick child's parents are respon-
sible for taking care of him and should be notified
immediately. The parent should be encouraged to
have a physician check the child.
e. According to Florida law, a school child who has
been ill with a communicable disease shall in no
case be allowed to return to school except on the
written permission of the full-time county health
officer or other reputable physician licensed to
practice in Florida (Section 232.35).
f. Personnel of the county health department should
keep the school authorities informed about inci-
dence of communicable disease, furnish informa-
tion and assistance when requested by schools, and
guide the schools in raising health standards,
thereby reducing disease incidence in the com-
B. Immunization and Vaccination
1. The school is responsible for the distribution and
collection of permit slips for immunizations given in
2. School personnel also assist in selection of children
needing immunization. The following recommenda-
tions are made by the State Board of Health and
may be modified from time to time depending upon
a. Ideally school age children will have received a
course of diphtheria-pertussis (whooping cough)-
tetanus immunizations in infancy (current pedi-
atric recommendations are that the initial three
dose series of this triple vaccine be started at 11/2
to 2 months of age) and will require boosters
every 3-4 years. If primary immunization has not
been given in infancy, it should be started at the
earliest opportunity. Under the age of 6 years the
combined triple antigen is recommended; over the
age of 6 years single antigens or combined diph-
theria-tetanus toxoids without pertussis vaccine
may be used because of severe reactions, such as a
high fever, which may follow the use of triple
antigens in older children. For children over 8
years of age an "adult type" diphtheria toxoid
(alone or combined) is usually substituted for the
standard diphtheria toxoid which may produce
severe reactions in persons over 8 years of age.
b. Initial smallpox vaccination is best carried out
toward the end of the first year of life (reactions
are least likely during this age period) and pref-
erably during a relatively cool season of the year.
Revaccination is recommended every 3-5 years
thereafter and immediately upon any known or
suspected exposure or in presence of an epidemic.
c. Tetanus toxoid is most commonly given in com-
bination with diphtheria and sometimes pertussis
(whooping cough) antigens as described in an
earlier paragraph, but it may be given singly ac-
cording to same schedule (initial series in early
infancy, booster after 1 year, then every 3-4
years). Boosters are also given after animal bites,
puncture wounds, and crusted or suppurating
d. Typhoid immunization is not usually recom-
mended routinely but may be given in rural areas
where typhoid is prevalent, during epidemics, or
before foreign travel. Boosters are needed every
3 to 4 years depending on likelihood of exposure.
e. Poliomyelitis vaccine (Salk type) should be
started at 11/2 to 2 months of age and may be given
separately at the same time as DPT or in com-
mercially available "quadruple" vaccines. After
the initial series, boosters are recommended every
two years. Oral vaccine is started at same age in
infants or at any age in older individuals. Three
doses are given, each of a different type. The
choice as to whether injected or oral vaccines are
to be used is made by the physician depending
upon individual community situations.
f. Most immunizations done outside the schools will
be performed by the child's family physician. Since
the family physician has intimate knowledge of
the child's health status, he may choose to vary
his procedures, in the case of certain children,
based upon his knowledge of the health status of
each child in his care.
SUGGESTED IMMUNIZATION SCHEDULE1
11/2 to 2 months D.P.T.
3 months D.P.T.
4 months D.P.T.
6 to 12 months Smallpox vaccine
12 months D.P.T.
2 years Poliovaccine
4 years D.P.T.
6 years Smallpox vaccine
8 years D.T. ("adult type")
10 years Poliovaccine
12 years D.T. ("adult type")
14 years Poliovaccine
16 years D.T. ("adult type")
'Recommended by American Academy of Pediatrics, 1961.
Communicable Disease Regulations
Case-patient-is a person or animal who shows signs and symp-
Stoms of sickness due to a specific infection.
Communicable Disease-An illness due to an infectious agent or
its toxic products which is transmitted directly or indirectly to
a well person from an affected person, animal, or other organ-
Period of Communicability-is considered as the period involved
from date of first exposure to an infection until the infecting
micro-organism is no longer present as revealed by examina-
tions of the patient.
Contact-A contact is any person or animal known to have been
in such association with an infected person or animal as to have
been presumably exposed to infection.
Contamination-Contamination of a surface (wound), article
(handkerchief or eating utensil), or substance (water or milk
or food) means the presence of disease producing agents on it
or in it.
Immune Person-An immune person is one who possesses or is
able to produce sufficient specific response to protect him from
illness following contact with the causative agent of the disease.
Immunity is relative and an ordinarily effective protection may
be overwhelmed by an excessive dose of the infectious agent.
Immunization-The induction or introduction of specific protec-
tion in a susceptible person or animal.
Incubation Period-The time interval between the infection of a
susceptible person or animal and the appearance of signs or
symptoms of the disease.
Infection-The entry and multiplication of the particular disease
agents in the body of man or animal. The presence of living in-
fectious agents on exterior surfaces of the body or on such
articles for human use as apparel or toilet article is not infec-
tion, but is soiling of such surfaces and articles.
The term infection should not be used to describe conditions
of inanimate matter such as soil, water, sewage, milk,'or food,
which are described in the term contamination.
Isolation-The separation for the period of communicability of
infected persons from other persons, in such places and under
such conditions as will prevent the direct or indirect convey-
ance of the infectious agent from infected persons to other
persons who are susceptible or who may spread the disease to
others. (This applies also to animals.)
Lesion-An injury, a wound; a sore.
Mucous Membrane-The lining of canals communicating with
the air (such as nose, mouth, throat).
Quarantine-The limitation of freedom of movement of such
persons or animals as have been exposed to a communicable
disease, for a period of time equal to the longest usual incuba-
tion period of the disease, in such manner as to prevent effective
contact with those not so exposed.
Segregation-The separation for special consideration, control,
or observation of some part of a group of persons from others
to facilitate the control of communicable disease.
Emergency Care Following Accidents
and Sudden Illness
A. Suggested General Policy
1. Simple first aid and emergency medical care are the
responsibility of the school personnel. The principal
or a member of the school staff trained in first aid
should be designated to care for the more serious
accidents. Trained volunteers may also be used as
clinic aides. Minor first aid, such as for scratches and
abrasions, should be administered. It is recommended
that every teacher be informed on standard first aid
methods and procedures, including mouth-to-mouth
resuscitation. Pamphlets describing this procedure
should be secured from the local health department
and the Red Cross.
2. Every accident which is treated should be recorded
on the National Safety Council form or a similar,
accident form. The school staff should have a stated
emergency care policy providing for notification of
Time to Observe
Disease (Incubation Period)
Signs and Symp-
Length of Acute
Communicability Control and Pre-
Period vpentivp lTronrPa
Chickenpox From 14 to 21 days
Diphtheria Usually 2-5 days,
sometimes a few
From 14 to 25 days;
usually about 18
Measles From 7 to 14 days,
(Rubeola) usually 10 days.
may be given to
make case milder.
