P8-9
シリーズ 64「健康教育をささえる」～養護教諭の現場から～小・中学校が連携して進める学校保健活動～成長曲線の活用を通して～
山梨県

身延町立身延清稜小学校

養護教諭

有野 久美

１．はじめに
平成 26 年 4 月 30 日付け学校保健安全法の一部改正を受け、「平成28 年度からの健康診断はどうしようか」と一抹の不安を感じつつ、仲間とともに通知や資料を読み込み、様々な研修会を通して改正のねらい等をまず理解することから始めた。具体的なイメージがなかなかまとまらず悩んだが、その後日本学校保健会から届いた『児童生徒等の健康診断マニュアル』が手掛かりとなった。このマニュアルをもとに町内小中学校の養護諭や関係者と協議を重ね、本町の実態を踏まえた健康診断を進めることができた。校長会、町教育委員会の助言と協力のおかげでもある。加えて、本町はここ数年間で小中学校の統廃合が進められている。学校が変わり進学しても、子供や保護者が安心できる学校保健活動を目指し、連携した取組を進めてきた。その中から「身長成長曲線、体重成長曲線、肥満度曲線」（以下、成長曲線等）の活用を通した取組の一部を報告する。

Series 64“Supporting health education” —From the site of practice of nursingteachers (YOGO teachers)
School Health Activities jointly linked and promoted between elementaryand junior high schools: Deploying growth curves
Kumi Arino, nursing teacher (YOGO teacher), Minobu Seiryo Elementary
School, Minobu Town, Yamanashi Prefecture
1. Introduction
I had a continual and vague feeling of anxiety as to “what should be done
about health checkups from FY 2016,” taking on the partial revision of theSchool Health and Safety Act on April 30, 2014. I read through the relevant
notifications and reference materials with my compatriots, and began tocomprehend the purpose of the revisions through various training sessions.
While I remained anxious that a specific vision was failing to coalesce,
subsequently the “Manual for health checkups for school children, etc.”
which arrived from the Japan Society of School Health helped me get ahandle on this. I was able to use this manual as the basis for various
discussions with nursing teachers (YOGO teachers) and other relevant
persons in elementary and junior high schools in the town in order toprogress in provisions for health checkups based on our town’s actual
circumstances. This progress can also be attributed to the advice andcooperation of the association of principals and the town’s board ofeducation. In addition, in the past several years the merger of elementaryand junior high schools has been ongoing. We have joined forces to further
initiatives for school health activities to allow children and guardians easeof mind even as they change schools and advance school years. I will reporton some of such initiatives which use “Height growth curves, weight1

growth curves and the percentage of overweight curve” (hereinafter, theseare called “Growth Curves”).
２．「子供の健康管理プログラム」の活用に向けた取組（１） 必要事項の入力
平成 28 年度の健康診断に向け、前年度の秋から、「子供の健康管理プログラム」（以下、プログラム）の Excel 原票へ、小学校入学時からの身長体重の値等の必要事項の入力を行った。中学生の場合、最長9 年間の測定値の入力になるので、町内の養護教諭で連携し随時入力を行った。測定値の入力数は、年 1 回、年 3 回、年 10 回で成長曲線等を作成し、グラフの見やすさを比較し、小児内分泌の専門医の助言を得て、原則年 3 回の入力とした。

（２） 成長曲線等に関する啓発
以前は、身体測定値を一つ一つプロットして作成するため、成長曲線等の作成は成長が気になる子供のみであった。しかし、プログラムの活用で全員分を効率的に作成でき、資料として示すことが可能になった。その分、それを手にする保護者や学級担任との共通理解をもつためには、成長曲線についての理解が必要となった。そこで、職員会議や保護者対象の資料（資料①）を作成し、平成 27 年度から、繰り

2. Initiatives towards deployment of “Children’s Health Management
Program”(1) Input of necessary items
In preparation for the FY 2016 health checkups, we began to input thenecessary items such as height and weight values form the time students
entered elementary school, into the “Children’s Health Management
Program in a prescribed format Excel sheet from autumn of the previous
fiscal year. For junior high school students, we regularly liaised withnursing teachers (YOGO teachers) in the town and input their details toencapsulate measurement values for a maximum length of nine years. We
created Growth Curves, etc. for once, three times and ten times yearly withinput figures for measurement values, and compared the appearance of
these graphs. We then decided in principle to input items three times per
year under the guidance of a certified medical specialist in pediatricendocrinology.
(2) Awareness-raising activities on Growth Curves, etc.
Previously we had only created Growth Curves, etc. of the heightmeasurement values for children whose growth was in some way
concerning, in order to plot one by one and draft body measurement values.
However, by actively deploying the Program we were able to efficiently
create these for all school children, facilitating the presentation of theseresources. In order to allow the guardians and homeroom teachers who are
to handle these resources to share a common understanding of them, theirunderstanding of the Growth Curves was required. With this in mind we2

created materials for teachers meetings and the reference of guardians,会等の機会に説明を重ねた。併せて、改正の内容をまとめた資料を作 again undertaking Awareness-raising activities from FY 2015. In FY 2016,
we offered further explanations on the occasion of the PTA general meeting
成し、町教育委員会を通して学校医に協力依頼をお願いした。
and meetings of the School Health Board. At the same time, we createdmaterials which summarized the content of the revisions and requested
cooperation from school doctors through the town’s board of education.
返し啓発を行ってきた。平成 28 年度にも、PTA 総会、学校保健委員（３） 学校医が行う健康診断での活用(3) Deployment in health checkups conducted by school doctors

