We are already getting kids in our clinic needing school physicals or sports physicals for the coming year. As a parent you do your duty and get your kids evaluated as requested by schools. Have you ever stopped and wondered what we were accomplishing with these exams? Why are these exams required by the state?
This goes as far back as Benjamin Franklin who was a proponent of a more formalized school system including required sports activity and health exams. In the mid 1800’s a report out of Massachusetts called for a more structured approach to disease control in the school system. Slowly schools began adopting these structures and then at the beginning of the 1900’s states began passing laws requiring things like vision exams and formalized health exams. You can thank tuberculosis for a lot of these changes as it was rampant back then and so an approach to control its spread was necessary.
Then again in the 1960’s with the Great Society and the War on Poverty more changes were made which brought federal funds to the system. Since then every decade has brought more and more structure to school healthcare and positive changes to our children’s health and education.
So what is a school physical exam? They come in several forms. For those of you with kids you’ve probably seen the standard Texas physical exam form that schools hand out. There is also your yearly exam with your doctor that is more comprehensive than just that Texas standardized form. The Texas school physical form starts off with a long list of health questions that require only a yes or no answer. The questions attempt to uncover any possible health problems, physical or mental, the student may have. Any ‘yes’ answers prompt the physician to inquire more about those issues. Next is the physical exam. The physical exam looks at the musculoskeletal part of the body and also the internal organs, vision and neurologic system.
So the doctor does their exam but what are they really looking for? We are looking for anything that may impact the child’s health but mostly we are looking for that ‘needle in the haystack’ that could result in the child dying suddenly. We have all seen those horrible headlines where some student athlete drops dead in the middle of sports play. These events usually occur from some undiagnosed cardiac anomaly that isn’t typically picked up on normal exams. The school physicals or sports physicals don’t usually include an EKG or an echocardiogram, which is necessary for finding these cardiac anomalies. This has changed as the last Texas legislative session included a bill that would require an EKG. There is a program that has been running for a few years here in Texas spearheaded by EMS called ‘Operation screen your athlete’ that includes onsite echocardiograms in the students identified with abnormal heart exams or EKG’s. I’m not discounting the value of the rest of the exam but in this case the heart exam is the most important part in detecting children at risk for sudden death.
The spinal exam is important in diagnosing previously undetected scoliosis. The vision exam can uncover unequal pupils, which can be normal as well as kids that are in need of glasses. So many children just don’t know that their vision is deficient and obviously if your playing sports you need your eyes to function appropriately as well as in the classroom to see the days lesson. Blood pressure is now becoming much more important in children with the rise of childhood obesity. Discussion with children identified as being overweight about healthy lifestyle changes is hugely important these days. Some of these kids come from families that unfortunately poorly select their food options so it’s up to us to try and help them make good choices when it comes to food. The dreaded testicular exam in boys can help detect hernias but in all honesty most young men are probably already aware of pain or swelling in that region and are asking for medical attention. Boys are pretty aware of that part of their body, I’m just saying.
The rest of the exam can also turn up undiagnosed things like diabetes or asthma or skin disorders like eczema. Some kids don’t get to see a physician regularly or for yearly exams and the school physical is our only real chance to examine them. It’s sad but this is also an opportunity to detect eating disorders or child abuse. We usually ask about body image and whether a child feels positive about their looks or not. We also ask if they feel safe. Any opportunity we can give our children to speak up in an environment that promotes safe communication we have to strive to do so.
These exams have proven themselves as beneficial to our children. We have been making changes over the years to make them even better. I have been involved in examining thousands of students over the years and I know I have made positive impacts on those kids health. This is something all communities can get behind and support. I know we are only halfway through our summer school break but I wish all our kids a successful upcoming school year.
John Turner MD
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