Mild fever; erup-
tion looks like small
water blisters. Be-
gins on trunk, often
in groins or axillae.
Sore throat, mod-
erate fever, swollen
neck glands; gray-
ish white membrane
sometimes seen on
back or side of
Mild symptoms of
head cold, followed
by rash on face and
body. Swollen glands
Usually brief, 3-4 1 day before to 6
days. Child not very days after appear-
sick. ance of rash.
Two weeks or less if
May have prolonged
Brief, a few days.
Child does not feel
Usually 2 weeks
from onset. After
treatment, 3 nega-
tive throat cultures,
taken at least 24
hrs. apart, are gen-
erally required for
From 4 to 7 days
after onset of symp-
Fever, red, watery 5 or 6 days as a rule. About 4 days before
eyes, cough. Kop- Longer if any cor- until 5th day after
like's spots (look like plications. rash appears.
grains of salt on
inside cheeks) are
missed. Rash begins
on face, neck,
spreads to body.
None specific. Ex-
None for child. Girls
should have rubella
before the child-
used as preventive
in pregnant women
-likelihood of dam-
age to unborn child
Gamma globulin in
preventive dose to
ill child. Same in
modifying dose to
make case milder in
older child. Vaccine
Stage Period ventive Measures
Meningitis Variable. Usually 3-
7 days with range
of 1-10 days.
Mumps From 14 to 28 days,
average 18 days.
Poliomye- Usually 7-14 days,
litis may be less.
Smallpox Usually 12 days,
range 8-12 days.
From 2-5 days.
Fever, headache, 7-10 days.
stiff neck, vomiting.
Spotty red rash may
Swelling of glands
in neck in front of
and below ears. One
side usually affected
first, other side a
few days later.
stiff neck, vomiting
follows after 3-4
subsides in 7-10
Prolonged if any
Sudden fever, chills, 2-4 weeks.
Rash follows, blis-
Sudden onset, nau-
sea, vomiting head-
ache, sore throat,
followed by bright
red rash which fades
ally returns to nor-
mal in a week. Scar-
let fever rash peels
after 1-3 weeks.
Brief (48 hrs.) if
is given (usually a
penicillin or other
ered infectious until
swelling has disap-
most infectious dur-
ing early stages and
until after 1st week
From first symp-
toms until all scabs
and crusts have
Isolation of patient.
Sulfa given to con-
tacts who should be
Avoid contact (not
used as preventive
in adult males in
are likely. Compli-
cations not frequent
should be repeated
at least every 5 yrs.
(Usually for 10
days) with penicil-
lin or other antibi-
otics is of value in
tic fever and kidney
Time to Observe
Disease (Incubation Period)
Signs and Symp- Length of Acute
Control and Pre-
Whooping From 5 to 21 days
Cough almost always with-
in 10 days.
Begins as ordinary Cough and whoop- Most infectious dur-
cough, later occurs ing may persist 6-8 ing early stages and
in spasms, some- weeks. for at least 3 weeks
times "whoop" de- of whooping period.
velops after a week
or two. Child may
vomit after cough-
SKIN DISEASES (INFECTIOUS)
Impetigo 1-5 days
Pediculosis "Nits" or eggs hatch
in about 1 week.
may ooze, become
yellow and crusted.
around nose and
Flat, spreading red
patches on body.
Cracks between toes.
toenails and finger-
nails. Ringworm of
scalp produces scaly
plaques covered by
short broken off
Itching, scabbed le-
sions over body or
scalp. Nits in hair
Variable depending As long as sores are
on personal hygiene. present.
Very persistent con-
dition. May recur
even after treatment
if personal hygiene
As long as fungus
is present in the
As long as there are As long as insects
live insects on body, or nits are present.
hair, or clothing.
and water scrubs,
clipping of hair
around scalp lesions,
application of oint-
ments. Caps used to
cover infected head
(must be boiled
after use). Inspec-
tion under wood
light (filtered ultra-
violet light) reveals
and shampoos are
parents and further procedures to be followed in
cases of serious accidents.
3. Each child's cumulative record folder should contain
the following information:
Name, address, and phone number of family physi-
Name, address, and phone number of another phy-
sician in case the family physician is not available.
Written permission to contact another physician
when the preferred ones are not available.
Written assurance from the parent that the child
has been cleared for treatment at a nearby hospital
in cases where the serious condition indicates such
action. This can be necessary because of lack of a
family physician and preference by parents.
B. Transportation of Sick Children
1. The principal should arrange with one or more re-
sponsible adults to transport sick children from the
school to the home or hospital in cases where it is
impossible for the parents to come for the child. This
particular problem has been met in some communi-
ties by cooperation with local civic organizations,
although the ultimate responsibility remains with
the principal. By making arrangements for transpor-
tation with a responsible adult other than a teacher,
the necessary supervision of other school children is
2. If the child is in such state that he may not be moved
safely, medical care and treatment should be secured
and costs should be defrayed under established
policies for such emergencies.
C. The First Aid Kit
1. First aid kits should be readily available (but in-
accessible to elementary school children) in adequate
2. In the elementary school one kit will ordinarily be
adequate for each three hundred pupils.
3. In the larger schools first aid kits should be easily
accessible during such activities as strenuous ath-
letics and conveniently located with respect to the
boiler room, the kitchen, laboratory classrooms, and
4. An instruction sheet showing approved procedures
of first aid should be posted in each first aid kit.
5. Each accident should be used as a teaching opportu-
nity in the interests of safety.
6. Suggested guides for first aid procedures and con-
tents of the kit are available free from some insur-
ance companies and are listed in the Red Cross In-
struction Book (nominal price).
7. Suggested equipment for the first aid kit or cabinet:
a. Green soap
b. An antiseptic such as tincture of Merthiolate
c. Aromatic spirits of ammonia
d. An ointment for first degree burns, such as
e. Oil of cloves
f. Band-aid (1 inch)
g. Gauze bandage (2 inch)
h. Adhesive (1 inch and 2 inch)
i. Absorbent cotton
m. Triangular bandages
o. Small basin
p. Splints, plastic or wood
q. Safety pins
r. Glass, drinking
First aid practices may vary slightly from community to com-
munity, therefore, the suggested items for inclusion in the first
aid kit should be reviewed and approved by the local health
officer and the appropriate medical association.
D. General Statement on Medications:
Medication unless under medical supervision should never be
administered by principal, teacher, or any school personnel.