学校医が行う健康診断での活用には、事前の準備が重要となる。プ
ログラムの検索で成長異常群に該当した子供の対応は、町内の学校で統一した。新年度の身体測定値を入力し、作成した成長曲線等を診察前に学校医に提示する資料に含めた。学校医からは、診察時の問診、診察結果を踏まえて、今後の対応について個別に指導していただいた。健康診断改正の趣旨や内容について事前に理解していただいたことから、診察時に「運動する時、痛みがあったり、気になったりするところはあるかな」「好き嫌いなく食べているかな」等、ていねいな問診、診察を進めていただけた。

（４） 健康診断の事後指導としてAdvance preparations are important to deploy health checkups conductedby school doctors. We standardized the response for children classified ashaving growth abnormalities through retrieval from the Program for theschools in the town. We input body measurement values for the new fiscal
year into the Growth Carves, etc. and included these measurements inmaterials presented to school doctors in advance of medical consultations.
We had school doctors offer individual guidance on ongoing responses
based on medical consultation content and the outcome of the medicalexaminations. As we had gained an understanding of the nature and contentof revisions to health checkups in advance, we were able to facilitate
scrupulous questioning as part of medical consultations and medicalconsultation. Questions included “Do you have any pain or other concerns
when you exercise?” and “Are you a fussy eater?”(4) Follow-up guidance after health checkups

For children falling under the retrieved groups 2, 4, 5, 7, and 9, classified as
プログラムで成長異常群のうち検索 2・4・5・7・9 のグループに該 having growth abnormalities under the Program, we recommended
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当した子供については、学校医の指導を踏まえ、専門医への相談受診を勧めた。その際、通知だけでなく、成長曲線等で読み取れる内容を含め、個別の面談や健康相談を行う等ていねいな対応を心がけた。
併せて、すべての子供の発育の評価として成長曲線等を家庭へ通知した。その中で、成長異常群に該当する子供にむけては、成長曲線等のグラフ上に生活指導を含めたコメントを加えた。成長曲線等の通知
は、個別指導を除き身体測定毎の年 3 回としている。

（５） 学校の統合や中学校への引継に関わって町内のそれぞれの学校での対応や成長異常群に該当する子供の受診状況とその後の経過を記録する様式を統一し、統合や進学時の引き継ぎ資料の一つとした。
（表 1）これにより、受診の有無、受診結果だけでなく、その後の経過や対応を確実に引き継ぐことができ、一貫した対応が可能になった。さらに、定期的に町内小中学校の養護教諭で事例検討を行うこともできた。

（６） 個別指導の資料としての活用

undergoing medical consultations with certified medical specialists basedon the instruction of school doctors. On such occasions, we endeavored tocomplete scrupulous response actions, including the use of individualinterviews and health consultation encompassing the content discerned
from Growth Curves, etc.
At the same time, we notified children’s households on Growth Curves, etc.
as assessments of all children’s development. As part of these notifications,
we appended comments, including lifestyle advice based on the GrowthCurve, etc. graph for children classified as having growth abnormalities.
Notifications of Growth Curves, etc. for body measurements are rolled out
three times per year excluding discrete provision of individual guidance.
(5) Involvement in school integration and handover to junior high schools
We standardized the form to record the actions taken at various schools in
the town for examination status of children categorized as having growthabnormalities, and their subsequent progress. This allowed generation ofmaterials to be handed over for integration and advancing years (Table 1).
By doing this, it became possible to complete a reliable handover for
subsequent progress rather than just offering statuses as to whether or notthey had undergone examinations and the results of examinations, thus
facilitating uniform responses. In addition, nursing teachers (YOGOteachers) at town elementary and junior high schools were able to routinely
implement case studies.
(6) Deployment as materials for individual guidance

Growth Curves, etc. can be effectively deployed as instructional resources
as they can easily be understood visually via graphs. Taking the example ofて効果的に活用することができる。本校を例にとると、6 年生には個 Minobu Seiryo Elementary School, Growth Curves, etc. are presented
成長曲線等は、視覚的にわかりやすいグラフのため、指導資料とし

4

別に健康診断の振り返りを行う際に、成長曲線等を示し、そこからわかる発育の状況を説明し、生活習慣の振り返りを行った。子供の中に自らの身長の伸びの見通しがわかり、早い就寝時刻を心がけ生活習慣を見直したり、次の身体測定を楽しみにしたりしている様子が伺うことができた。また、肥満ややせ傾向の子供に対しても、身体測定の回数を増やし、極端な体重の増減を目指すのでなく、成長曲線の基準線を参考に次回身体測定時の目標を理解するための資料として有効に活用できた。

when conducting individual reviews of health checkups among sixth year
students. Information which can be derived from these as it relates to childdevelopment is explained and lifestyle habits are reviewed. We were able toobserve the responses of children as they gained perspective on their own
growth in height, and how they can make individual efforts to ensure thatthey maintain an early sleep schedule and review their lifestyle habits,
while looking forward to the next time they will take their bodymeasurements. In addition, we increased the frequency of bodymeasurements for children tending towards obesity or thin body. We
effectively deployed these measurements as resources to understand targets
for subsequent measurements with reference to baseline values of growth
curves, rather than aiming for extreme increases or decreases in weight.

