• In some schools there is a full-time certified school nurse who spends most of his or her day attending to the acute and chronic health needs of students. He or she handles acute health problems, administers medica­tions, and performs health assessments and screenings as well as special procedures ordered by a child's personal doctor; he or she also refers children to their physician for physical exams, diagnosis, and treatment. School nurses can also play a central role in promoting a healthy and safe school environment.
• In some communities, a full-time school nurse is responsible for several schools and thus spends only a limited time in each school. He or she is responsible for training other staff members (teachers, administrators, secretaries, health aides) to handle acute health situations when the nurse is not on site.
• A full- or part-time nurse practitioner is available in some schools, work­ing with consulting physicians, school nurses, social workers, or health educators in a school-based health center where routine medical care is delivered in the school. This has been an important and successful way to provide care to students in areas where care has been limited because of a lack of health-care providers, an absence of insurance, or transportation problems. The American Academy of Pediatrics believes that all children deserve a "medical home" and supports the implementation of school-based clinics, especially in areas where children do not have access to health care.

Acute Health Problems

Most illnesses and injuries that arise during school are minor (bumps, scrapes, headaches) and can be cared for by the school nurse. In many in­stances the child can return to class. When the problem is more serious, a par­ent will be called to come and take the child home. If the situation is extremely serious or life-threatening, the child will be transported by ambulance to the hospital emergency room or nearest physician. In many but not all schools, one or more staff members have been trained in CPR (cardiopulmonary re­suscitation) and first aid. Parents should know how these situations are han­dled at their child's school.

Seeing the Nurse

Most students can go to the school's health office and speak with the nurse whenever they need to during the day, usually just by asking their teacher. If you would like your child to consult with the nurse, send a note to school with your youngster, or call the school early in the day. Let your child know the rea­son for the visit so that she will not be confused or surprised when she is called to the office.

Short-Term Health Problems

Sometimes your child may have a health condition that does not last long but still interferes with her functioning at school. This kind of problem should be brought to the attention of the school nurse, the teacher, or the principal. For instance:

• Hearing loss related to an ear infection could require a temporary change of seats to the front of the classroom.
• Some infections—especially an ear infection, strep throat, bronchitis, and sinusitis—may necessitate the administration of medication for a week af­ter your child is well enough to return to school. Ask your pediatrician if a medication can be prescribed that can be given before and after school and then at bedtime, thus not requiring it to be taken at school. Ask about your school's policy about medication before your child's first illness. Your school may require a written order from the doctor before it will administer the medication, plus require that the medication be in its origi­nal, labeled container. It will be easier to take care of this during the visit to the doctor's office.
• If your child has a readily visible problem—like a rash, conjunctivitis (pinkeye), or unusual bruises—that has already been evaluated by your pediatrician, let the school staff know about the doctor's diagnosis and treatment. Thus, school personnel will not have to pursue further evalua­tion of your youngster, which may disrupt her classroom work and un­necessarily concern her.
• If your child has an injury or illness that requires immobilization or limi­tations on physical activity, ask the school about alternative activities available during physical education classes and recess. When the child is unable to participate in PE for months or even years, a formal adaptive PE program—one that is appropriate and safe—needs to be designed for her. Discuss this with the school principal.