Manual For School Health Programs


Chapter 4: Screening Program Recommendations and Standards

School health programs should make a health screenings plan considering the need, personnel, referral sources, time, and facilities. Programs must determine priorities for each type of screening based on the ability to complete follow-up for referrals made. It is more desirable to screen fewer students and see referrals resolved than to simply identify numbers of students with possible deficits. Any mass screenings must have parent notification with an opt out option. Screenings for vision, hearing, and dental provide baseline health status data. If time for screenings is limited, consider making students new to the district a priority to gather this baseline data.

All screening programs should include an educational component. Students should understand the value of the screening and the implications of the outcome. Follow-up should include quick notification of parent(s)/guardian(s) and teachers of possible deficits as well as suggestions for interim management and referral sources, if needed.

School health programs should communicate, with parent/guardian permission, any obvious health problem and subsequent plans with school personnel. Schools should recommend that students have a comprehensive health examination and dental check-up prior to starting school for the first time.

Vision

Standards

  • Screen at 10 or 20 feet (10 ft. recommended for younger children).
  • Use screening chart/cards that include 20/25 line.
  • Measure distance and ensure child’s heels are on measured line.
  • Screen with glasses on if appropriate.
  • Do not use vision testing machines for screening students below Grade 3.
  • Rescreen at least once within a month of any screenings indicating a possible concern before referral, and perform additional screenings as indicated.

Recommendations

Prioritize screenings as follows:

  • All new students.
  • Grades Pre-K, K, 1st, 2nd, and 3rd as recommended in Guidelines for Vision Screening in Missouri Schools.
  • Special education students (district compliance plan).
  • Referrals from teachers, parent(s)/guardian(s), and student self-referrals.
  • Grades 5, 7, 9 and 11 as resources permit

Find education materials to prepare students for vision screening at:
http://ccox.sites.truman.edu/2018/01/26/vision-screening-prep/
https://ccox.sites.truman.edu/2018/08/28/vision-screening-prep-spanish/ 

Preschool and non-verbal students may require functional screening to determine visual ability. Refer to Screening Infants and Toddlers section of Guidelines for Vision Screening in Missouri Schools. [NEEDS LINK]

Referral

Hearing

Standards

  • Use pure-tone audiometry at 1,000, 2,000, and 4,000 MHz, at 20 db.
  • Conduct impedance bridge (tympanometer) screening, when available, giving priority to youngest students.
  • Otoscopy (if nurse has assessment skills and equipment).

Recommendations

Base the individuals or grades screened on the availability of trained screeners, the environment available in which to screen, and the ability to complete a high percentage of referrals. Always place emphasis on the youngest population. Consider screening the following groups:

  • Students in Pre-K, K, 1st, 2nd, and 3rd grades, and all new students.
  • Referrals from teachers, parent(s)/guardian(s), and student self-referrals.
  • Special education evaluation requests.
  • Students in 7th grade for educational purposes regarding noise exposure if time permits.

Preschool and non-verbal students may require functional hearing screening, refer to Guidelines for Hearing Screening, Missouri Department of Health and Senior Services, (2021).

Find education materials to prepare students for hearing screening at:
http://ccox.sites.truman.edu/2018/01/24/hearing-screening-prep/
https://ccox.sites.truman.edu/2018/08/28/hearing-screening-prep-spanish/ 

Clean/disinfect equipment according to manufacturer’s instructions between each student. Do not use alcohol on headphones. See Infection and Prevention Control for Audiology Equipment.

Referral

Develop local referral criteria with community health professionals or refer to Guidelines for Hearing Screening.

Oral Health

Standards

Systematic sequence of visual inspection, using tongue blade and illumination:

  1. Face and neck for lesions and palpate for swollen glands.
  2. Mucous membranes (lips, tongue, soft and hard palate, tonsillar area, and cheeks) for redness, exudates, swelling, blisters, and growth.
  3. Teeth and gums:
    1. Evidence of dental caries
    2. Broken or chipped teeth
    3. Gross malocclusion
    4. Infection or swelling
    5. Bleeding or inflamed gums
    6. Changes in color, texture, position of gums, tissue
    7. Poor oral hygiene
    8. Foul breath

Recommendations

  • As time and resources permit, screen students in grades K-7 who do not report routine professional care, using a visual inspection of the mouth with light and tongue blade.
  • Screen secondary students who have not reported routine care.
  • Include dental education as part of the inspection process.

Referral

Refer any student with gross oral or dental problems who is not receiving routine, comprehensive oral health care.

Blood Pressure

Standard

The size of the cuff used to determine the blood pressure is the single most important factor. The cuff should cover no more than one-half and no less than one-third the length of the upper arm. The cuff should not cause pressure in the axilla or cover the antecubital space. If the proper-sized cuff is not available, do not do reading. A pediatric stethoscope with a small diaphragm is helpful in hearing blood pressure sounds in younger children. Seat the student in a comfortable position, with arm slightly flexed, abducted and at the level of the student’s heart. Keep the setting as quiet and non-stressful as possible. Explain the procedure to the student and allow younger children to handle the equipment prior to use to help increase comfort.

Recommendations

The American Academy of Pediatrics recommends that children above the age of three have their blood pressure checked annually, during non-school, routine physical examinations. The school is not an ideal setting in which to do mass screenings. Blood pressure screenings that are part of an educational unit on the cardiovascular system or included in a health risk appraisal program, can be effective if done under proper circumstances and with appropriate equipment.

Referral

Children are known to have widely fluctuating blood pressure readings, even within a period of 10 minutes. Recommended “normal blood pressure” readings for children may change with new research, so it is best to check with your school’s physician or local pediatricians to find out the current parameters for children.

Scoliosis Screening

No longer recommended in the school setting.

Tuberculosis Screening

Recommendation

School personnel and K-12 students are at no greater risk for tuberculosis infection than the public; therefore, routine testing is no longer recommended. If a district continues to test, the school nurse may contact the Missouri Department of Health and Senior Services (MDHSS), Bureau of Communicable Disease Control and Prevention, TB Control, 573-751-6113, for guidance.

Local public health departments provide tuberculosis case management and may request a school nurse to assist with Directly Observed Therapy (DOT) for students or school personnel receiving medication for latent tuberculosis infection (LTBI) or active disease after the patient is determined to be non-infectious.

Schools with preschool programs serving children four years of age and younger, should be familiar with the MDESE, Office of Childhood, rules regarding tuberculosis risk assessment and screening for that population.

Resources

Table 9. Resources for Screenings

Resources for Screenings
Missouri Department of Health and Senior Services. (2021). Guidelines for Hearing Screening in the School Setting [BROKEN LINK]
Truman State University. (2018). Hearing Screening Preparations for Kids (Spanish Version)
Guidelines for Vision Screening in Missouri Schools [NEEDS LINK]
Truman State University. (2018.) Vision Screening Preparations for Kids (Spanish Version)
U.S. Preventive Services Task Force. (2017). Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement, JAMA. 2017; 317(23):2417-2426. doi:10.1001/jama.2017.6803

Chapter 4 References

Table of Contents

On this page