The Follow-Up Program
1. One of the purposes of the school health service
should be to prevent and eliminate defects as well as
maintain and promote good health. The follow-up is
important. Some corrections will not be obtained by
the parents unless there is sufficient follow-up. The
parents generally are interested in getting the correc-
tions done if economically able, but sometimes they
need advice and direction on what to do. It should be
remembered that unless the follow-up is carefully
planned and diligently pursued the value of the total
program is decreased.
2. The facilities and resources available in a community
must be completely known before a plan can be
organized for a follow-up program, and the problems
peculiar to the local community must be understood
by the health and school authorities.
3. The health officer with the county school health
planning committee should establish the plan and
cooperate with the private physician. The entire pro-
gram and especially the part related to obtaining
correction of defects should be planned and devel-
oped with the aid and understanding of private phy-
sicians and the professional health societies.
1. The scope of the follow-up program includes all those
processes and procedures which are employed to
follow the child to obtain the desired corrections and
treatment. Everyone concerned with school health
has an important role in the follow-up.
a. The public health nurse, because of her close as-
sociation with the family and her relationship to
the school, community, and other health workers,
has a major part in the follow-up work.
b. The individual teacher, because of his close as-
association with the child and parent, also has an
important role in the follow-up procedures.
2. Because of their effect on physical and mental devel-
opment, remediable defects should be corrected early
in the life of the child. Children with non-remediable
defects should be helped to understand their limita-
tions and to develop their optimum potentialities.
3. Follow-up must be continuous and active with the
child, family, and community until the desired treat-
ments or corrections are completed.
4. Proper procedures for obtaining family-aid services
should be familiar and understood by county superin-
tendents, principals, and teachers as well as person-
nel of the county health department.
5. Parent interest in obtaining corrections should be
6. There should be procedure developed whereby the
school and the health department can keep each
other informed of the correction of defects as these
corrections are secured.
7. There should be cooperation among pupil, parents,
nurses, teachers, and principals in selecting cases for
Mental Health Services
Mental health services are available to the teachers in thirty-
eight counties through mental health clinics or mental health
workers. The remaining counties have access to these services
through referral by the county health department.
If a teacher feels the need for consultation on some aspect of
his pupil's mental health, she should arrange to discuss the prob-
lem with the public health nurse in her district. The public
health nurse can then make the proper referral to the mental
health resources available to that county.
A. Counseling, including effective follow-up procedures, may
well have a greater influence upon improved health of
children than any one single activity included in the school
health program. Health counseling is a procedure designed
to help pupils and parents understand and respect the
nature of conditions revealed by various appraisal and
screening techniques. Counseling aims at encouraging
parents to provide and obtain the care that their children
need, and in instances where parents cannot fulfill this
responsibility counseling helps in locating resources avail-
able for meeting these needs.
Some of the more specific aims of counseling are:
1. Provide pupils with information about their health
status, gained from the various appraisal procedures
which they can use to good advantage in improving
2. To interpret health needs of children to parents so as to
encourage necessary parent action.
3. To motivate pupils to accept needed treatment or
changed practices in order to attain improved health.
4. To increase health knowledge of pupils and parents
through an individualized approach.
5. To enable individuals who may influence or contribute
to the improvement of a pupil's health status to make
a group approach toward resolving the physical and
emotional needs of a specific individual.
B. There is another form of consultation which occurs, and
even though the child or parent is not directly involved,
each stands to benefit because the child's welfare is the
subject on which the consultation is centered. Such con-
sultations may include two or more of the following
individuals or groups: teacher, principal, physician, dentist,
optometrist, opthalmologist, health department, parent
organizations, voluntary health agencies, and civic groups.
Such consultations will be as much concerned with pro-
tecting and promoting the health of all children as they are
with meeting the needs of a particular child with a special
School Food Service
One of the most important health services of the school is the
provision of nutritionally adequate food for all children in the
Full and proper use of the school lunch will not be fully
realized unless pupils are taught to appreciate the quality and low
cost of the school lunch and its superiority to foods offered by
If breakfasts are known to be inadequate or deficiencies are
apparent, more than one-third of the child's nutritive require-
ments for the day should be provided by the school lunch.
Some selected criteria' for judging a school lunch program
A. Foods and beverages served at school should be those
which most effectively meet the nutritional needs of pupils
and promote the development of desirable food habits.
B. Lunches should meet one-third of the pupils' daily food and
nutrition needs. The recommendations for the Type A
lunch provide guidance in meeting these needs.
C. Foods other than the regular lunch and recommended
between-meal snacks should not be served.
D. The school lunch should be supervised by persons qualified
to advise on nutritive values, sanitary operations, and edu-
E. Children should have time to wash their hands before the
meal and time to eat in a relaxed atmosphere.
1 Taken from Health Aspects of the School Lunch Program. A report of the Join
Committee on Health Problems in Education of the National Education Association and
the American Medical Association.
F. Long waiting lines should be avoided by increasing the
number of noonhour shifts, if necessary.
G. The cost of the lunch should be the lowest price possible
for an adequate meal.
H. Food handlers should be under constant supervision. They
should be checked for communicable disease, skin infection,
or other condition through which food might be con-
taminated. They should be sensitized to the importance of
proper food handling and sanitation practices.
I. In-service training programs for school lunch managers,
supervisors, all full-time and part-time food handlers, and
all persons concerned with sanitization of equipment
should be provided. This may be a cooperative venture
between the school and the public health authorities.
J. There should be planned progress to interpret the objec-
tives and values of the school lunch program to all school
personnel, children, parents, and the community-at-large.
K. Cooperation with parents should be an integral part of the
total educational program associated with the school lunch.
L. A school lunch committee involving both adults and chil-
dren, either as a part of a school health council or of a more
inclusive school-community health council, aids in coordi-
nation of the school lunch program.
HEALTH EDUCATION, as a process, involves providing
learning experiences for the purpose of influencing favor-
ably knowledge, attitudes, or conduct relating to individual, com-
munity, and world health.
Where Health Learning Occurs
Health education is an action program concerned with real
people living in real situations. The ability to recognize health
problems in the school, home, or community, to find solutions,
and to institute and carry out programs that change undesirable
conditions, actions, and beliefs are the real tests of the effective-
ness of a program of health education.
Health education concerns itself with man's existence, his
adjustment and survival, and is founded on biological and social
Health education in school, like every other aspect of learning,
is a product of experiences. The individual patterns of behavior,
healthful and unhealthful, are influenced by many forces.
It is important to determine which of the goals that contribute
to optimum living are to be achieved through health instruction
and which are to be left to other areas of the curriculum. The
importance placed upon good health by school officials and the
community in general and the time available for the teaching of
health will, to a great extent, determine the experiences provided
through health education.
