Page 1 of 6 HEALTH SCREENINGS PROCEDURE 1. Head Start children will be screened within 45 days of enrollment and ECEAP children will be screened within 90 days of enrollment. ECEAP children at Head Start direct service sites will follow the 45 day timeline. 2. All screening results are recorded on a Health Screening Notice (H-18) at time of screening. Original goes to parent, yellow copy in child file. If two files, provide a copy for the health file. If child is absent indicate on form. 3. Classroom or health staff will measure height/weight twice a year. 4. Health staff will screen vision and hearing within designated timelines. 5. Use a pen to record on the Health Screening notice. Press firmly to assure the copy is legible. (See next page.) Growth Teachers or health staff measure height and weight twice a year (within the first 45 days of enrollment and near the end of the year by April 15). Per program standards, children are weighed and measured without shoes or coat/sweater. Height: 1. Place the vertical measuring board on a hard surface 2. Ask child to take shoes off. If child resists, give encouragement. If child refuses, be sensitive and do screening with shoes. Note under comments that child was measured with shoes and mark as re-screen. 3. Have child stand straight, facing away from the tape measure with heels all the way back and chin level. 4. Bring measuring tool to the child s head. Ponytails may need to be moved out of the way. 5. Ask the child to step out from the measuring tool, keep it in place and read measurement to the nearest ¼ inch. Weight: 1. Place standard scale on hard surface. 2. Ask child to take shoes and coat off and say, I want to see how much you weigh, not what your shoes weigh give encouragement. If child resists, weight will not be taken at all, write, Refused and check re-screen. 3. Ask child to step up on scale, make sure their hands are not touching any objects. Measure weight to the nearest ½ pound. 4. To the greatest attempt possible, children are re-weighed on same scale.
Page 2 of 6 Distance Vision (Every year, beginning at age 3) Vision is screened at ten feet using the chart. 1. Two people should screen vision whenever possible, with one person at the chart, the other with the child. 2. The vision chart is placed so that glare is not reflected to the chart or to the child s eyes. Vision chart is approximately 36 from the floor. 3. Placement for the child is well marked on the floor by tape. 4. The child is shown the objects and has the opportunity to practice. 5. Have the child stand behind the ten-foot marker. Starting with the 20/200 line, ask child to name the objects on the chart. 6. Point to one symbol per line. (Use symbol box for smaller symbols). Continue down the chart if child correctly identifies symbols. Stop at the 20/30 line and go across the line to assess whether child can identify at least half of the symbols. If child can, move down to the 20/20 line and repeat. If child cannot correctly identify half, move up to the 20/40 line. The lowest line on which child can identify at least one more than half of the symbols is the passing line. 7. Measure right eye first with the left covered, then the reverse followed by both eyes together. 8. Children with glasses are screened for both eyes only, not individually, with glasses on. 9. The eyes are observed for any noticeable difference such as pupil size. 10. Watch for squinting, tilting head, peeking from behind the cover, excessive blinking, eyes filling with tears or eye rubbing. 11. Refer child for re-screening or referral when: a. 3 year olds failure to correctly identify one more than half or more of symbols on the 20/40 line. Rescreen a child with a two-line difference between the eyes in the passing range (e.g., Both = 20/20, R = 20/20, L = 20/40). b. 4 and 5 year olds failure to correctly identify one more than half or more of the symbols on the 20/30 line. Rescreen any child with a two-line difference between the eyes (e.g. Both = 20/20, R = 20/20, L = 20/40). c. Rescreen within the 45 or 90 day timelines. d. Refer a child with a two-line difference between the eyes after the second screening. Refer children who did not pass after the second screening. Health staff may refer before a second screening, after consultation with Health Services Coordinator. 12. Attempt near vision screening if a child fails the distance vision screening protocol. 13. If a child is unable to be screened because they do not understand or are unable to mentally focus on any portion of the screening, mark DNUT (Did Not Understand Test) and check rescreen. Children not passing initial screenings are re-screened within the 45 or 90 day timeline and/or are referred to their medical provider for further evaluation. Children with two
Page 3 of 6 screening failures are referred to their medical provider. The Screening Notice H-18 will be stamped and the exact results will be recorded and sent home. Notification for referral is done by the Screening Notice, phone call and/or correspondence. 14. Health Services Staff will evaluate referred concerns and contact parent or medical provider, as necessary. Near Vision (As Needed, beginning at age 3) Near vision is screened at 16 inches using the correct chart. 1. The child remains seated in a chair the entire time. 2. A string is attached to the near card. Place the card in front of the child at the correct distance by pulling the string on the card to the child s nose. Drop the string once the correct testing distance is established. 3. Begin with both eyes open and ask the child to identify the five biggest symbols at the top. This is to gain their confidence. 4. Work quickly down the card one line at a time pointing to one symbol per line. 5. Once a line is reached where the child does not identify a symbol correctly, go back up to the next biggest line above and try to have the child identify all the symbols across the entire row. 6. If they identify over half the symbols correctly on that line, encourage the child to go back down and try the next smallest line again. 7. Identify the final visual acuity as the smallest line in which over half of the symbols were correctly identified. 8. Next, cover the left eye. Work quickly down the card one line at a time as described above. 9. Now switch the cover the right eye and repeat the steps again. 10. SPECIAL NOTE: A small coffee plastic stir stick works well for pointing to the individual symbols or letters you want the child to identify. A finger is too large. 11. Watch for squinting, tilting head, peeking from behind the cover, excessive blinking, eyes filling with tears or eye rubbing. 12. Refer child for re-screening or referral when: a. 3 year olds failure to correctly identify one more than half or more of symbols on the 20/40 line. Rescreen a child with a two-line difference between the eyes in the passing range (e.g., Both = 20/20, R = 20/20, L = 20/40). b. 4 and 5 year olds failure to correctly identify one more than half or more of the symbols on the 20/30 line. Rescreen any child with a two-line difference between the eyes (e.g., Both = 20/20, R = 20/20, L = 20/40). c. Rescreen within the 45 or 90 day timelines.
