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Nutrition, Health and Safety

Position Statement onNutrition Programs and Services in Schools

The Massachusetts School Nutrition Task Force

The following statement was written by members of the Massachusetts School Nutrition Task Force. Nutrition influences a child's development, health status, well-being and potential for learning. We encourage schools to meet the following goals:

1. Ensure children have access to adequate and healthy food while in school,
2. Promote healthy eating patterns through classroom nutrition education coordinated with the comprehensive health education program including education, health and food services,
3. ensure children have access to appropriate nutrition services, and establish a school-wide nutrition policy that involves input from a wide variety of representatives from the school community.

Rationale

Students must go to school with minds and bodies ready to take advantage of the learning environment schools work so hard to develop. Good nutrition is a prime factor in the student's ability to learn. In addition to families, the school environment plays a vital role in shaping students nutritional health throughout the growing years in the following ways:

• Students eat one to two of their meals in the school cafeteria;
• Classroom teachers provide factual instruction on human health and biology;
• Peer relationships and adult role models influence eating patterns and provide subtle but strong messages in body image development;
• Physical education and school sports programs strengthen student's bodies and often are sources of nutrition information; and
• School health services, guidance counselors and classroom teachers provide essential support for students' physical and psychological growth.

The Effect of Nutrition on Cognitive Development and Readiness to Learn

Hunger affects learning

Research demonstrates that under-nutrition can affect a child's behavior, school performance and overall cognitive development. Even when a child misses one meal, behavior and academic performances are affected. A hungry child has difficulty learning.

For a school age child, not eating breakfast can lead to fatigue and a diminished attention span. While the body adjusts to decreased blood sugar levels, the brain struggles to perform its function with a minimal supply of nutrients. Children up to the age of ten need to eat every four to six hours to maintain a blood sugar concentration high enough to support the activity of the brain and the nervous system. 2 Most teachers can quickly identify those children who come to school without breakfast. Their heads are on their desks at 10:00 AM- the peak learning hours. Chronic poor nutrition may cause more serious learning deficits.

Poor nutrition affects learning and overall health status

Iron deficiency anemia, caused by a diet low in iron-rich foods has been shown to cause lethargy and decreased attention span and memory. Further, research demonstrates chronic anemia has a direct effect on cognitive development. -4 Iron is an essential nutrient utilized for the transport of oxygen, energy production and formation of neurotransmitters, chemicals in the brain that regulate one's ability to pay attention.

Poor nutritional intake over time increases a child's susceptibility to illness, which results in increased absenteeism. A 1989 study in Lawrence, MA demonstrated the link between school breakfast participation and attendance. 5 Children who participated in the School Breakfast Program had significantly reduced absence and tardiness rates when compared to eligible non-participants.

All children suffer from the effects of poor nutrition. Increased susceptibility to illness caused by poor diets; low blood sugars caused by skipping meals; and iron deficiency anemia caused by poor selection of food continue to be problems for high school students. The increased nutritional requirements of the intense growth spurt and for some, participation in sports, make teenagers particularly vulnerable. Headaches, stomach upsets, and general malaise, common complaints in the school nurse's office, may be a direct result of poor nutrition. Other nutritional concerns including restrictive dieting, distorted body images, eating disorders and obesity may have an indirect effect on learning, and be significant predictors of a teen's success in school.

Nutrition Education

Nutrition education promotes healthy eating practices

Quality nutrition education which is presented creatively and is grade appropriate builds knowledge and skills throughout the child's school experience. It addresses factual information and explores the health, social, cultural and personal issues influencing food choices. Nutrition and nutrition education are recognized as important contributors to overall health in the Massachusetts Education Reform initiatives as they are part of the Health Curriculum Frameworks.

Comprehensive nutrition education programs extend beyond the classroom into the larger school environment. The school cafeteria serves as a laboratory where students apply critical thinking skills taught in the classroom. Physical education programs, after-school sports and school health services are appropriate avenues for nutrition education efforts.

According to the Massachusetts Common Core of Learning, 6 -7 Students need to explore how 1) knowledge has purpose and meaning in their lives and 2) curriculum points to the connections within and across disciplines.8-9 Examples of how nutrition can be integrated into other classes are: discussing ethnic food practices in the context of history and geography; the study of essential nutrients in science and biology classes; applying mathematical and technological skills to conduct dietary analysis; and addressing the wide range of social, cultural and psychological aspects of food in language and social studies classrooms.

School Meals

School meals provide essential nutrients and calorie

Research has shown that children eating school meals consume more nutrients than those who do not participate in the school meals programs. For students from homes where food is scarce, school meals may be the major source of their calories and nutrients for the day. School meals may also be adapted for children with special health care needs. A quality school meal program is an essential component of a healthy school environment.

