Department of Nursing Services Guidelines on School Attendance, Screenings and Exemptions

Every Child Deserves a School Nurse

The purpose of the comprehensive school health program is to encourage the best possible health outcome for each student and to teach concepts that help students make responsible decisions regarding their own health in the future.

The members of the Nursing Department collaborate with parents/ guardians and staff to provide every possible educational opportunity for all students by providing services to support their health, well being, and safety in school.

The comprehensive school health program includes screening procedures, protocols to prevent the spread of communicable diseases, emergency care, and procedures to facilitate school attendance for children with special health care needs.  Due to nursing assessment and intervention, more students are able to stay in school. The nurse identifies health related barriers to learning, and collaborates with teachers to accommodate students with special health care needs. The nurse may act as liaison between schools and physicians and/or refer students to appropriate resources within the school or community.

The WPS nursing department employs registered nurses licensed to practice by the Massachusetts Board of Registered Nurses (http://www.mass.gov/dph/boards/rn) and certified by Massachusetts Department of Elementary and Secondary Education (http://www.doe.mass.edu/educators/e_license.html).

SCHOOL ATTENDANCE GUIDELINES

School attendance is key to your child’s success in school.  Children should be in school if they are rested, eating well, feeling good and are fever free.  There are certain circumstances, however, when your child should stay home from school.  The following information should give you direction when making the decision to send your child to school or keep them home.  REMEMBER: Your school nurse is an excellent resource if you need any guidance or direction when making this decision.  Never hesitate to consult with your school nurse.

Illness

Students receiving antibiotics for a contagious condition such as strep throat must stay out of school until 24 hours of antibiotic therapy has been completed. Excessive coughing and nasal discharge and generally not feeling well are indications that the child should remain home.

Fever

If your child has a temperature of 100 degrees or above (taken orally) in the morning, it is recommended that your child remain home.  Students should remain home for 24 hours after a fever has subsided without the use of fever-reducing medication such as acetaminophen (Tylenol) or ibuprofen (Motrin).  If your child develops a fever during school hours, they will not be allowed to return to the classroom and will remain in the health office until dismissed to a parent/guardian or their designee.

Rash

If your child develops a rash please consult with the school nurse.  Rashes are very difficult to diagnose and many are viral in origin and should not prevent your child from attending school.  There are cases of breakthrough chicken pox disease and a few other diseases that would certainly influence your child’s attendance in school and impact other students who may be medically compromised so consultation with your school nurse is important.

Injury

Any student who has sustained an injury that has been treated by a physician or in an emergency room and will have restricted activity for a limited period of time  (cast, stitches, sprains, fractures, concussions, etc.), must bring a note from the physician stating the nature of the restrictions and when the student can resume participation in Health and Fitness class, recess, and sports in the upper grades.  The student will not be allowed to return to Health and Fitness class and sports activities until this note is received. If your child sustains an injury, or you feel your child should limit their activity for 1 – 2 days; or that will affect their school performance, you will need to send a note to the nurse.

Dismissal Due to Illness or Injury

Students who become ill or injured at school will be dismissed to a parent/ guardian or their designee from the nursing office. The student will not be allowed to walk home alone with the exception of High School students after consultation with the school nurse and the student’s parent.  It is the expectation that a sick or injured student will be picked up as soon as possible.

School Absence

Please notify the school when your child will be absent and whether it is due to illness or injury.  By leaving information about your child’s absence allows for the school nurse to track and trend illness in the school and begin interventions should a pattern of illness develop.

Emergency Information

Please keep the emergency information on your child current to facilitate contacting you if your child is ill or injured.  Work numbers, home telephone and cell phone numbers change throughout the school year and the school needs to be informed of these changes so that you or your designee can be contacted quickly in the case of an emergency.

Immunizations

Massachusetts state law requires that students be fully immunized against DPT (Diphtheria, Pertussis and Tetanus), Polio, Measles, Mumps, Rubella, Hepatitis B, and Varicella in order to attend school.  Students MUST meet all the immunization requirements before beginning school.   The statute does include exemptions from this law for medical and religious reasons.  Your school nurse can answer any questions regarding your child’s immunization status.

Physical Examinations  

Examinations by a licensed physician, nurse practitioner or physician’s assistant are required for all students entering PAWS, Kindergarten and any new student entering the district regardless of age or grade.  These examinations must be within one year prior to entering school or within 30 days after school entry. Examinations are also required for all students in grades 4, 7 and 9.

In order to participate in any interscholastic sport, documentation of a physical examination within the last 13 months by the student’s primary health care provider must be on file with the school nurse prior to tryouts.

Screenings

  1. Vision and Hearing Screenings are conducted according to guidelines provided by MDPH (http://www.mass.gov/eohhs/gov/departments/dph/). A referral letter is sent home when the student does not meet the screening parameters recommending evaluation by your physician.
  2. Postural screening is conducted annually in collaboration with the Fitness and Health Department for students in Grades 5 through 9.  A report from the student’s doctor is required in order to be excused from the school screening.   A referral letter is sent home when the student does not meet the screening parameters so that further evaluation can be done.
  3. Heights and weights are done on students in grades 1,4, 7, and 10. Body Mass Index (BMI) and corresponding percentile is calculated and recorded following guidelines from the MDPH for each student. The results will be recorded in the student’s cumulative health record at school.  Parents are welcome to call the school nurse to discuss the findings.
  4. SBIRT Screening (Screening, Brief Intervention, Referral for Treatment) will be conducted for all grade 9 students. SBIRT is a comprehensive, integrated, public health approach to prevent and/or delay substance use and to identify early the small percentage of students thought to be at risk for substance abuse.

Exemptions

A student may be exempt from physical examination, vision, hearing, and BMI screenings upon written request from the parent/ guardian.

Immunization exemption and communicable diseases is addressed in Massachusetts General Law ( M.G.L. c.71, s.57) http://www.mass.gov/eohhs/gov/departments/dph/.  The law in Massachusetts does not allow philosophical exemptions. There are only two situations in which children who are not fully immunized may be admitted to school.

  1. Medical exemptions are allowed if a physician submits documentation stating that an immunization is medically contraindicated for the child.
  2. Religious exemptions are allowed if a parent/ guardian submits a written statement that immunizations conflict with their sincere religious beliefs.

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