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School Physicals 2007

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The document provides guidance for conducting school physical examinations, including procedures to check vision, height/weight, blood pressure, scalp, eyes, ears, nose, throat, heart, lungs, spine, skin, lymphatics, and dental health. Key points emphasized are notifying parents/physicians of any abnormalities, using gentle examination techniques, and focusing on preventive health education and screening for common issues in children.

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School Physicals Michelle R. Colen, MD Dept of Family Medicine, Preventive Medicine and Community Health September 2007
School Health Record (Yellow form review) Notes made on back of form (abnormal) XX = notify physician and school nurse; refer for further evaluation X = minor defect; observe = normal Pencil only Please ask physician before noting abnormality
Vision Screen will be done for acuity by volunteer staff prior to or after your exam Parents will be notified of visual deficit if needed
Height/Weight Done prior to your exam Note if obese or malnourished appearing—BMI May refer to growth charts which will be provided Pink = girls Blue = boys Talk to them about healthy food choices
Blood Pressure Junior high/middle school and older only May be difficult due to sound in room If an increased reading, notify physician with you
Scalp/Lice Lice (nits) stick to the hair shaft Most often found postauricular and occipital regions Often confused with dandruff Stigma
Eyes EOM (Extraocular Muscles) Note strabismus (cross-eyed) May attempt funduscopic exam (don’t torture child) Room will not be dark Check red reflex
Ears Looking for cerumen impaction, fluid behind TM, foreign bodies, otitis externa, otitis media Tubes are common (blue, green) Note if cerumen occludes TM, but not a reason for a follow up physician visit Remember to use tug to help straighten EAC (more comfortable)
Nose Avoid contact with nasal septum Gently insert then direct speculum posteriorly then upwards Blue, swollen turbinates associated with allergies Pink/red, swollen turbinates associated with resp infection
Throat Kids tonsils naturally look “big”/enlarged Erythema exudate or possibly unilateral enlargement would be indicative of tonsillitis or pharyngitis Use tongue depressors (say “aah”) & place tongue depressor on anterior 2/3 of tongue
Dental Dental caries/cavities most common chronic disease of children aged 5 to 17 5 times more common than asthma (59% vs 11%) untreated can lead to problems eating, speaking, and learning Fewer than 1 in 5 Medicaid-covered children received at least one preventive dental service in a recent year
Dental Talk to child about dental hygiene Do they have a toothbrush? Have they been to a dentist? Brush teeth at least twice a day
Dental Primary Teeth Eruption Chart
Dental Permanent Teeth Eruption Chart
Dental Normal Teeth free from caries range from white to gray or yellow well positioned in the arch a free from bacterial plaque deposits The gingival tissue is coral-pink color.
Early childhood caries
Early childhood caries
Heart Can be difficult to auscultate in large, busy room If question abnormality, go to a quiet area Do not lift shirts to expose chest (inappropriate setting)--listen on thinnest piece of clothing or can usually “feed” stethoscope
Lungs Remember to ask the child to breath through their mouth If abnormality noted, consider upper airway sounds If questions, ask attending to listen
Scoliosis/Spine Always check if child’s feet are lined up evenly Ask student to bend at waist or “touch their toes” May need to ask student to remove a sweatshirt D recommendation from USPTF Requested by schools on health record form
Skin Note any rashes or unusual lesions Ecchymosis, scrapes, scratches common especially on lower legs. “Grip” bruises on upper arms are questionable Poison ivy & eczema are common findings
Lymphatics Will often feel lymphatic chains on children (benign) Pronounced asymmetrically or tender is considered abnormal
School Physicals: Additional Details You must participate to pass You can still have fun even though its required! Sign in when you arrive at the school. Wear professional dress, white coat, and name tag. Bring your equipment with you. Charge batteries prior to coming. Use the hand sanitizer in btw each student.
School Physicals: Additional Details Teach the first year students. Remember they were you a year ago.

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School Physicals 2007

  • 1. School Physicals Michelle R. Colen, MD Dept of Family Medicine, Preventive Medicine and Community Health September 2007
  • 2. School Health Record (Yellow form review) Notes made on back of form (abnormal) XX = notify physician and school nurse; refer for further evaluation X = minor defect; observe = normal Pencil only Please ask physician before noting abnormality
  • 3. Vision Screen will be done for acuity by volunteer staff prior to or after your exam Parents will be notified of visual deficit if needed
  • 4. Height/Weight Done prior to your exam Note if obese or malnourished appearing—BMI May refer to growth charts which will be provided Pink = girls Blue = boys Talk to them about healthy food choices
  • 5.
  • 6. Blood Pressure Junior high/middle school and older only May be difficult due to sound in room If an increased reading, notify physician with you
  • 7. Scalp/Lice Lice (nits) stick to the hair shaft Most often found postauricular and occipital regions Often confused with dandruff Stigma
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  • 10. Eyes EOM (Extraocular Muscles) Note strabismus (cross-eyed) May attempt funduscopic exam (don’t torture child) Room will not be dark Check red reflex
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  • 15. Ears Looking for cerumen impaction, fluid behind TM, foreign bodies, otitis externa, otitis media Tubes are common (blue, green) Note if cerumen occludes TM, but not a reason for a follow up physician visit Remember to use tug to help straighten EAC (more comfortable)
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  • 43. Nose Avoid contact with nasal septum Gently insert then direct speculum posteriorly then upwards Blue, swollen turbinates associated with allergies Pink/red, swollen turbinates associated with resp infection
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  • 47. Throat Kids tonsils naturally look “big”/enlarged Erythema exudate or possibly unilateral enlargement would be indicative of tonsillitis or pharyngitis Use tongue depressors (say “aah”) & place tongue depressor on anterior 2/3 of tongue
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  • 54. Dental Dental caries/cavities most common chronic disease of children aged 5 to 17 5 times more common than asthma (59% vs 11%) untreated can lead to problems eating, speaking, and learning Fewer than 1 in 5 Medicaid-covered children received at least one preventive dental service in a recent year
  • 55. Dental Talk to child about dental hygiene Do they have a toothbrush? Have they been to a dentist? Brush teeth at least twice a day
  • 56. Dental Primary Teeth Eruption Chart
  • 57. Dental Permanent Teeth Eruption Chart
  • 58. Dental Normal Teeth free from caries range from white to gray or yellow well positioned in the arch a free from bacterial plaque deposits The gingival tissue is coral-pink color.
  • 61. Heart Can be difficult to auscultate in large, busy room If question abnormality, go to a quiet area Do not lift shirts to expose chest (inappropriate setting)--listen on thinnest piece of clothing or can usually “feed” stethoscope
  • 62. Lungs Remember to ask the child to breath through their mouth If abnormality noted, consider upper airway sounds If questions, ask attending to listen
  • 63. Scoliosis/Spine Always check if child’s feet are lined up evenly Ask student to bend at waist or “touch their toes” May need to ask student to remove a sweatshirt D recommendation from USPTF Requested by schools on health record form
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  • 66. Skin Note any rashes or unusual lesions Ecchymosis, scrapes, scratches common especially on lower legs. “Grip” bruises on upper arms are questionable Poison ivy & eczema are common findings
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  • 71. Lymphatics Will often feel lymphatic chains on children (benign) Pronounced asymmetrically or tender is considered abnormal
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  • 73. School Physicals: Additional Details You must participate to pass You can still have fun even though its required! Sign in when you arrive at the school. Wear professional dress, white coat, and name tag. Bring your equipment with you. Charge batteries prior to coming. Use the hand sanitizer in btw each student.
  • 74. School Physicals: Additional Details Teach the first year students. Remember they were you a year ago.