Mealtime is a learning experience and helps a child make informed nutritional choices as part of a healthy lifestyle. The 1995 Dietary Guidelines for Americans10 reflect new scientific and medical research that links a diet low in fat and high in fruits, vegetables and grains with a decreased risk for coronary heart disease, stroke, some cancers and diabetes. They are the guiding principles for the U.S. Department of Agriculture's School Meals Initiative for Healthy Children. 11 The School Meals Initiative helps safeguard children's health by requiring schools to develop menus that meet the Dietary Guidelines.

Team Nutrition 12 is an innovative network of public/private partnerships supporting schools in implementing the School Meals Initiative for Healthy Children. Team Nutrition provides creative nutrition education for children and families, and state-of -the -art training and technical assistance for food service professionals. Team Nutrition Schools are the link to community-level implementation by actively involving a network of more than 200 supporting organizations that in turn form community coalitions that promote the Team Nutrition message through school, families, the community and the media.

School meal programs can be an active center of learning in the school although they may look different in each community. They model healthy food choices and encourage students to apply knowledge from the classroom in a practical setting. Exposure to health promoting school meals and environment encourages students to make more skillful food choices throughout their lives.13

Nutrition Services

Nutrition services complement and enhance school health services

Nutrition services include screening, assessment, counseling/education and referral and follow-up services. Students who may benefit most from school-based nutrition services include:

• children with special health care needs,
• adolescents who are obese, underweight, follow a vegetarian diet, or have other related issues (e.g. eating disorders),
• students living in impoverished conditions with limited access to nutritionally adequate food, and
• students who abuse substances such as food, drugs, alcohol and tobacco.

Optimally, nutrition services are provided on the school premises by a qualified nutrition professionalwho is recognized as a valued member of the health care team. The Triton Regional School District inNortheastern Massachusetts represents an example of a well-defined team approach to nutrition services. The health coordinator, school nurse, hospital dietitian, food service director and teachers workcollaboratively to successfully integrate nutrition into the school's comprehensive health program. Tointegrate nutrition into its health services, the school negotiated with the local hospital to securethe services of the hospital outpatient dietitian. The dietitian serves as an integral member of theschool health advisory team and works collaboratively with the school nurse to screen and assess students' nutritional status and provide counseling, referral and follow-up services.

Nutrition services are linked to physical education, school meals and health promotion programs in theschool and community. At a minimum, nutrition services in a school health program have the following three components:

1. standard nutrition screening criteria integrated into regular health screening services
   
2. a well-defined plan for follow-up of students referred for community-based services
   
3. established linkages with community-based providers of nutrition services

The type and extent of nutrition services may vary from district to district or school to school.After assessing their individual needs and available resources schools can determine the most compatible system for integrating nutrition serviceEMI 14 produced by the Massachusetts Department of Public Health is one resource readily available to all schools.

School Community

The support of the school community helps create a healthy environment

For a truly comprehensive approach to school-based nutrition programs and services, it is crucial that all members of the school community help to create an environment that supports healthy eating practices. Administrators, teachers, school food service and other personnel, parents and students, all need to be involved in this effort. Decisions made in all school programming need to reflect and encourage positive nutrition messages and healthy food choices. This includes coordination of nutrition education with the cafeteria and the promotion of healthy food choices in the cafeteria and all school events from fund-raisers to rewards for positive classroom behavior.

Establishing a nutrition policy is an effective way to create a school environment that supports healthy food choices. The policy sets standards and guidelines that promote healthy eating in all facets of the school life. The Centers for Disease Control and Prevention (CDC) publishes a guide to nutrition in schools which provides guidance on how to establish a nutrition policy.15

Advising parents when their children are participating in a nutrition education or counseling experience will encourage their support at home. Parent involvement can be in person or through communication sent to the home.

Local Community

The local community can help support school-based nutrition and health promotion activities

The effectiveness of school-based nutrition programs and services can be enhanced by outreach efforts in the surrounding community. At the very least, school personnel should be familiar with the health and nutrition resources available through the town and local agencies. Contacts can be made with the health department, community nutrition programs, health centers, local food pantries and fitness programs. Once contacts are established, schools can collaborate with other community agencies to positively influence the health and nutritional status of school-age children.

In Conclusion

As schools reshape themselves to meet the educational needs of students in the 21st century, they need to recognize their role in health promotion in general and nutritional health in particular. Knowledge gained about school-based nutrition interventions over the past 15 years justifies the importance of school programs and services aimed at improving nutritional health. School communities will benefit by integrating nutrition education, programs and services into comprehensive school health initiatives which promote healthy minds and bodies and student readiness to learn.