School health examinations were begun years ago because parents, educators, and physicians all realized that healthy children learned more effectively than children with health problems. Earlier in this century, many children in the United States entered school without having had a health evaluation. Most children in this country today receive health care during their preschool years. Therefore, reevaluation of the concept of routine health exammations is now indicated because of changing health patterns in the United States and children's different health needs. PHYSICAL EXAMINATION Ideally, every school child should have a complete physical examination and health evaluation every one to two years from his or her personal physician or source of ongoing medical care. Several things should be accomplished during this examination: (1) interval health history; (2) head-to-toe health appraisal; (3) assessment of growth, development, and school progress; (4) mental health evaluation of the child and family; (5) assessment of immunization status; (6) health education and counseling for both parent and child; (7) evaluation for participation in athletics; (8) recommendations about the child's health needs. Physicians may not be available for comprehensive health supervision in some rural and urban areas. Therefore, the Committee makes the following recommendations for health examinations required by schools. 1. Schools should require a complete physical examination for all children at least every three years. 2. Ideally, this physical examination should be done by the child's pediatrician or primary care physician. A school nurse, with physician backup, if trained in physical assessment skills, can do an assessment if no physician is available to conduct the examinations.

The American Academy of Pediatrics believes that it is necessary to reaffirm its support for the concept of school health education, from kindergarten through grade 12, for all schoolchildren in the United States. A basic concept of pediatrics is prevention, and health education is a basic element in the delivery of comprehensive health care. The public is continually bombarded by the media about the high cost of medical care and the overutilization and incorrect use of medical facilities. The media also writes about the problems of increasing promiscuity and illegitimacy; the money wasted on quackery; practices that are detrimental to the health of people in the United States; and the lag in the dissemination of new health information and facts to the public. The Committee on School Health believes that community health education programs, of which school health education programs from kindergarten through grade 12 are an integral part, are one of the most viable methods to help alleviate these and similar problems. Therefore, the Committee on School Health makes the following recommendations and urges action for them at state and local levels. 1. Health education is a basic education subject, and it should be taught as such. Health education is compatible with other traditional subjects and can enhance the contribution that other basic subjects make to general life experience, understanding, and skills. 2. Planned, integrated programs of comprehensive health education should be required for students from kindergarten through grade 12. Instruction should be given by teachers qualified to teach health education.

The Committee on School Health would like to thank the journal for the opportunity to answer the comments by Drs. Stern, Boat, et al. The problem of medication in the schools was researched at great length over a two-year period before publication of the aforementioned guidelines. Competent school administrators from across the country were consulted, as were numerous school physicians, so the recommendations were not made lightly or without the utmost consideration. We agree that many of the concerns of Dr. Stern and his colleagues seem logical and have considerable immediate emotional appeal to the practicing physician.

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