Home, School, and Community Must
Work Together for Health
The health program of the school should supplement and re-
enforce the health efforts of the home and should be closely
coordinated with all community efforts to provide healthful
learning experiences. The child's first learning experience in
health occurs in the home. The health knowledge of parents is
strongly influenced by outside factors in the environment and by
health information received from many varied sources, both
reliable and unreliable. Many homes are still influenced by infor-
mation and misinformation handed down from generation to
generation. Radio and television in the home, public exhibits,
newspapers, magazines, and other media of communication are
all channels through which health education takes place. Public
services and commercial enterprises within the community also
exert influence upon the health behavior of parents and their
children. Information received does not solve health problems;
it does create interest, stimulate thinking, and sometimes lead to
action. It is important that these influences are recognized and
that both children and their parents are provided with facts that
enable them to weigh carefully the information to which they
are constantly exposed and to choose wisely.
The environment in which a child grows and develops is an
entity. However, schools, parents, and health groups frequently
act independently of each other with apparent disregard for the
universality of the child's environment. Such action results in
duplications or omissions and frequently results in complete dis-
service to the child. Those who influence the environment of the
child are obligated to work cooperatively to provide those ex-
periences which contribute constructively to the pupil's health
learning. Teachers must be concerned with the home and com-
munity in which the child lives. Health departments, professional
groups, and civic agencies must be concerned with the manner
in which the school influences the child's health as well as the
influences of the home.
Relationship of Health Education to the Total
School Health Program
Health is one of the primary goals of education; therefore, all
educators have some responsibility in this area and almost every
area of the curriculum has some opportunity to contribute to
health education. A fully-developed and well-conceived school
health program requires the participation of the entire staff
working toward common goals.
Health education is a means of developing understanding
about health and how it may be attained and improved. It is
also a procedure for securing desirable action based upon sound
The school health program includes all school experiences and
activities designed to protect, improve, and promote the health
and well-being of children. Health education of the child must be
a planned part of the total school health program in order that
desirable health practices and attitudes may be more nearly
When the health of the child becomes a common objective of
the entire school system, it can be emphasized in proper perspec-
tive. When this occurs, there is little doubt that the child will
develop a respect for the importance of health and assume some
responsibility for his own health, as well as that of his family and
What a pupil learns can influence his health, and his health
can influence his ability to learn. As the health of the individual
improves, so does his application to learn. When poor vision or
impaired hearing is corrected; when the causes of poor nutrition,
tenseness, anxiety, or frustrations are removed, the close relation-
ship between the pupil's health and his ability to learn becomes
obvious and dramatic.
The School Setting
Learning experiences in health education are provided
through the school environment. The cleanliness and sanitation
of toilet facilities, the water supply, the school grounds, and the
school lunch department directly influence the child's attitude
toward the importance of such practices and encourages him to
cooperate in helping maintain a clean environment. Improvement
and repair of the school plant, buildings and grounds, and interior
decorations provide excellent examples of good health practices
in action. The classroom can be an example of healthful living
with proper attention to such factors as lighting, glare, seating,
ventilation, cleanliness, and maintenance of toilet facilities..
The methods used in the instructional program and day-to-day
experiences of the students are factors which influence health
behavior of the pupil.
Length of the School Day
The frequency and length of rest periods and the adaptation
of individual pupil programs to physical and mental capacities
have a bearing on pupil health as well as on the pupil's applica-
tion to learning.
The School Lunch
The school lunch period provides many opportunities for im-
proving the health practices of pupils. It is quite possible that no
other phase of the school day offers greater possibility. Whether
or not full advantage is taken of the school lunch as an educa-
tional experience depends upon the interest and skill of the
teacher. Although the importance of the contribution of the
school lunch to the child's dietary needs cannot be over-empha-
sized, one must not lose sight of its potential educational implica-
When food eaten at school is nutritious, properly prepared,
and served in a pleasing environment, the following types of
teaching-learning opportunities are available to the alert and
1. Eating nutritionally adequate meals.
2. Developing taste for new foods and new combinations of
3. Practicing good personal hygiene, such as washing hands
4. Demonstrating the importance of cleanliness in the storage,
preparation, and serving of food.
5. Showing the relationship between adequate nutrition and
general good health.
6. Gaining knowledge of an optimum daily dietary intake.
7. Planning meals.
8. Developing proper eating behavior and manners
9. Cooperating in maintaining a clean and attractive lunch
10. Evaluating food waste and the effects of the availability of
soft drinks and candy on this situation.
The following problems, common in children and the general
population, should stimulate more aggressive action in the area of
1. Observable signs of poor nutrition among children and
2. Dental caries.
3. Inadequate intake of such foods as milk, fruit, and vege-
4. Underweight and overweight.
5. Omission of meals, especially breakfast.
6. Poor food habits and food wastes.
7. Misinformation about certain foods.
8. Substitution of soft drinks and sweets for essential foods.
The American Medical Association and the American Dental
Association have issued resolutions opposing the sale of soft
drinks and sweets in school cafeterias and during lunch periods.
Teachers should be further encouraged to intensify their ef-
forts to improve food habits through education by using the
wealth of good teaching aids now available in the form of films,
slides, pamphlets, posters, charts, etc.
The teacher of the primary grades can assist children in get-
ting acquainted with and being willing to try new foods. Oppor-
tunities will be present through which children can be helped to
understand the relationship between eating habits and growth.
Perhaps the most important nutrition learning to be achieved at
this level centers around the acquisition of good eating habits.
At the intermediate level, nutrition education should be
directed toward helping the pupil understand desirable food
habits and their relationship to health, growth, and proper weight;
developing knowledge of the basic food groups and the essential
nutrients supplied by these foods; developing desirable habits of
food selection; developing knowledge and practice of sanitation
in food service; and developing a desire to put into practice at
home that which is learned at school.
Junior high school pupils will readily understand the rela-
tionship of nutrition and adolescent growth and development,
vigorous health, and appearance. Information concerning mal-
nutrition and overeating will interest pupils of this grade level.
This age group is also receptive to learning about the effects of
emotions on good nutrition, the desirability of courteous manners
and pleasant surroundings at meal time; the importance of wise
buying, sanitary handling, adequate storage, and careful prepara-
tion of food; and the protective contribution made to health by
public programs in the provision of safe and sanitary water,
milk, and other foods.
Nutrition education at the high school level might well be
planned to help pupils achieve the following objectives:
Development of desirable attitudes concerning
(1) the importance of nutrition to achievement and appear-
(2) the contribution of each of the basic food groups to body
(3) an understanding of the best sources of different types of
(4) an appreciation of individual responsibility for foods
selection and eating habits
(5) an understanding of the various causes of eating problems
among children and how to cope with them
(6) the realization of the impact of advertising and the need
to be discerning concerning food facts and fallacies
(7) the knowledge of proper practices in relation to dieting
(8) understanding the need for modified diets for individuals
with certain types of illness.
