School Health and Adolescent Populations Services

1. School Health and Adolescent Populations Services November 2003

2. Learning Objectives Identify major health problems of school-aged and adolescent populations Describe types of programs and services for health promotion and illness and injury prevention in school-aged and adolescent populations Explain immunisation schedule for school-aged children and explain the timing of each immunisation Describe the three main functions of school nursing practice (health services, health education and improvement of the school environment

3. Health problems of school-aged children Problems associated with poverty 2.7 times more likely to have stunted growth 2 to 3 times more likely to have fatal accidental injuries 1.5 to 3 times more likely to die in childhood in comparison to children that are never-poor (Sherman, 1997)

4. Problems associated with poverty Physical health problems related to poverty Lead poisoning Iron deficiency anemia Increased susceptibility to illness Poor academic achievement, because of Developmental and cognitive delays Chronically poor nutrition

5. Accidents and injuries The leading cause of death of children ages 5 to 14 years (CDC, 1998)

6. Communicable diseases Morbidity is high in school children: Respiratory illness (most frequent) Infectious and parasitic diseases Injuries Digestive conditions Measles, rubella, pertussis (whooping cough), mumps and chickenpox have dropped because of immunisation.

7. Chronic diseases See figure 28-1 Hay fever, sinusitis, dermatitis, tonsillitis, asthma ( the most common chronic disease of childhood), diabetes (common), seizure disorders, hearing difficulties. Most frequent complaints of school children: Stomachaches, headaches, colds and flu

8. Type 2 diabetes Rising: among school-aged children because of: Obesity, sedentary life-style, and predisposition of certain ethnic groups. Almost one-third of new cases of diabetes in children under 18 have type 2 diabetes (Kaplowitz 1999) Prevention of type 2 diabetes: An important area of focus of health professionals working with school-aged children Education Improvement in exercise Nutrition and lifestyle

9. Chronic conditions (continued) Juvenile rheumatoid arthritis: A painful immune disorder treated with anti-inflammatory drugs (Ipobrufen, Ibugesic) and occasionally steroid injections (Cron, Sharma and Sherry 1999) It is important to monitor medication intake (AEDs) for seizure disorders and teach school staff first-aid measures Malignant neoplasms are the second leading cause of death in 5- 14 year old children (CDC 1998) Leukemia now have better outcomes than ever before (60-70% decrease in death between 1960-1993) (ACS, 1999)

10. Behavioural Problems and Learning Disabilities Emotional, behavioural and intellectual development Between 2-15% of school-aged children have conduct or oppositional disorders Between 3-10% have Attention Deficit Hyperactivity Disorder (ADHD) 2.5% are mentally retarded Between 2-10% have some type of learning disability ( Kurtz, Dowrick, Levy and Batshaw, 1996)

11. Learning Disabilities (continued) Who? Children who have a lot of difficulty in reading, writing or mathematics may have a learning disability Causes of learning disability and emotional behavioural problems Genetic, Environmental Stressed and dysfunctional families have high incidence of child abuse, physical and sexual and neglect. 26% of children under 18live with a divorced or separated parent or stepparent (Behrman & Quinn 1994) Cultural

12. Attention Deficit Hyperactivity Disorder See figure 28-2 ADHD = hyperactivity+impulsivity+inattention Affects 3-5% of all school-aged children (Kwasman, Tinsley & Lepper 1995) Girls are less recognised because they often do not show the hyperactivity component (Bussing et.al 1998)

13. ADHD (continued) Sometimes found with communication or language disorders 28% of children have more than one co-existing condition: learning disabilities (12%), poor social skills, aggression and depression (18%), anxiety (25%), oppositional defiant disorders (35%)and conduct disorders (26%) Cara 1999; Hinshaw 1994) Usually more accident �prone or suspension and expulsion from school Teacher confirmation of ADHD-related behaviours is very important (Cara 1999)

14. Treatment of ADHD Multi-modal approach is the most effective: Medication (Ritalin and Adderall amphetamine) School accomodations for learning problems Social skills training for the child (Pelham, Aronoff and Midlam 1999) Family and individual counseling Parent support group and training in behaviour management techniques Family education about the condition

15. Head lice Pediculosis: A frustrating and common problem for many children at school 1 out of 4 children in elementary school had a lice infestation in 1998 in USA (Price, Burkhart and Islam 1999) Pediculus Humanus capitis (parasite) lives and feeds on the human scalp. They need blood to survive and they can cause itching and skin irritation (Miller 1999) Found on the nape of the neck (hair is the thickest), the eggs are distributed all over the head. Attached to the hair with a gluelike substance and easily detected by examination. Recurring cycles of infection are common because the nits open within 10 days and reproduction happens within 8-9 days. Transmitted by direct contact or by shared items: combs and brushes, hats and scarves, sheets and towels Treatment includes shampoos RID Nix or Kwell shampoo (Price, Burkhart and Islam 1999)

