Health Services

The National Association of School Nurse's (NASN) Framework for 21st Century School Nursing Practice™ creates an overarching structure that includes concepts integral to the complex clinical specialty practice of school nursing. The framework provides a graphic illustration of the key principles of professional school nursing practice, reflecting the organization's stance for evidence-based best practice and providing focus to priority school nursing activities. The framework provides guidance for the practicing school nurse to reach the goal of supporting student health and academic success by contributing to a healthy and safe school environment. NASN believes it has a responsibility to its members and to the public they serve to develop a framework for professional school nursing practice.

Supervisor of Nurses

Avery Hines, MS, RN, NCSN

Email
ahines@medford.k12.ma.us

Phone: 781-393-2292

Roberts Nurses' Office

Phone: 781-393-2155 x4508

School Entrance Requirements and Immunizations

A school nurse will review your child’s health information for clearance into school in order to maintain protection from communicable diseases, identify your child’s health needs and promote health safety in school.

The following is a list of health requirements required by the Massachusetts Department of Public Health for entry of students into public school. Please provide documentation from your primary care physician when you register at the Parent Information Center located at Medford High School. Free immunizations are available at the Medford Board of Health by appointment. Please call 781-393-2448.

Pre-school

Pre-school:

– Physical Exam: completed within the last 12 months
– Lead Screening with results
– Tuberculosis skin test or risk assessment with results

Immunizations:

Hepatitis B: 3 doses (last dose after 6 months of age)
DTAP (Diptheria, Tetanus, Pertussis): 4 doses
Polio: 3 doses
HIB (H influenza bacteria): >3 doses
MMR (Measles, Mumps, Rubella): 1 dose given after age 12 months
Varicella (Chickenpox): 1 dose given after age 12 months

Kindergarten

– Physical Exam: completed within the last 12 months
– Lead Screening with results
– Tuberculosis skin test or risk assessment with results
– Vision Screening with stereopsis exam

Immunizations:

Hepatitis B: 3 doses (last dose after 6 months of age)
DTAP (Diptheria, Tetanus, Pertussis): 5 doses (last dose after age 4)
Polio: 4 doses (last dose after age 4)
HIB (H influenza bacteria): >3 doses
MMR (Measles, Mumps, Rubella): 2 doses (first dose after age 12 months)
Varicella (Chickenpox): 2 doses (first dose after age 12 months)

Grades 1-6

– Physical Exam: completed within the last 12 months
– Tuberculosis skin test or risk assessment with results

Immunizations:

Hepatitis B: 3 doses (last dose after 6 months of age)
DTAP (Diptheria, Tetanus, Pertussis): 5 doses (last dose after age 4)
Polio: 4 doses (last dose after age 4)
HIB (H influenza bacteria): >3 doses
MMR (Measles, Mumps, Rubella): 2 doses
Varicella (Chickenpox): 2 doses

Grades 7-12

– Physical Exam: completed within the last 12 months
– Tuberculosis skin test or risk assessment with results

Immunizations:

Hepatitis B: 3 doses (last dose after 6 months of age)
DTAP (Diptheria, Tetanus, Pertussis): 5 doses (last dose after age 4)
Polio: 4 doses (last dose after age 4)
HIB (H influenza bacteria): >3 doses
MMR (Measles, Mumps, Rubella): 2 doses
Varicella (Chickenpox): 2 doses
Meningitis: 2 doses
Dose 1: 7th Grade
Booster dose: 11th Grade
Tdap

Health Services Department Message

A message from the Medford Public Schools Health Services Department

Don’t Wait, Vaccinate!

The school nurses help maintain safety of our environment through careful monitoring of student immunizations. Vaccines work to safeguard children from illnesses and death caused by communicable diseases. They protect children by helping prepare their bodies to fight often serious, and potentially, deadly diseases. Should there be an outbreak of a communicable disease, students who have not been immunized will be excluded from school during the infectious period in accordance with the Massachusetts Department of Public Health regulations.

Use of crutches

Physical Exams

Medford Public Schools requires a physical exam for all students new to the school system and students in Grades Kindergarten and 7. Yearly physical exams are required to meet the requirements of the Massachusetts Interscholastic Athletic Association (MIAA ) for student athletes enrolled at the high and middle schools.

When your child enters Grade 4, an interval health history will be sent home so you may update your child’s medical information. The school nurses request you return it fully completed with all pertinent medical information to the school health office as soon as possible after you receive it.

Medications

It may be necessary for your child to receive medication during the school day. Our school district requires that the following forms must be on file in your child’s health record before we begin to give any medicine at school:

1. Signed consent by the parent or guardian to give the medicine. Please complete the enclosed consent form and give it to your school nurse. (waiting for new updated form.)

