This joint report of the Committees on School Health and Rheumatic Fever of the American Academy of Pediatrics has been prepared as a guide to school authorities in determining what can be done about this disease through the schools.

The school occupies a unique position in relation to rheumatic fever control. Rheumatic fever causes more deaths than any other disease in children of school age. A first attack usually occurs in children at the age when they are in the first or second grade and recurrences are most common up to the age when children are leaving high school. The insidious onset of so many cases during the school years suggests that teachers and others in daily contact with school children should be aware of early signs and symptoms which may mean acute rheumatic fever.

The periodic school health examination when done hastily without removal of clothing may miss children with rheumatic heart disease. On the other hand, children may be labeled with the diagnosis of a rheumatic heart because a heart murmur Was wrongly interpreted. This serves to emphasize the opportunities as well as the difficulties of discovering rheumatic fever and rheumatic heart disease in school children.

Improvement of School Medical Procedures

The American Academy of Pediatrics believes the problem of what to do about rheumatic fever through the schools is an integral part of what should be done about the health of all school children. The following recommendations, while pointed towards case-finding and health supervision of the rheumatic child, will, if applied, lead to better health service for all school children.

The periodic school medical examination should be improved:

1. By obtaining a health history of the child from the parent and the teacher, if possible, at the time of the child's examination.

2. By being performed without haste and with the child disrobed.

3. By the employment of physicians trained in pediatrics, if possible. Where this is not feasible, arrangements should be made for giving physicians who make school medical examinations additional clinical training in normal child growth and development as well as in children's medical problems including rheumatic fever and heart disease.

4. By allowing time for the physicians to plan with the nurse and parent for medical attention. The examination is then more likely to be of greater aid in getting medical care for school children who need it.

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