Health Services as Educational Experiences
Almost every health service activity provides an excellent
opportunity for health education. It is important to realize that
education does occur as a result of a pupil's experience with this
service, whether or not such learning is planned. Attitudes con-
cerning the value and significance of medical and dental examina-
tions are developed. The measures instituted to control com-
municable diseases and promote general good health will provide
experiences that have a lasting effect upon the individual's be-
havior when he is confronted by similar situations. The quality
of health services and the manner in which they are rendered will,
in part, determine the individual's acceptance of physicians,
dentists, nurses, and other health personnel. In reality, and when
properly planned, the health service serves as a laboratory experi-
ence in health education.
Personal counseling and guidance which children receive con-
cerning their health needs and practices represent one of the most
effective approaches to health education. This counseling and
guidance is done by various types of public health personnel,
school personnel, parents, and family physicians and dentists. If
such counseling is to achieve maximum results, opportunities
must be provided so that each of those involved in the counseling
of the individual is aware of what is being attempted by the other.
When school personnel, health department personnel, private
physicians and dentists, and personnel of related health profes-
sions plan as carefully for the educational aspects of the health
services as they do for the specific medical, dental, and nursing
techniques involved, not only are the direct benefits increased but
also the indirect benefits reflected in lasting attitudes practices
and behavior are more nearly assured. The development of
proper attitudes, practices, and behavior is the real purpose of the
What to Teach
Meaningful health education experiences help pupils, at their
various levels of development and maturation, to meet their needs,
cope with their concerns, and solve their problems. A properly
conceived health education program considers that a person, as an
individual and as a member of a group, must make these acquired
applications in his own environment. The teacher, in order to plan
an effective educational program for children, must have an
adequate understanding of each child's health needs and interests.
Variations in the growth and development of the child; defects or
inadequacies; problems stemming from the environment in class-
rooms, in the general school surroundings, in the home, or in the
community; or problems that may arise from daily living must be
considered in planning the health curriculum.
The teacher is in a strategic position to notice the day-to-day
variations of the child's health, and these may afford opportunities
for incidental instruction. However, no one person can be ex-
pected to detect all of the varied problems in health which exist
among children. Only through cooperative study and planning
can these health problems be discovered and solved.
School personnel, parents, private physicians, public health
personnel, personnel of related health professions, and represent-
atives of other community organizations interested in health
should participate in the development of the health curriculum.
The following questions may prove helpful in discovering the
health needs and interests of boys and girls of school age and in
determining the educational experiences which are directed to-
ward meeting these needs and interests:
1. What are the social, emotional, mental, and physical character-
istics of children at specific age levels?
The teacher should understand the physical, social, emotional,
and mental characteristics of the age group for which he is respon-
sible. The degree to which individual children deviate from known
characteristics will indicate areas to be included in the health
education program. An understanding of children at specific age
levels will determine the teacher's choice of teaching methods and
2. How do health situations in the school furnish leads to needed
The total school environment has a decided influence upon
children. It is the teacher's responsibility to recognize the school
environmental forces affecting pupils and to guide their adjust-
ment in this environment so that sound educational experiences
A study of the local school environment as suggested in Chap-
ter 3, "Healthful School Living," of this bulletin, should suggest
many teaching and learning opportunities. The school lunch de-
partment, for example, should certainly be used as a laboratory
for health education. The type of room in which children eat, the
kind of food provided, and the children's food practices all pro-
vide educational opportunities. Other aspects of the school en-
vironment should be studied for the purpose of discovering addi-
tional practical educational experiences.
3. What are the health and safety practices of particular children
in specific situations?
The classroom teacher is in a strategic position to judge the
needs for health education based on an observation of the actual
practices of children in regard to handwashing, use of toilet
facilities, food handling, getting to and from school, and behavior
at play and rest. Informal discussions and conferences with other
teachers, parents, and other persons responsible for the health
guidance of children provide additional sources of information
concerning the health practices and problems of children.
4. What are some student interests that should be considered?
Recognition of pupil interest not only guides the teacher in
selecting what to teach but also helps determine the teaching
methods to be used. Student interest may be centered around play
activities, Boy or Girl Scout activities, hobbies, or a special event.
More general interest may be centered around the interest in
growth, a desire to be accepted by the group, or ambition to
achieve success. The degree to which health experiences are
related to interests will influence the degree to which health
experiences are significant to children.
5. What are the basic health needs of people?
Health needs of man have been described as food, exercise,
rest, safety, emotional health, and protection from disease and
accidents. A study of the pupil's understanding of these basic
needs will indicate some of the learning experiences required by
6. What are the findings of the health examination?
Information concerning the health status of each child may be
available in health records or secured through conferences with
the examining physician or the public health nurse. The teacher
may find it helpful to keep certain significant and appropriate
information concerning the health status of each pupil on separate
records. If, for example, visual defects or malnutrition are found
to be problems of specific children, attempts should be made to
remedy these through guidance, counseling, and education.
7. What are the health practices in the homes of children?
Through the use of informal discussions with the children,
simple pupil questionnaires, home visits, and conferences with the
nurse, the teacher can determine many of the home health
practices which influence the health attitudes of the children.
An awareness of home health practices will help determine the
experiences to be included in health and safety education.
8. What have been the previous health learning experiences of
Conferences with teachers, a study of the students' records,
results of health knowledge tests, pupils' self-inventory, and other
similar procedures will indicate some of the previous health ex-
periences of the pupils. An inquiry should be made concerning
methods and emphasis previously employed. The result of pre-
vious education should be both observed and tested. Such study
will reveal the needs for certain emphasis, for a change or con-
tinuance of certain methods, and for the introduction of new
9. What other study areas provide opportunities for health educa-
The opportunities for emphasizing and enriching health teach-
ing through other study areas should not be overlooked. The
health needs of children, rather than opportunities for correlation,
should determine the emphasis given to health by other subject
areas. If other subject areas are to contribute effectively to health
knowledge and practices, the teaching in other areas must be
planned with this objective in mind.
10. What are the health and safety hazards in the community?
The teacher's knowledge of community health and safety prob-
lems will indicate definitely the health education needed by the
children. Local statistics concerning the prevalence of certain
diseases; the causes of accidents; the safety of water, milk, and
food will. indicate other problems for consideration in planning
the health education program.
The measures employed for communicable disease control and
the possible presence of malarial mosquito breeding ponds or of
unsanitary privies will provide additional content for health edu-
cation. A visit of inquiry to the local health department or to
other official or voluntary agencies should disclose to the teacher
facts about these problems.
11. How may we use current health events or problems to in-
fluence health education?
A local epidemic, an accident, a pupil's illness, a program of a
specific health organization, a special health campaign may pro-
vide excellent opportunities for health teaching. Some of these
events can be foreseen and steps can be taken to develop student
interest and enthusiasm to the best educational advantage. Al-
through pre-planning is often impossible, the teacher who is con-
stantly aware of the health needs of pupils will be prepared and
ready to use such opportunities to stimulate and motivate pupil
12. What do statistics reveal concerning the most important
health problems in the state?
