Health observation in action.

Abstract

PERCEPTIVE observation of children's behavior and appearance as clues to health, not only by those responsible for their care but also those responsible for. their education, is today a fundamental tenet of child rearing. Health observation has been practiced intuitively by those who have cared for children throughout the ages. However, it does not appear to have become an integral part of school health practice in this country until the end of the last century when the American ideal of education for all children was threatened by the rising prevalence of infections and other health problems that kept children out of school. Following epidemics of diphtheria and scarlet fever in Boston in 1894, school physicians visited the schools daily and examined all children thought by their teachers to be ailing. In New York City, in 1897, Health Department medical inspectors began to call at the schools daily to examine those children whom the teachers selected. Thus, health observations by teachers have long been a key factor in the effective utilization of the specialized services of the physician and nurse in the schools. Formal recognition of the importance of the teacher as an observer of child health was accorded in 1924 when Dr. Jamnes Frederick Rogers, then consultant in hygiene of the United States Office of Education, published his classic pamphlet What Every Teacher Should Know About the Physical Condition of Her Pupils. Dr. Rogers paid tribute to the unique first-line position of the teacher in the health observation of schoolchildren, calling her the keystone of the health examination service. The practical information given in this publication introduced many teachers to the art of health appraisal. Many have relayed and extended Dr. Rogers' insight and principles in publications and other media to the present time. Health observation of schoolchildren assumes added significance in view of current physician and nursing shortages. The need for more health care manpower has led to a search for new approaches and more use of allied health workers on the health care team. Health planners have predicted and experience has demonstrated that ghetto parents and children can be assisted by trained, intelligent social peers in the early detection and referral for health problems and in the important phase of follow-up care. The report of the National Commission on Community Health Services1 pointed out that inadequate health care of the poor stems in considerable part from lack of communications, and ad-