2. Signed medication order. The written medication order form should be taken to your child’s licensed prescriber (your child’s physician, nurse practitioner, etc.) for completion and returned to the school nurse. This order must be renewed as needed and at the beginning of each academic year. Please download it here.

Medicines must be delivered to the school in a pharmacy or manufacturer-labeled container by you or a responsible adult whom you designate. Please ask your pharmacy to provide separate bottles for school and home. No more than a thirty-day supply of the medicine should be delivered to the school.

When your child needs a medicine to be given during the school day, please act quickly to follow these policies so we may begin to give the medicine as soon as possible.

Thank you for your help.

MPS Medication Policy and Procedures

Health Screenings

Health screenings are conducted throughout the school year as required by the Massachusetts Department of Public Health and Massachusetts General Laws. The following chart illustrated the purpose and required grade level for each screening. Parents may opt out of screenings for their child with written permission, provided they provide documentation that their child has been examined by their primary care provider. All information is confidential and parents are notified whenever there is a finding after screening.

Vision

Hearing

Height/Weights/BMI

Postural Screening

SBIRT

Vision Resources in the Medford Community

Vision Resources in the Medford Community

If your son/daughter has failed the school screening, you will receive a letter requesting that you bring him/her to an eye doctor for evaluation and treatment. Your school nurse also requests that you return the completed doctor’s note back to her. Here are some places where you can obtain eyeglasses for your son/daughter if needed.

Online Resources

Medford Public Schools Wellness Policy

Head Lice

Purpose

To contain infestation of head lice among the school age population while maximizing students’ academic performance and minimizing absences due to unnecessary exclusion of students using nursing/medical best practices. The American Academy of Pediatrics and the National Association of School Nurses no longer endorse a “No Nits” policy in schools. Exclusion is not an effective tool in reducing lice outbreaks (CDC, 2010; Frankowski & Bocchini, 2010; Frankowski & Weiner, 2002). In cases that involve head lice, as in all school health issues, it is vital that the school nurse prevent stigmatizing and maintain the student’s privacy as well as the family’s right to confidentiality (Gordon, 2007).

Standard

The school nurse will examine the head of any child suspected of having a live lice infestation and notify the parent/guardian. Head lice are not a health hazard or a sign of uncleanliness and are not responsible for the spread of disease (Frankowski & Weiner, 2002). Lice are not a public health emergency. Lice cannot hop or fly; they crawl. Transmission in most cases occurs by direct contact with the head of another infested individual (Frankowski & Bocchini, 2010).
Children returning to school after treatment for head lice will be examined by the school nurse to verify absence of live lice prior to entering the classroom.
Presence of nits does not indicate active infestation and there is no evidence that the presence of nits correlates with any disease process (Scott, Gilmer, Johannessen, 2004). Other studies show that lice are not highly transferable in the school setting (Hootman, 2002) and no outbreaks of lice resulted when allowing children with nits to remain in class (Scott, Gilner & Johannessen, 2004). Nurses will perform targeted pediculosis screenings based on the affected student’s known close contacts and family members. Whole class screenings for nits alone have not been proven to be effective (CDC, 2010; Andresen & McCarthy, 2009).

Procedure

Upon notification of suspected cases of head lice, the school nurse will examine the student.

An infestation will be determined by looking closely through the hair and scalp for viable nits or live lice. Lice and nits (dirty-white to gray colored eggs attached to the hair shaft) are visible to the naked eye. Nits which are farther than ¼ inch from the scalp are not considered viable because eggs are laid at the scalp and the life cycle is short, therefore, any remaining nits beyond 1/4 inch (hair growth takes time) are either empty or dead.
The nurse will determine the severity of the infestation (live lice or just nits) and the parent/guardian will be notified via phone, email, and/or a note sent home with the student (see “Head Lice Screen Information for Parents”). Based on the infestation, the nurse will determine if the child is so uncomfortable that they should go home or if the child can remain in school. The parent/guardian will be provided with information on biology of head lice, methods to eliminate infestation, and directions to examine household contacts for lice and nits and that the student must check in first with the school nurse upon returning to school the next day.
If only nits are detected the student will remain in his/her classroom for the remainder of the school day. Parents will be notified and provided with treatment information as above.
The school nurse, at his/her discretion, may perform a targeted screening of the students most likely to have had direct head to head contact with the affected student (especially recent sleepovers). Parents/guardians will be referred to their health care provider for follow up if there are positive findings, or lice are resistant to treatment. If multiple students in one class are affected, at the nurses’ discretion, classmates will be checked and at that time a class wide letter will be sent home (see “Notes from the Nurse” classroom letter).