The most recent statistics should be secured through the local
county health unit. A study of Florida's major health problems
will point to many specific knowledge, attitudes, and practices
that Florida children should develop. The locality, need, age level,
and characteristics of the pupils will help the teacher determine
the degree to which each of these problems is important to the
13. How should health education be related to the general pro-
gram of education for elementary grades described in Bulletin 9?
Since the guidance of health experiences is an integral part of
the program of general education for Florida's elementary
schools, a study of Bulletin 9 should indicate additional opportu-
nities for effective health education procedures. This program is
based upon expanding interests of children and provides a plan
for gradation applicable to health education as well as to other
Suggestions Concerning Gradation
Suggestions for organizing the health experiences of the
various grade levels are outlined in this section. It is not the in-
tention to set up a pattern for adoption in schools. On the con-
trary, the plan and description of activities presented here are
offered as an illustration of methods and as a guide to selection.
While many of the experiences of the schools of one county may
be utilized in the schools of other counties, the educational pro-
gram is effective only when it is planned for a specific community.
Health education, including the gradation of health experiences,
methods employed, and materials used, should be consistent with
the curriculum and the general educational policies of the school.
Emphasis in health education at the kindergarten-primary
level should be placed upon establishing positive health practices.
Impressions gained by children at this age level often remain
through life. Health teaching should center around everyday
living experiences. Practically everything that goes on during the
day offers the alert teacher the opportunity to guide and direct
the child's health practices for the purpose of helping the child
develop healthful behavior and responsibility to the extent of
which he is capable.
At this early level, it is necessary for the child to recognize
immediate results from his health practices. The habits which he
learns to practice must be easily and pleasurably accomplished.
He must be surrounded by evidence proving the worth of the
habits which he is encouraged to cultivate. This evidence includes
the appearance and behavior of his teachers and his parents.
In most instances health teaching at the kindergarten and
primary level will include the following areas:
1. Avoiding accidents and knowing what to do when they
2. Selecting an adequate diet, learning to like healthful food
and how to behave while eating.
3. Caring for eyes, ears, and teeth and gaining respect for
physicians, dentists, and personnel of related health profes-
sions as individuals who help children keep well.
4. Recognizing the importance of exercise, rest, and sleep.
5. Choosing clothing appropriate for weather conditions and
for indoor and outdoor comfort.
6. Assuming increased responsibility for personal cleanliness
7. Adjusting to the environment, to other children, and to new
8. Inculcating practices that help the individual protect him-
self and others against communicable diseases.
9. Learning ways of helping to make the home, school, and
community safe and healthful.
The Intermediate Grades
Because pupils of the intermediate level have a variety of
health needs, and because they are eager and curious about them-
selves and the world around them, the teaching of health to this
group can be an extremely rewarding experience for the teacher.
It can also be a challenging experience, for these children have
reached a new level of maturity and have some knowledge of edu-
cational procedures. They have skills that enable them to pursue
Challenging problems and real life situations will provide
significant learning experiences for pupils of these grades.
The areas of health learning for boys and girls of the inter-
mediate grades will include many of those listed for kindergarten
and primary level; however, the objective of the teacher will be
to achieve a higher level of achievement for pupils of the middle
grades. In addition, new areas will be introduced. These new
areas will frequently include:
1. Posture and body control.
2. Structure and function of the human body. Instructions
about growth and development, especially 5-6 grades.
3. First aid and emergency care.
4. Evaluation of health services and health products.
5. Environmental health and how the communities' health is
The Secondary Grades
Sometimes the departmentalization of study at the secondary
level results in a serious neglect of health education. The guidance
of health practices, assumed to be every schoolteacher's respon-
sibility, may become no one's responsibility. Children who have
been carefully guided in their development of health practices
and attitudes in the elementary school should have this guidance
continued throughout the high school years, but with different
emphases and objectives. Otherwise, much that has been gained
earlier in elementary schools may be lost since pupils of this age
have not reached full maturity and total self-reliance.
The hoped for health practices and understandings at the
secondary level should be based upon the many problems faced
by young people for the first time. The adolescent finds himself
with an almost new body that is reaching adult proportions and
maturation. These changes present many perplexing and frustrat-
ing problems of adjustment. The growth development and matur-
ing of these boys and girls cannot be left to chance. They need
sound and scientific health information, and they need guidance
and direction in making wise decisions that affect their health
Responsibility for directing and providing orderly sequence of
health education in the secondary schools should be placed with
teachers who are specially trained and prepared for the respon-
sibility. However, through discussions, studies, and cooperative
planning of all secondary teachers, each can be made to under-
stand his role in providing experiences from which the secondary
level pupil can learn and mature.
Junior High School
If, in grades seven and eight, separate courses are offered, one
semester in science and one semester in health are recommended
as minimal. In schools developing integrated or core programs,
health should be included in the core areas, provided the teacher
is competent in the area of health. Where the core teacher is not
competent in health education, the suggested separate one-
semester courses in science or health should be offered.
Health education at the ninth-grade level should be offered
through a general science course and homemaking education un-
less it is included in the core program.
Areas that should be included in a junior high health course:
1. Personal health to include good grooming practices.
2. Nutrition and desirable weight control.
3. Community health, sanitation and communicable diseases.
4. Consumer health (health advertising: insurance, fads and
superstitions, and home remedies).
5. Family living (growth and development-boy-girl rela-
6. Mental and emotional health.
7. Safety education and first aid and home nursing.
8. Driver education (9th grade).
Senior High School
For grade 10, it is recommended that a health course be offered
and that health units be emphasized in biology courses. Health
education experiences should be expanded in grades 11 and 12.
Two alternatives for doing this are: (1) providing a special
course in health education, and (2) integrating health education
experiences with the existing areas of the curriculum. Whatever
procedure the school chooses to use, it is recommended that all
students be provided with a program which includes the follow-
1. Structure and function of the human body including normal
and atypical functioning.
2. Evaluation of individual health needs and the individual's
responsibility for meeting these needs.
3. Development of emotional and social maturity and under-
standing of maturing sex roles.
4. Preparation for marriage and family life.
5. Communicable and chronic diseases with emphasis on those
that are of greatest concern to the adolescent and adult such
as venereal diseases, cancer, diabetes, and heart diseases.
6. Consumer health which is directed toward making wise
choices of health products and services.
7. Accident prevention, recreational and occupational safety,
civil defense, and protection in time of disaster.
8. Understanding of effects of alcohol, narcotics, radiation, and
air pollution hazards; chemical hazards in the production
and processing of foods; and hazards associated with pesti-
9. Local, state, national, and international organizations for the
promotion and protection of health.
