"I Would Have My Children Participate IF ": Perceptions of Canadian Caregivers Towards School Food Programs.

Purpose: The Canadian federal government has expressed an intention to work with provinces and territories to develop a national school food program (SFP). This study aimed to explore caregivers' perception of attributes important to include in a future SFP.Methods: An online cross-sectional survey was conducted. Fifteen elementary schools from high, medium, or low median income neighbourhoods in Saskatoon were invited to participate. School principals sent a survey link to students' caregivers. The 37-item survey included an item with 15 statements asking caregivers to rate the importance of various components of a SFP. Descriptive statistics and exploratory factor analysis were conducted.Results: A total of 510 caregivers completed the survey (response rate of 52%). The factor analysis indicated four key components of a future SFP: (1) learning opportunities on growing and preparing food, (2) offering healthy food following Canada's Food Guide, (3) affordability of the meals offered, and (4) cultural adaptability of the meal program. Over 90% of caregivers thought providing healthy meals and ample time to eat meals to be very important.Conclusion: Our results indicate caregivers support multicomponent meal programs that, along with providing nutritious food, help children build healthy habits and sustainable food systems. These findings will help dietitians understand caregivers' perspectives to inform the design of a national SFP.

Impact of COVID-19 School-Related Policies in Ontario on Parents' School Lunch Packing Habits.

Purpose: COVID-19 has disrupted the daily routines of many Canadian families. In Ontario, provincially mandated public health measures have resulted in significant changes to school policies, including those related to food. The impact of COVID-19 related school food policies on parental lunch packing habits is unknown; therefore, this study investigated how school-related COVID-19 policies have impacted parental school lunch packing habits.Methods: Parents (N = 287) of school-aged children were recruited from parent-specific Facebook groups across Ontario, Canada, to complete an online survey regarding lunch packing habits. This survey was developed based on findings from a previously conducted scoping review. Open-ended survey responses were inductively analyzed.Results: Three over-arching themes were constructed: (1) Food Programs and COVID-19; (2) Schedule Changes; and (3) School Policy Changes. Parents explained that the cancellation or modification of food programs at schools, changes to the length of time children are given to eat at school, and removal of access to microwaves, garbage cans, and teacher assistance during lunch have forced parents to change their lunch packing habits.Conclusion: Findings from this study demonstrate a need for better support to help ease the burden parents experience when packing their child's school lunch, during an already extremely stressful time.

Acceptability, Helpfulness, and Utility of the Healthy Lunch Box Booklet (HLBB) for Parents and School-Age Children.

Purpose: School lunches are of poor nutritional quality in Canada. Parents play an important role in the preparation of school lunches for young children. This study aimed to evaluate the acceptability and helpfulness of the Healthy Lunch Box Booklet (HLBB) to support parents in packing healthy school lunches for their children.Methods: The HLBB was distributed at four schools in London, Ontario to students in full-day Kindergarten to Grade three. Parents were asked to complete an online survey from April to November 2019.Results: Parents (n = 58) reported the HLBB to be helpful (96.3%) and found the sections on new school lunch and snack ideas and nutritional information (e.g., label reading) particularly useful. Some parents also stated that the HLBB created opportunities to interact with their children regarding school lunch preparation. In terms of perceived impacts, parents reported increased confidence (68.6%) and learning something new (79.6%) about school lunch preparation and felt that their children's diet was impacted accordingly.Conclusions: The HLBB was found to be an acceptable and useful nutrition resource that supports parents in packing healthy school lunches for their children and therefore warrants further study.

Undergraduate Medical Students' Perceptions of Nutrition Education at the Northern Ontario School of Medicine.

The objective of this evaluation was to determine Northern Ontario School of Medicine (NOSM) undergraduate medical education (UME) students' perceptions of the curriculum related to their nutrition knowledge, attitudes, and counseling self-efficacy/confidence. A 16-item electronic survey (Qualtrics©) was developed, and it included nutrition competency statements, adult and pediatric nutrition assessment and counseling confidence, and nutrition curriculum satisfaction. Students in Years 2, 3, and 4 (n = 192, 66%-73% female) were invited to answer the survey. Of the 61 respondents, 50.8% were Year 2, 34.9% Year 3, and 10.6% Year 4. Overall, 72.1% of the respondents were dissatisfied. Respondents perceived they were least competent in strategies to prevent and treat disease (72.1%), in applying basic dietary strategies (65.6%), and in ethics and nutrition management (62.3%), whereas 52.5% felt competent in the team approach to nutrition care. Respondents reported lowest confidence (less than 10%-15%) in specialized nutrition support, cancer care, renal nutrition, and mental health/eating disorders for both populations. NOSM medical learners reported curriculum dissatisfaction, nutrition incompetence, and poor levels of perceived confidence in nutrition management. Results will be used to inform nutrition curriculum enhancements and future outcome evaluations. Current and future physicians with enhanced nutrition knowledge, awareness of the Registered Dietitian (RD) roles, and an understanding of when to refer patients to an RD can provide better patient-centred care.