16. Other health problems in young school children (6-11years) Poor nutrition : Overeating and obesity A risk factor for cardiovascular disease and diabetes Diets are high in fat, saturated fat and sodium Survey on Youth Risk behaviour showed that 72% of children ate less than five servings of fruit and vegetables the day before (CDC 1999) Top 10 sources of energy for children 2 to 18 (Subar, et.al 1998): Milk Yeast bread Cake/cookies/doughnuts Beef Cheese

17. Dental health  Dental caries affect more than half of school children School days are lost for dental problems and dental visits Dental trauma can happen in playgrounds, car accidents, sport-related activities 87% of primary tooth injuries were in the front teeth and most common injuries were lacerations and tooth fractures (33%) (Lombardi et al. 1997)

18. Health Problems of Adolescents Problems of adolescents Spiritual Poverty Disengagement from home and school Boredom, Low self-esteem Lack of motivation Adolescents turn to drugs, alcohol and indiscriminate sexual activity School violence is increasing (Gorski 1999) Rapid developmental adjustments create a variety of stresses that have an impact on their health

19. Health Problems of Adolescents (continued) Hormonal influences make the teen to be emotional and unpredictable Peer pressure is more important than parental concerns The best method to ride this period is with love and understanding 1in 5 adolescents may have emotional, behavioural and mental health problems and 1 in 10 may have serious problems that disrupts ability to function (USDHHS 1996) Violence: related to the cultural and environmental factors, and the movies and TV as well. More prevalent in the 9th and 10th grade (Hill and Drolet 1999) Violence accounts for 40% of all adolescent deaths (CDC 1999) 1 in 4 is caused by firearms (15-19years of age)

20. Substance abuse in adolescents Almost 55% of high school students reported using drugs and 82% used alcohol ( National Clearinghouse on Alcohol and Drug information 1997). Median age for first use of alcohol 14years Beginning to smoke cigarettes between 15 and 16 years of age. Inhalant abuse ( glue, lighter fluid, spray paint) is another problem and can result in can result in severe nervous system damage National Clearinghouse on Alcohol and Drug information 1999). Other drugs are Ecstasy, Rohypnol the �date rape�.

21. Health of Adolescents Acne: A recognised genetic disease (3 out of 4) children of a mother or father with acne as a teenager will follow (Fulton 1999) Begins during puberty (10-12 years of age) with the increase of circulating male hormones. Whiteheads and blackheads form. Aggravating factors: Greasy foods and chocolates Stress Certain cosmetics Treatment includes skin cleansers, peelers and medication to decrease sebaceous gland activity, vitamin A ointment to peel the impacted cells from the pores

22. Prevention of Acne Keep the skin clean Eating a balanced diet including fresh fruits and vegetables Drinking lots of water Getting adequate sleep Sometimes with severe acne referral to a dermatologist is needed

23. Poor nutrition and eating disorders in adolescents Female adolescents are more at risk for problems with nutrition because inappropriate dieting, more finicky eating habits and less physically active than males (CDC 1999). Body image and control issues are behind anorexia nervosa and bulimia problems in adolescent girls.

24. Poor nutrition and eating disorders in adolescents (continued) Anorexia nervosa: an eating disorder of emotional etiology with body image disturbance ( seeing themselves as fat when they may be extremely thin), an intense fear of becoming fat. Bulimia is an eating disorder with recurrent episodes of binge eating with repeated compensation mechanism to prevent weight gain (purging type- vomiting or non-purging type-fasting or exercise) Because of emotional origin, challenge to treat them, nutrition education, psychological counselling, positive visualisation and a support network (Muscari 1998)

25. Role of the School Nurse By the 1920s school health services consisted mainly of health education and minimal health services ( emergency care, periodic health assessments, documentation of state or district health requirements) Responsibilities of the school nurse: Prevent illness and promote and maintain the health of the school community Identifies health-related barriers to learning Serves as a health advocate for children and families Care provider Change agent Teacher and educator Manager Health services: vision and hearing screening, scoliosis screening, monitoring of height, weight and Blood pressure, oral health, TB screening, immunisation monitoring, health appraisal and counseling

26. Functions of School Nurse (Hass 1993) Health services (as discussed in previous slide) Health education (planned and incidental teaching of health concepts, curriculum development ie classes in health science and healthful living, use of educational media, library resources and community facilities) Promotion of a healthy school environment (safety, visual, thermal and acoustic factors, aesthetic values, sanitation, safety of the school bus system and food services, emotional climate, suspected child abuse