10. Opportunities offered by careers in health, such as medicine,
dentistry, nursing, optometry, and public health.
Many schools will require for graduation from high school a
course in health, as soon as it is administratively possible. If it is
offered as a separate course, it is recommended that one unit of
credit toward graduation be granted. When offered as a separate
course, it should be taught by carefully selected teachers whose
training in health education, personal characteristics, skill, and
experience fit them for this work.
When there is no separate course, the health education areas
listed above should be included in other appropriate courses. The
faculty should decide cooperatively the proper placement of
specific health experiences in other areas of the curriculum.
Competencies of the teachers and appropriateness of subject mat-
ter are important considerations in determining such placement.
Regardless of the plan used, additional emphasis on health
education should be accomplished through the inclusion of prob-
lems of community health in the social studies. Courses in
homemaking should give considerable emphasis to health prob-
lems related to the home and family. Physical education activi-
ties afford a natural setting for health guidance of pupils and
provide an opportunity for the practice of sanitation measures
and health principles related to physical activities.
All teachers of health should make use of specialists and re-
source persons in order to enrich the learning experiences and to
assure themselves that the facts they present are correct and
significant to the individual and community.
The program of general education of the first and second years
of college should include personal and community hygiene. The
objectives of this basic health course should be:
1. To provide a body of information concerning the function-
ing of all parts of the human body under various conditions;
the beneficial and detrimental factors of the environment;
their effects upon the body; and how these factors can be
used, modified or adapted to in order that improved health
2. To induce behavior which will assist the individual student
to attain and maintain optimum health-mental, physical,
3. To develop attitudes and understandings which will lead
the student to cooperate with community and group pro-
grams for health protection and improvement.
The health education of the general college student of the
junior college level should include nutrition, family living, mental
hygiene, effects of external factors on the body, control of disease
and infection, other major health problems, significance of the
periodic health examination, community health organization, and
evaluation of health activities and practices.
Evaluation of the Health Education Program
Evaluation is the process of determining the degree to which
objectives have been accomplished. The evaluation of educational
programs in the field of health is difficult. Pupil progress and
school improvement are often slow and difficult to measure in
specific, tangible ways. Home and community changes may be
still more slow and even more difficult to measure. Evaluation is
worthwhile, even though the ability to measure effectively is
It is profitable for a school and community to study what it is
doing in the light of what could be done and to evaluate its pro-
cedures in terms of accepted practices. A measurement of results
and accomplishments is helpful even though it is not precise or
Evaluation contributes to the effectiveness of a program by:
1. Showing where emphasis needs to be placed, pointing out
conditions that have been improved and those which
need further attention.
2. Detecting the strengths and weaknesses in the develop-
ment of the program, pointing out the effective and the
ineffective techniques and procedures.
.3. Demonstrating progress made by pupils in improving
health behavior. The measurement of effective health in-
struction is accomplished by observing the changed atti-
tudes and behavior of the pupils.
4. Providing information that is important in curriculum plan-
ning and in determining program content and methods.
There are many types of evaluation activities that may be
employed. Some of these are listed below:
1. Teacher observation. This is a widely used method of eval-
uation. The ease with which it may be handled leads to its
wide use. Records may be kept by noting conditions ob-
2. Interviews. Personal interviews with children and with
their parents may reveal information that is helpful in de-
termining progress in health education. It is important
that records of such interviews be preserved and be re-
tained for future reference.
3. Checklist or questionnaires. Instruments selected for use
may be a standardized national form, or they may be devel-
oped locally. They may include health attitudes, interest,
knowledge, or health practices. A self-appraisal inventory
may be designed for pupil use. Such inventories should
be made at regular intervals and improvement noted.
4. Records and reports. Health examination records, records of
attendance, causes of absences, and anecdotal records pro-
vide valuable information for consideration in evaluating
the effectiveness of the health education program.
5. Surveys and appraisals. Standard appraisal forms for use in
evaluating the total school health program are not available
at the present time. It is suggested that a school develop its
own forms to fit the local situation. Care must be exercised
in determining the activities to be surveyed and appraised.
6. Photographs and motion pictures. Both still pictures and
motion pictures are being utilized as a means of recording
developing programs of health education. They provide in-
teresting and appealing evidence of improvements made
and improvements needed.
7. Pupils' work booklets. Notations in work books may give
evidence of understanding health concepts. Health knowl-
edge may be measured by oral or written tests. It must be
remembered that health knowledge acquired does not nec-
essarily indicate health improvement made.
8. Cases studied. The detailed study of an individual pupil
may indicate changes that have occurred as a result of his
school health experiences.
Evaluation is a part of the total education process, interwoven
with every aspect of teaching and learning, and is carried on
continuously from the inception of the program to its culmina-
tion. The teacher should evaluate the materials and methods used
every year. This is imperative to keep health information and
knowledge current and applicable to everyday living.
The school health program, well developed and well super-
vised, may be the key to effective learning by preparing the child
physically, mentally, emotionally, and socially for the demands of
our space age. A child with a problem will not learn as rapidly as
one who is in harmony with his environs. He should receive in-
formation so he can modify his problems as they confront him. He
must learn to change his attitude and behavior to permit him to
live more effectively and more efficiently.
Health Education Terminology1
CUMULATIVE SCHOOL HEALTH RECORD-A form used to note
pertinent consecutive information about a student's health.
DENTAL EXAMINATION-The appraisal, performed by a dentist, of
the condition of the oral structures to determine the dental health
status of the individual.
DENTAL INSPECTION-The limited appraisal, performed by anyone
with or without special dental preparation, of the oral structures to
determine the presence or absence of obvious defects.
HEALTH APPRAISAL-The evaluation of the health status of the in-
dividual through the utilization of varied organized and systematic
procedures such as medical and dental examinations, laboratory
tests, health history, teacher observation, etc.
HEALTH COUNSELING-A method of interpreting to students or
their parents the findings of health appraisals and encouraging and
assisting them to take such action as needed to realize their fullest
HEALTH OBSERVATION-The estimation of an individual's well-be-
ing by noting the nature of his appearance and behavior.
HEALTH SCIENCE INSTRUCTION-The organized teaching proce-
dures directed toward developing understandings, attitudes, and
practices relating to health and factors affecting health.
HEALTHFUL SCHOOL ENVIRONMENT-The physical, social, and
emotional factors of the school setting which affect the health,
comfort, and performance of an individual or a group.
HEALTHFUL SCHOOL LIVING-The utilization of a safe and whole-
some environment, consideration of individual health, organizing
the school day, and planning classroom procedures to influence fa-
vorably emotional, social, and physical health.
MEDICAL EXAMINATION-The determination, by a physician, of an
individual's health status.
