We don't tend to think about physical health and wellbeing as a 'special educational need' but when we look into the data around children's health and its impact on academic outcomes, this is a perspective that needs to change. Not only is children's health deteriorating, affecting pupil achievement, but chronic and acute conditions are affecting pupils sense of inclusion and belonging in schools, too.

This area of screening is particularly under-developed because there are significant research gaps in between the fields of health and education. I wonder how we might be able to contribute to the field through our screening work in the coming years...

This section relates to Chapter 9

NCIM Action Point 9.1:

Physical Fitness, Oxygen Efficiency, Asthma

Physical Fitness:

It might not surprise you, but physical fitness and learning progress are closely linked. The better our body is working, the better our brain is working. They are not separate entities, so the more you can do to support children's fitness, the better it will be for their progress.

If you are directly working with children and young people when they are running about and exercising, you will have a sense of which children might benefit from more opportunities to develop physical confidence. If not, it is worth linking up with the PE staff and monitoring fitness, gross motor skill, balance and core stability through their observations to help build your understanding of a child or young person and their profile.

You can find out more here about typical exercise needs and strategies for each age group:

Those who are trained may also want to consider Heart Rate Variability and VO2 Max as indicators of overall health.

Oxygen Efficiency & Asthma Support (Individual):

The following questions can be asked to either pupil or parent-carer depending on age/stage/context and are aimed at understanding aspects of asthma (state, prevention and response strategies) to explore where any improvements/support can be targeted:

• How is your asthma at the moment? Do you feel it is well-managed?

• Are you able to breathe freely through your nose or do you find yourself breathing through your mouth?

• How often have you been advised to use your brown (prevention) inhaler?

• Is it helping?

• What can get in the way/stop you from using it?

• Where do you keep your blue (reliever) inhaler?

• How often do you need to use it at the moment?

• When is your next appointment with the asthma nurse/consultant?

(to parents-carers only)

• Have you noticed any snoring and/or mouth breathing when they're asleep? (Mouth-breathing is often signalled by an open mouth when asleep, and can affect attention and concentration levels during the day)

You can access these questions in the parent-carer conversation guides in the free Get Started download, too.

Whilst we are not trained to give advice on asthma management, if you feel concerned that a pupil is experiencing breathing difficulties and their medical support needs further review, strongly encourage parents-carers to make an appointment with the asthma support service, GP or pharmacist as soon as possible. It is also prudent to ask for a review if you are concerned by a pupil's inattention or lack of progress in class, as their breathing may be a factor.

There's also lots of brilliant support information on the Lung + Asthma website

Oxygen Efficiency & Asthma Support (Whole School):

You can explore how safe your school or setting is by considering the level of pollution in the air. Is the air toxic in your playground? If so, break times will be unsafe for everyone, but particularly those with breathing difficulties. You can read more about it here and join the Lung + Asthma campaign to improve child health through air quality.

You can think about how easy it is for children and young people to look after their own health. For example, you could monitor pupil voice about storing personal belongings an accessing toilet/private space to administer medication when needed. You could also think about regular opportunities to exercise - are pupils getting what they need? Is break-time an opportunity to run around and blow off some steam?

The INSCHOOL research project explored barriers and supports for pupils with medical conditions at secondary level. The British Psychological Society is asking for the Government to prioritise play at primary level. (It's even worse at secondary, though!)

NCIM Action Point 9.2:

Relationships with Food, Blood Sugar, Diabetes

Central Manchester and Manchester Children's University Hospital NHS Trust:

Screening Tool for the Assessment of Malnutrition in Paediatrics

Questions based on the STAMP that you might feel you are able to ask:

• Any current diagnosis/diagnoses that might impact upon dietary intake?

Food allergies?

Gastro issues e.g. IBS, constipation, reflux

Coeliac Disease or diabetes?

Other medical diagnosis?

Whilst the STAMP questionnaire is not recommended as part of a screening, below are some of their questions which you might like to draw upon, and may help to guide conversations with parent-carers around dietary health. These questions have been suggested by a Speech and Language Therapist and Dietitian working with children and young people around their healthy eating skills. Caution should also be taken in any conversations with children and young people around their diet, to avoid shaming.

The point of these questions is to consider and/or rule out any food related aspects of pupil wellbeing which may be affecting progress and happiness. If any of the answers shared suggest further support is needed, you can tailor your recommendations to them. In the first instance, visiting the GP or speaking to the health visitor for medical advice and any relevant referrals is a critical step. Following this, monitoring and checking a child's support needs will continue to be important. Good health management is a vital part of enabling positive outcomes.

• What is nutrition / hydrational intake like?

Restricted diet e.g. whole food groups excluded

Limited range of foods eaten (<10 different foods)

Limited intake of water during the day

• Are there any observations about weight or height?

Overweight

Underweight

Fluctuating weight

NHS information about Dental Checks for Children:

Basic information about Dental Check-Ups for Children

Find a Dentist Near You

NCIM Action Point 9.3:

Hay Fever, Allergies, Anaphylaxis

Allergies & Anaphylaxis:

Research is beginning to highlight the impact of allergies on focus and attention levels. There is a lot more research to do to understand the functional impact of allergies on learning and wellbeing. Even less is known about the impact of anaphylaxis on learning ability. One way you can begin to make your own small contribution to this research gap is to monitor pupils who have allergies and their progress. If you are concerned about their inattention and/or outcomes, and know they have an allergy, encourage parents to speak to their GP or consultant about this. They may get nowhere, or advise being assessed for ADHD, but bringing this connection into people's minds is a good place to start.

Hay Fever:

Pollen count, not just on the day of the exam, but in the preceding weeks can have a measurable (negative) impact on pupil outcomes for those who experience hay fever. It sounds obvious, and it is. But in the stresses of the external exam season, it may not be something that your Exams Officer knows or thinks about. Schools can apply for Special Consideration on behalf of the pupil - ensure your Head of Year and/or SEND team have alerted the Exams Officer to the need for an application on behalf of CYP with hay fever. This, again, is an area for much needed research along with the wider issues we are aware of in terms of the inequity of exams access arrangements.

Listen to a NCIM podcast about assessing for Access Arrangements

Hannah and Dr Emily McGhee discuss the barriers to timely and equitable assessments and accurate and supportive access arrangements in the current UK system.

NCIM Research Gaps & Helpful Links

Research Gaps:

There are large research gaps between education and health, particularly also in child health and wellbeing. But there are people who are actively working to change that. Have a listen to conversations between Hannah and Dr Ben Sinclair and Dr Simon Pini about their work in different areas.

If you are unsure how to help a pupil in an area which is still not well-understood, here are some websites which might help you. Let us know if there are any other websites we can point colleagues to.

Jump to:

Phonological Processing

Visual Processing

Handwriting & Sensory Integration

Executive Function

Social Emotional Mental Health

Physical Health