Physicals for Obese Students

[Allie911]

I need some advice. We have a few elementary aged students who are morbidly obese. The PE teacher wants me to set up physicals for them, including thyroid tests. The students do not have insurance that I am aware of, and the parents have been a bit slow to be compliant with other things we have asked them to do. First question is can we require that a student have a physical, second is there funding out there to help with the cost of a physical and lab work?

One parent sent a note this week to school excusing her child from running in PE because she claims his allergies are too bad and he has troubles breathing while running. Should I require a doctor's note to excuse him, he really really needs the exercise!! I feel so bad for these poor students, but am not too sure where to start to help them out!

Thanks

[Flare, ASN, BSN]

It all depends on your state's codes for physicals. Honestly I can't imagine any school having the authority to require a thyroid assessment, though.

If I were in your boat, I'd meet with the school social worker to ensure that the concerns are shared. The social worker may be able to assist with filing paperwork for state sponsored insurance for the children or may know of a clinic that will do the physicals pro bono or prorated. I have found with parents that are lax in getting things done, if the school sets the appointment, they will often comply.

As far as a note for PE goes - I allow a parent to write a student out for no more than two days - and it has to be a good reason to merit the 2nd day. Beyond that I require a note from a HCP.

[schooldistrictnurse]

Wouldn't you be discriminating if you demand physicals from only one segment of your population?

[LACA, BSN, LPN, RN]

I wouldn't think you would be able to make them get the physical...

As for the note, I would let Mom know that anything longer than 2-3 days requires a doctor's note, SPECIFYING why and how long he should miss.

[Jolie, BSN]

While I understand and appreciate the PE teacher's concerns reagarding the safety of these children participating in PE as well as overall concern for their health, I know of no situation in which a teacher has the authority to require a physical exam or testing.

If these are elementary students, they must have had a physical upon entry to school. Were they obese then? Did the physician address the issue at that time, or just let it go, as seems to often be the case? Does your district measure ht, wt and BMI on a regular basis? If so, what do the growth curves look like?

If requiring (or even suggesting) a physical represents a financial burden to the parents, is your district ready to offer assistance or at least suggestions for lower cost care?

Obviously, this is a sensitive issue. I would not dive into a conversation with the parents until you have concrete examples of how the child's physical condition interferes with his/her participation in educational activities, and until you can sketch out a plan of how you can offer assistance to the family. What professional resources do you have in your district to assist you? Dietician, PT, OT, athletic trainer?

Good luck!

As for the PE note, in our district parents may excuse their student from PE for no more than 3 consecutive days. After that, a doctor's note is required. If a student is excused from PE, they may not go out for recess either. It amazes me how many kids are too sick or fragile to participate in PE, but not to sick to run like crazy on the playground after lunch. Not on my watch.

[Allie911]

Thanks, I appreciate the feedback. Our school district has only had a school nurse for the past 4 years, so we are still learning what policies we should have had in place ) Obesity is such a tender topic that I worried when the PE teachers said they wanted me to approach the parents and demand a physical.

[Neveranurseagain, RN]

The PE teacher need to sensitive also as to requiring these kids to exercise like the students that are not overweight. They may be in such poor physical condition that a modified approach needs to be taken to prevent injuries. They may need to be excused from running until they develop and build muscle and enough endurance to run. They should be encouraged and graded on effort, not speed. Be sure your PE teachers are not singling these students out.

As far as requiring PE's, it is up to the parents, not the school to make medical decisions regarding students, unless it is mandated in your state statutes.

For the first time this year, our local hospital received a Fit Kids grant, and did ht., wt, BMI on all our students. They then offered a free physical and fitness classes to any student that was underweight as well as overweight. Fit Kids also paid for the family to see a dietitian. Here is the link to Fit Kids:

American Heart Association - Fit Kids

[2ndgenschoolnurse]

Wow! I work in NYS and Health appraisals with a PE are mandated in grades K,2,4,7 and 10...if a parent does not provide a PE from a private MD the child by law gets one a school. I would contact either NASN or your state's Dept. of Education. We also are mandated to screen for vision, hearing and scoliosis. If a child has any "deficiencies" in vision or hearing or scoliosis we refere them for follow up. Unfortunately since being over weight (as I am) also has a social stigma, we struggle with refering these students. I would not be offended if I got a note home saying my child needs a referral for his vision, however, I am not sure how I would feel if I got one due to his weight...even though it is a severe health concern with proven medical conditions that are a result of being overwieght. With the new BMI monitoring/percentiles, it is my understanding that once a physcian determines that a child is overweight (or not in a healthy BMI percentile) they are to give the parents & child health counseling. Again, our weight has been associated with our looks for so long, that I think it is hard to differentiate between health counseling and getting our feelings hurt...I know I get mine hurt and will decline stepping on the scale at my MDs office, however if they want to draw blood to check my cholesterol I don't have a problem with that. I think as nurses, we are able to recommend certain screenings...ie: having your child's thyroid levels checked, but I know we can't require them. I know I have mine checked. I will be honest here, I do it to give me a medical reason for being heavy and therefor not having to acknowledge my poor choices in regards to nutrition and exercise, and I am sure I am not alone in this...parents may be more open to having their child examined if there is a medical reason, for their child's obesity.

Just my on this topic.