PRIVATE OR VOLUNTARY HEALTH AGENCY-A nongovernmental
group organized to protect or improve the health of individuals and
PROFESSIONAL HEALTH AGENCY-A group with established stand-
ards of membership, composed of persons specially prepared in some
health disciplines and organized for the purpose of upgrading the
quality of their services and improving their contribution to the pub-
1 These generally accepted definitions for health education terminology have been taken
from an article in the Journal of School Health, Vol. XXXIII, No. 3, March 1963, which
was a reprint from the Journal of the American Association for Health, Physical
Education and Recreation, November 1962.
PUBLIC HEALTH EDUCATOR-An individual with professional prep-
aration in education and public health who helps develop and initi-
ate programs to improve health understandings, attitudes and prac-
tices in the community.
PUBLIC HEALTH NURSE-An individual with professional prepara-
tion in public health nursing who works cooperatively with teachers,
parents, and students to help achieve the purposes of the school
PUBLIC OR OFFICIAL HEALTH AGENCY-A tax-supported organi-
zation, charged by law with the responsibility of maintaining, pro-
tecting, and promoting the health and well-being of the people of a
SAFETY EDUCATION-The process of providing or utilizing experi-
ences for favorably influencing understandings, attitudes, and prac-
tices relating to safe living.
SCHOOL HEALTH COORDINATION-A process designed to bring
about a harmonious working relationship among the various person-
nel and groups in the school and community that have interest, con-
cern, and responsibility for development and conduct of the school
SCHOOL HEALTH EDUCATION-The process of providing or utiliz-
ing experiences for favorably influencing understandings, attitudes,
and practices relating to individual, family and community health.
SCHOOL HEALTH EDUCATOR OR HEALTH SCIENCE TEACHER-
An individual professionally prepared and certified to teach health
science and give leadership in developing the health science curricu-
SCHOOL HEALTH PROGRAM-The composite of procedures used in
school health services, healthful school living, and health science
instruction to promote health among students and school personnel.
SCHOOL HEALTH SERVICE-The procedures used by physicians,
dentists, nurses, teachers, and other professional personnel designed
to appraise, protect, and promote optimum health of students and
SCHOOL LUNCH PROGRAM-The composite of procedures used in
the school food service including the relation of food served at
school to learning activities and healthful living.
SCHOOL LUNCH SUPERVISOR-An individual with professional
preparation in nutrition, education, and food service operation
who is responsible for the supervision of a group of school lunch
SCHOOL MEDICAL ADVISOR-A physician who provides counsel and
assistance with the school procedures influencing the health and
well-being of students and school personnel.
VISION EXAMINATION-The appraisal, performed by an ophthalmol-
ogist or optometrist, of the condition of the eyes and visual mecha-
nism to determine the health and visual performance of the indi-
VISION SCREENING-The limited appraisal, performed by anyone
with or without special training, to determine the presence or ab-
sence of obvious vision deficiencies.
State Services for Florida Children
1. Agriculture Extension Service-Provides the settings for an edu-
cational program for rural and nonrural youths enrolled in 4-H
Clubs, plus recreation and group experience components.
2. Florida Council for the Blind-Is responsible for the prevention
of blindness, sight restoration, and vocational rehabilitation of
3. Division of Child Training Schools-Has supervisory and protec-
tive care, custody, and control of all minor offenders and of the
buildings, grounds, and property and other matters concerning
the state correctional institutions.
4. The Florida Industrial Commission-Administers the State Child
Labor Law through its Child Labor Department which defines
conditions under which children may be gainfully employed.
Through the Florida State Employment Service Division's thirty
local offices it offers counseling service and vocational guidance.
5. Florida Crippled Children's Commission-Offers medical, surgical,
and related care to handicapped children whose parents are un-
able to pay for private care.
6. State Board of Health-Has functions especially related to chil-
dren. Through the Bureau of Maternal and Child Health, the
county health departments provide prenatal and postnatal serv-
ices, well-baby clinics, and public health nursing. The Bureau of
Mental Health participates in the operation of 17 mental health
clinics to which children with problems of emotional and social
adjustment may be referred.
7. The State Department of Education-Assists counties to provide
educational facilities for children. Above the services of the regu-
lar classroom are the Division of Vocational Rehabilitation, the
Section on Education for Exceptional Children, and the Attend-
8. State Department of Public Welfare-Serves children who need
social services their parents are unable to provide for them for
certain stipulated reasons. Licenses private child-placing agencies
and child-caring institutions.
9. Florida School for the Deaf and the Blind-Provides both the deaf
and blind students with an educational program that parallels
that of public school. These are two separate institutions.
10. State Tuberculosis Board-Operates state tuberculosis hospitals
one of which has a special ward for children.
11. Sunland Training Center-Provides care for the mentally handi-
12. Many voluntary health organizations-Are concerned with such
specific diseases and health problems as cancer, tuberculosis, heart,
diabetes, muscular dystrophy, cerebral palsy, multiple sclerosis,
cystic fibrosis, the handicapped child, and others.
Laws Relating to School Health
The following sections from Florida School Law pertain to
the health of the school child, the teacher, and other personnel
and the school environment. (For complete code see Florida
School Law, 1963 Edition.)
SECTION 228.041, Florida Statutes
(18) School Day.-A school day for any group of pupils is that
portion of the day in which school is actually in session and
shall comprise not less than five net hours and not less than
six hours including intermissions for all grades above the third;
not less than four net hours for the first three grades; and
not less than three net hours in kindergarten and nursery
school grades; provided that the minimum length of the school
day herein specified may be decreased not to exceed one net
hour under regulations of the state board.
SECTION 230.23, Florida Statutes
POWERS AND DUTIES OF COUNTY BOARD.-The county board
acting as a board shall exercise all powers and perform all duties listed
(6) (e) Provide for Education of Special Groups.-Provide, inso-
far as practicable, for special facilities for classes for back-
ward, defective, truant, or incorrigible children of school age,
and for part-time or night school or classes for adolescents
and adults, including illiterate and groups needing Americani-
zation, and, when desirable and practicable, to provide for the
education of children below the first grade level in nursery
school or kindergarten classes.
(f) Health Examination and Treatments.-Provide for all
children of school age in the county to have periodic physical
and dental examinations and, insofar as practicable, arrange
and cooperate with other organizations for the prompt treat-
ment of all pupils who are in need of remedial and preventive
treatment; provided, that except in emergencies pupils may
be given remedial or preventive treatment only on written
consent of the parent.
(8) Transportation of Pupils.-After considering recommendations
of the the county superintendent to make provisions for the
transportation of pupils to the public schools or school activi-
ties they are required or expected to attend; authorize
transportation routes arranged efficiently and economically;
provide the necessary transportation facilities, and, when au-
thorized under regulations of the state board and if more