5表1

Table 1.

List of response statuses for growth abnormalities under the program

Interview
with guardianMonthly
weightmeasurement⑨

Handover items

Weekly weightmeasurement
and review oflifestyle
Having regular
visits toPediatrics, XX
Hospital

Guardians do notbelieve in necessity
to undergo medical
consultation

Positively taking on
board achievement of aheight of up to a
maximum of 165–170
cm. Advanced to juniorhigh outside the town

Having regular
visits to
Pediatrics, XX
Hospital

Regularly holdpediatric medical
examinations andcheckups

Not yetPediatrics Dept.,
XX Hospital
Precocious
puberty
No action taken
Having regular④
visits to
Pediatrics, XX ⑧
Hospital

Outcome andsubsequentactions taken

DoneNot yet⑨⑤

Not yet④⑦DoneHaving regularvisits toPediatrics, XX
Hospital

Done

Not yet④Done②⑥

Not yet⑤⑦

StatusBegan strollswith guardian
at homeNot yetSaw a doctor at
Pediatrics, XX
Hospital
X-ray taken ofwrist bones
Continued tomonitor
condition

Sorting⑥⑦

Not yetDone⑤

Interview
withguardian⑥

Guidance on
how to eat
school meals⑥⑦

Not yet⑥⑦

Outcome andsubsequentactions taken

Not yetNot yet⑦

StatusStatus⑥

Outcome andsubsequentactions taken

Jan. 2017

Sep. 2016
Sorting

Sorting

NameGender
NumberSchool year

Apr. 2016

Interview withguardianInstruction on
monthly weightmeasurement/
review of lifestyleAlso making
individual efforts on
dietary habits athome

３．成長曲線等の活用１年目の成果と課題

3. Outcomes and challenges from the first year of deployment ofGrowth Curves, etc.

全ての子供の成長曲線等を保健管理・保健指導資料に活用すること

By actively using the Growth Curves of all children in health management
6

で、見落としがちな男子の思春期早発症等の対応を行うこともできた。町内小中学校では、成長異常群の出現率は各学年で 2 ～ 4 割を占めた。
（図 1）特に中学生の検索グループ④、⑦の割合が高く、思春期早発症、進行性肥満が疑われる生徒が含まれている可能性がある。
小学校での適切な対応により、今後この割合の減少を目指したい。
また、小学校入学後の身体測定値だけでは、小学校低学年の成長の評価は十分でない。今後は乳幼児期の状況の把握を考えていかなければならない。

and health guidance materials we were also able to take actions on
precocious puberty in males which there is a tendency to overlook. The
incidence rate of growth abnormalities in elementary and junior highschools in the town accounted for between 20% and 40% for respective
school years (Figure 1). Rates were high in the retrieved groups ④and ⑦of junior high school in particular, and there may be a possibility that thisincludes students in whom delayed puberty or progressive obesity issuspected. We hope to decrease this percentage on an ongoing basis bymeans of appropriate responses in elementary schools.
In addition, only having body measurement values for entering
elementary school, is insufficient to evaluate the growth of children in thelower grades of elementary school. Going forward, it will be necessary toconsider obesity status from infancy.
Figure 1.

The incidence rate of growth abnormalities from Program retrieval

図1
Retrieved status by school year (April 2016) n=568
1st year elementary
2nd year elementary
3rd year elementary
4th year elementary
5th year elementary
6th year elementary
1st year junior high
2nd year junior high
3rd year junior high7

4. Conclusion
It has become increasingly clear in the course of integrating health
保健管理と保健教育を一体化させて学校保健活動を進めていく中
management and health education and furthering school health activities
で、成長の評価とその対応は健康づくりの基盤になることがより明確
that the assessment of child growth and actions taken in relation to suchになった。今後も小・中学校で連携した取組を進め、健康教育の充実 will become the foundation for promoting health. I hope that cooperative
initiatives of elementary and junior high schools will continue to progress,
を進めてand that health education will continue to be enriched.
いきたい。
４．おわりに研究同人
塩谷典子（身延小学校）望月直美（身延中学校）
馬場浩江（下山小学校）樋川明香（大河内小学校）

Study compatriots
Noriko Shioya (Minobu Elementary School), Naomi Mochizuki (MinobuJunior High School), Hiroe Baba (Shimoyama Elementary School), Asuka
Hikawa (Okouchi Elementary School), Kumi Arino (Minobu Seiryo
Elementary School)

有野久美（身延清稜小学校）8