Upon Student’s Return to School

Additional Information Relating to Head Lice

Parents/guardians will be encouraged to verify treatment as soon as possible after notification. Parents will be encouraged to check their child’s head daily for at least 2-3 weeks after discovery. Removing nits EVERY day for 3 weeks is the most effective treatment.
Students will be discouraged from direct head to head contact with other students. The school nurse will provide in-service education to staff regarding how to handle nits and/or live lice in the classroom.
The most common means of transmission is through physical/direct (head to head) contact. Indirect transmission is uncommon but may occur from shared combs, brushes, hats, and hair accessories that have been in contact with an infested person. Schools are not a common source of transmission. Lice prefer clean hair because it is easier to attach to the hair shaft to lay their eggs.
Staff will maintain the privacy of students identified as being infected with head lice.
The school nurse is the key health professional to provide education and anticipatory guidance to the school community regarding best practice guidance in the management of pediculosis. The school nurse’s goals are to facilitate an accurate assessment of the problem, contain infestation, provide appropriate health information for treatment and prevention, prevent overexposure to potentially hazardous chemicals, and minimize school absence.

Resources

American Academy of Pediatrics. (2010). Policy statement: Clinical report head lice. Retrieved from http://aappolicy.aappublications.org/cgi/content/full/pediatrics;126/2/392.

American School Health Association. (2005). School policies in the management of Pediculosis. Retrieved from: http://www.ashaweb.org/files/public/resolutions/pediculosis.pdf.

Andresen, K., & McCarthy, A.M. (2009). A policy change strategy for head lice management. The Journal of School Nursing. 25 (6) 407-416. dli:10.1177/1059840509347316.

Centers for Disease Control and Prevention. (2010). Head lice information for schools. Retrieved from http://www.cdc.gov/parasites/lice/head/index/html.

Chunge, R.N., et al. (1991). A pilot study to investigate transmission of head lice. Canadian Journal of Public Health, 82, 207-208.

Frankowski, B.L., & Bocchini, J.A. (2010). Committee on School Health American Committee on Infectious Disease, Academy of Pediatrics. Clinical report: Head lice. Pediatrics, 126(2), 392-403.

Frankowski, B.L., & Weiner, L.B. (2002). Committee on School Health Committee on Infectious Disease, American Academy of Pediatrics. Clinical report: Head lice. Pediatrics, 126(2), 392-403.

Gordon, S. (2007). Shared Vulnerability: A theory of caring for children with persistent head lice. The Journal of School Nursing. 23 (5) 283-292. doi: 10.1177/10598405070230050701

Hootman, J. (2002). Quality Improvement Projects Related to Pediculosis Management. Journal of School Nursing, 18(2) 80-86.

Humphreys, Elizabeth et. al. (2008). Outcomes of the California Ban on Pharmaceutical Lindane: Clinical and Ecological Impacts. Environmental Health Perspectives, 116(3), 297-302.

Massachusetts Department of Public Health. (2007). Pediculosis (Head Lice). The Comprehensive School Health Manual, (8), 56-58.

National Association of School Nurses. (2011). Position Statement: Pediculosis in the School Setting. Retrieved from http://www.nasn.org/defalt.aspx?tabid+237.

National Guideline Clearinghouse. (2008). Guidelines for the diagnosis and treatment of Pediculosis capitis (head lice) in children and adults. Retrieved from http:www.guideline.gov/summary/summary/aspx?doc_id+12784&nbr=00658&string=Pediculosis.

Pollack, R. (2009). Head Lice information. Statement from the Harvard School of Public Health. Retrieved from http://www.hsph.harvard.edu.headlice.html.

Pollock, R. J. (2010). How many people are infested with head lice? Retrieved from: https://identify.us.com/head-lice/head-lice-FAQS/how-many-people-infested.html

Pollack R.J., Kiszewski A.E., Spielman A., (2000). Over diagnosis and consequent mismanagement of head louse infestations in North America. Pediatric Infectious Disease Journal. 2000 (8):689-93.

Williams, L.K., et al (2001). Lice, Nits, and School Policy. Pediatrics, 107 (5), 1011-1015.

Revised March 2015

Prevention Tips & Lice Facts

Watch for students scratching their heads constantly, particularly after holiday or vacation periods.
Advise students to not share hats, hair ornaments, scarves, barrettes, scrunchies or combs/brushes.
Children should place all hats, scarves and coats into their backpack prior to hanging backpack in their locker or cubby space.
Children should keep long hair tied back and off of their shoulders.
Parents/guardians should periodically check their child’s hair for the presence of nits and/or lice. White vinegar/water rinses are recommended after regular hairwashing.
When you find a case of nits/lice, tell others. Notify your child’s school nurse, day care providers and parents of your child’s friends, especially after sleepovers.