Page 4 of 6 d. Refer a child with a two-line difference between the eyes after the second screening. Refer children who did not pass after the second screening. Health staff may refer before a second screening, after consultation with Health Services Coordinator. 13. Health Services Staff will evaluate referred concerns and contact parent or medical provider, as necessary. Strabismus Screening (Every year, beginning at age 3) Two screening tests are used to check the muscle function of the eyes. If muscles are not functioning properly, strabismus (crossed eyes) may result. These screening tests are the corneal light reflex test and cover/uncover test. If the eyes are not aligned, amblyopia (lazy eye) or double vision may occur. This condition needs to be corrected before age 6 or permanent loss of vision in one eye may occur. 1. Hirschberg (Corneal Light Reflex Test) a. A penlight is held under the examiner s right eye with the light approximately 18 from the child s eyes, aimed at bridge of child s nose. b. The bright dot of light reflection should be located at the same spot in each eye. c. The light reflection should be equal in both pupils. An asymmetrical reflex will indicate a deviating eye and probably a muscle imbalance. Child should be referred to their medical provider. 2. Cover/uncover test a. Have child fixate on examiner s nose or other object. b. Cover the child s left eye, and watch the right eye to see if it moves. Any movement of the right eye is not normal. c. Uncover the left eye and observe it for movement. Any movement of the left eye is not normal. d. Repeat this procedure for the right eye. e. If movement is detected in either eye (shifting into or out of focus), it means that a concern may exist and the child is to be referred to his/her medical provider. 3. If using the 3-Figure flashlight Test, follow appropriate protocol. This test may be used alone for Strabismus screening. If questionable positive result, follow up with tests #1 and #2. 4. Children with questionable screening results due to immaturity, fatigue, etc. are re-screened in 4-6 weeks.
Page 5 of 6 Hearing (Every year, beginning at age 3) Hearing screenings are done with an audiometer instrument. Explain to child I want to see how well your ears are working. Put this on your ear like this. (Put headphone up to your ear.) 1. Start with child s right ear. 2. Make sure their hair is not in the way. You may need to gently cover the other ear. 3. Say, Listen (don t tell them you re going to push a button). a. Give child first tone at 4000hz 60db (loudest tone). Ask, Did you hear that? If they say yes, say, OK, use your words and tell me each time you hear the noise. b. Move from 4000hz at 25db to 2000hz at 25db, 1000hz at 25db, 500hz at 25db. If successful, move to other ear. If room is loud, give 500hz at 40db, as this is normal. Anything above 500hz heard at 40db is a fail (re-screen). To pass, a child must respond correctly 2 out of 3 times for each frequency in each ear. c. If a child is unwilling to be verbal, ask if they hear the noise. Try to get them to raise their hand, or nod their head, or squeeze your hand, etc. d. If nothing works, use blocks. Give several to child and explain, When you hear the noise, give me a block. 4. Do both ears. For any failures, specify which ear and at what frequency and decibel. 5. If child does not understand, write DNUT (Did Not Understand Test) and check re-screen. 6. Children not passing initial screenings are re-screened within the 45 or 90 day timeline and/or are referred to their medical provider for further evaluation. Children with two screening failures are referred to their medical provider. The Screening Notice H-18 will be stamped and the exact results will be recorded and sent home. Notification for referral is done by the Screening Notice, phone call and/or correspondence. 7. Children who through observation are thought to have hearing concerns are re-screened in 4-6 weeks. The teachers in the classroom may monitor children with such concerns before a formal referral is made. Teachers will consult with Health Staff. 8. For specialized equipment, such as the Handtronix, follow the instructions in the case. Hematocrit (Once, at beginning of enrollment) 1. Children may receive hematocrit/hemoglobin from their medical provider and/or WIC medical providers. Providers may opt not perform the test, but may indicate low risk/not indicated on medical examination form. 2. Any child with a hematocrit reading of less than 34% or hemoglobin reading of less than 11gm/dl will be monitored and the medical provider contacted for recommendations and/or referral.
Blood Lead Toxicity Screenings Page 6 of 6 (At 12 and 24 months, or at 36 months) 1. Children may receive Blood Lead tests from their from their medical provider and/or WIC medical providers. Providers may also opt not to perform the test, but may indicate low risk/not indicated on a medical examination form. 2. Blood lead screenings may also be done at on-site clinics in the centers by contracted medical professionals. 3. Any children with a blood lead level of 5 ug/dl will be referred for monitoring by his medical provider. Immunization Status See Immunization Compliance for Program Children Health Services Procedure. Other Screenings Other screenings may be initiated dependent on environmental, genetic or community health factors. 1. Screenings in this category may include, as example: Sickle cell screening, color blindness, depth perception, blood pressure, Tuberculin testing or parasite screening. 2. Screenings in this category are recommended on a case-by-case basis. Additional vision screening and blood pressure can be done by health staff and others through the family medical provider. (Updated 10/3/14)