The “Back-to-school Medical” – Protecting your child’s heart and health

The school medical examination has been practiced in Jamaica for several years, and in September 2012 Minister of Education the Rev Hon Ronald Thwaites made mandatory for all children entering Grade One (1) and Grade seven (7).  Jamaica is not the only country that practices mandatory health screening for school-age children. This practice is also observed in Germany, Bahamas, Australia to name a few. The US does not have mandatory screening, however annual well-child Paediatrician visits are encouraged and widely practiced. The UK instituted mandatory routine screening in the early 1960’s and then changed in favour of selective screening. Selective screening is where the child is only taken for a physical exam if they exhibit symptoms.

While routine screening is controversial, at best, it is useful in guiding parents and children about the child’s involvement in physical activity and sports. These children, and their parents would have otherwise had no knowledge of the existence of any sort of health or heart problems. The child and the parent can then be counseled re participation in physical activity and sports, and not be caught off guard in the middle of the school year, or at worse be faced with a child who collapses during Physical Education classes or other physical activity.

The objectives of such a screening program are:

1. To detect silent medical problems that may interfere with the child’s learning and performance at school including
   1. Abnormal hearing.
   4. Abnormal vision.
   5. Referral and detected dental caries.
   6. Heart disease.
   7. Sickle cell.
2. To determine immunization coverage.
3. To list any other pertinent health information.

The school medical may be performed at child’s paediatrican, Family doctor or community health centre. Schools will usually provide the form which has two (2) parts. The first part asks the parents to document details of the child’s medical history and the second is the part to be completed by the Physician or Nurse Practitioner.

In Jamaica, the school medical exam includes the following

1. Comprehensive medical and family history completed by parent
2. Immunization History
3. Weight, Height, Vision screening, Urine testing, Blood Pressure
4. Head-to-toe examination performed by a physician or Nurse Practitioner
5. Recommendations for physical activity and or referrals for further evaluation and treatment for children who have abnormal findings during screening.

While some parents my find the school medical a nuisance or expensive, it is one of the best things you can do for your child and should be placed above the new uniforms, and new Jansport® Bags. The American Pediatric association reports that one in four 1:4 children may have vision problems. Children with these problems may exhibit poor school performance or behavioural problems. It is recommended that each child receive an annual examination on his birthday by Paediatrician or Family Physician. Here in Jamaica, lots of other things take priority, and so the school medical is the ideal opportunity to get this done. In addition to picking up vision and hearing problems, one of the major benefits is the early detection of silent heart disease.

Although the evidence is mixed regarding screening for hypertension before 18 years of age, many experts recommend checking blood pressure annually beginning at three years of age. The American Academy of Pediatrics recommends vision and hearing screening annually or every two years in school-aged children. One study has shown that physical examination in an asymptomatic, school-aged child will find a new abnormality in less than 4 percent of patients, and most of these abnormalities are not clinically significant. This is the argument used against routine screening of children who do not exhibit any symptoms. This has to be interpreted with caution – noting that this is a single research study, and it is based on information in communities where rheumatic heart disease is extinct etc.

In our population, Rheumatic fever and rheumatic heart disease are still prevalent and may lead to heart valve damage. Each year, in September, we see a spike in the number of children referred to our heart clinic for echocardiogram to further define a heart murmur detected on routine school medical.

Last year, we performed routine screening of school age children for the purposes of the school entrance medical exam. We screened roughly 100 children, up to 7% had abnormal vision screening and were referred to ophthalmologist for further in-depth evaluation and glasses. This is in keeping with figures from other communities and this is one of the major benefits of routine screening.

Do your child and yourself a favour, and get a comprehensive health screen on at least these two occasions.