The current epidemic of inactivity and the associated epidemic of obesity are being driven by multiple factors (societal, technologic, industrial, commercial, financial) and must be addressed likewise on several fronts. Foremost among these are the expansion of school physical education, dissuading children from pursuing sedentary activities, providing suitable role models for physical activity, and making activity-promoting changes in the environment. This statement outlines ways that pediatric health care providers and public health officials can encourage, monitor, and advocate for increased physical activity for children and teenagers. INTRODUCTION IN 1997, THE World Health Organization declared obesity a global epidemic with major health implications. 1 According to the 1999 -2000 National Health and Nutrition Examination Survey (www.cdc.gov/nchs/nhanes.htm), the prevalence of overweight or obesity in children and youth in the United States is over 15%, a value that has tripled since the 1960s. 2 The health implications of this epidemic are profound. Insulin resistance, type 2 diabetes mellitus, hypertension, obstructive sleep apnea, nonalcoholic steatohepatitis, poor self-esteem, and a lower health-related quality of life are among the comorbidities seen more commonly in affected children and youth than in their unaffected counterparts. [3][4][5][6][7] In addition, up to 80% of obese youth continue this trend into adulthood. 8,9 Adult obesity is associated with higher rates of hypertension, dyslipidemia, and insulin resistance, which are risk factors for coronary artery disease, the leading cause of death in North America. 10 Assessment of OverweightIdeally, methods of measuring body fat should be accurate, inexpensive, and easy to use; have small measurement error; and be well documented with published reference values. Direct measures of body composition, such as underwater weighing, magnetic resonance imaging, computed axial tomography, and dual-energy radiograph absorptiometry, provide an estimate of total body fat mass. These techniques, however, are used mainly in tertiary care centers for research purposes. Anthropometric measures of relative fatness may be inexpensive and easy to use but rely on the skill of the measurer, and their relative accuracy must be validated against a "gold-standard" measure of adiposity. Such indirect methods of www.pediatrics.org/cgi
Clinicians who care for children with asthma have an obligation to coordinate asthma care with the schools. Aside from routine clinical care of asthmatic children, providers must educate the family and child about the need for an asthma treatment plan in school and support the school nurse meeting the needs of the student requiring school-based asthma care. The following article was developed by multiple stakeholders to address this need. It describes the 4 components of the School-based Asthma Management Program (SAMPRO™). SAMPRO™ details elements necessary for the education of children, families, clinicians, and school-based personnel based on a “circle of support” that would enhance multidirectional communication and promote better care for children with asthma within the school setting.
The 2009 H1N1 influenza A virus vaccination campaign focused on use of school-located vaccination (SLV) clinics because of the ability of SLV to reach targeted populations. Large numbers of children are found in schools, and schools are conveniently located throughout communities. Communities are generally familiar with and trust schools, and school facilities can generally accommodate mass vaccination clinics. School nurses are familiar with the health of individual students and may be available to assist in vaccination activities. In addition, schools have access to parental contact information, which can facilitate communications. Challenges faced by local health departments (LHDs) and schools in implementing 2009 H1N1 SLV clinics, including disruption of educational activities, locating adequate staff, tailoring immunization activities to meet the needs of each school district, and transportation and administration of vaccine, are explored.
BACKGROUNDThe Whole School, Whole Community, Whole Child (WSCC) model shows the interrelationship between health and learning and the potential for improving educational outcomes by improving health outcomes. However, current descriptions do not explain how to implement the model.METHODSThe existing literature, including scientific articles, programmatic guidance, and publications by national agencies and organizations, was reviewed and synthesized to describe an overview of interrelatedness of learning and health and the 10 components of the WSCC model.RESULTSThe literature suggests potential benefits of applying the WSCC model at the district and school level. But, the model lacks specific guidance as to how this might be made actionable. A collaborative approach to health and learning is suggested, including a 10-step systematic process to help schools and districts develop an action plan for improving health and education outcomes. Essential preliminary actions are suggested to minimize the impact of the challenges that commonly derail systematic planning processes and program implementation, such as lack of readiness, personnel shortages, insufficient resources, and competing priorities.CONCLUSIONSAll new models require testing and evidence to confirm their value. District and schools will need to test this model and put plans into action to show that significant, substantial, and sustainable health and academic outcomes can be achieved.
The school nurse has a crucial role in the seamless provision of comprehensive health services to children and youth. Increasing numbers of students enter schools with chronic health conditions that require management during the school day. This policy statement describes for pediatricians the role of the school nurse in serving as a team member in providing preventive services, early identification of problems, interventions, and referrals to foster health and educational success. To optimally care for children, preparation, ongoing education, and appropriate staffing levels of school nurses are important factors for success. Recommendations are offered to facilitate the working relationship between the school nurse and the child's medical home. This statement has been endorsed by the National Association of School Nurses. SCHOOL NURSE DEFINITION The National Association of School Nurses defines school nursing as:A specialized practice of professional nursing that advances the well-being, academic success, and lifelong achievement of students. To that end, school nurses facilitate positive student responses to normal development; promote health and safety; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, self-advocacy, and learning. 1
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