[Suspension of judgment, play and creativity in helping relationships]. / La suspension du jugement, le jeu et la créativité dans les relations d'aide.

The relational field does not only concern psychiatric professionals. A school teacher has carried out a university research work on the specificity of the psychic processes which are the basis of the helping relationship. Situations experienced in a kindergarten class describe the relational complexity involved, as well as the questioning and doubts of the professional. Finally, constructive approaches propose alternatives for maintaining the link in the relationship.

[Impact of adapted physical activities on the health and psychological factors involved in the learning of pupils and students]. / Impacts des APA sur les facteurs psychologiques impliqués dans les apprentissages des élèves et des étudiants.

The literature documenting the positive role of adapted physical activities (APA) in academic success is flourishing. It's widely accepted that practicing APA helps you succeed. However, the pathway linking the impact of physical activity on student health to academic success remains unclear, and there is still a great deal of ground to cover. With this in mind, the aim of this article is to review what is known about the health benefits of physical activity and the psychological factors involved in learning in the school and university context.

Comprehensive Nutrition Interventions in First Nation-Operated Schools in Canada.

Comprehensive school-based nutrition interventions offer a promising strategy to support healthy eating for First Nations children. A targeted strategic review was performed to identify nutrition interventions in 514 First Nation-operated schools across Canada through their websites. Directed content analysis was used to describe if interventions used 1 or more of the 4 components of the Comprehensive School Health (CSH) framework. Sixty schools had interventions. Nearly all (n = 56, 93%) schools offered breakfast, snack, and (or) lunch programs (social and physical environment). About one-third provided opportunities for students to learn about traditional healthy Indigenous foods and food procurement methods (n = 18, 30%) (teaching and learning) or facilitated connections between the school and students' families or the community (n = 16, 27%) (partnerships and services). Few schools (n = 10, 17%) had a nutrition policy outlining permitted foods (school policy). Less than 1% (n = 3) of interventions included all 4 CSH components. Results suggest that most First Nation-operated schools provide children with food, but few have nutrition interventions that include multiple CSH components. First Nation-operated schools may require additional financial and (or) logistical support to implement comprehensive school-based nutrition interventions, which have greater potential to support long-term health outcomes for children than single approaches.

Examining Elementary School Children's Knowledge about Food and Nutrition in Southwestern Ontario, Canada.

Purpose: Knowledge is fundamental to helping children make nutritional choices that support lifelong healthy behaviours. This study (i) investigates elementary school children's knowledge about food and nutrition and (ii) identifies sociodemographic factors influencing children's reported knowledge.Methods: In 2017-2019, a survey was administered to 2443 students (grades 5-8) at 60 schools across southwestern Ontario, Canada, and a parent survey was used to validate self-reported sociodemographics. Multiple regression was used to analyse children's knowledge scores and related sociodemographic factors. A total knowledge score was calculated by summing correct responses derived from 46 individual questions in the student survey.Results: Mean total knowledge score was 29.2 out of a possible 46 points (63.5% correct). Students demonstrated some knowledge and awareness of strategies to encourage fruit and vegetable consumption, healthy food selection, nutrition, and food preparation skills, although knowledge of food guide recommendations and locally sourced produce were limited. Female sex, family income, and rurality were associated with higher knowledge scores.Conclusions: Results provide insight regarding strengths and gaps in elementary-school children's food and nutrition knowledge. Poor performance of students on specific food guide-related questions suggests that the general guidance of the 2019 Canada's Food Guide might be better understood by children and adolescents.

[Food allergy at school: Personalized healthcare project and adrenaline]. / Prise en charge des allergies alimentaires en milieu scolaire en France : projet d'accueil individualisé et adrénaline.

In Europe, the prevalence of food allergy is estimated at 6-8% of children. Ten to 20% of pediatric food-induced anaphylaxis reactions occur at school. Individual healthcare plans (IHP) for food allergy aim at: identifying children at risk of allergic reactions; reducing the risk of allergen exposure; providing emergency kits containing adrenaline auto-injectors (AAI) if needed with emergency action plans and instructions about when and how to use AAI. In France, IHP were introduced into law in 2003 and was updated in 2021. The number of IHP for allergy is increasing since 10 years (50,000 IHP for allergy/year). While the recommendations of the learned societies have resulted in the national harmonization of criteria for the implementation of IHP for allergy and for the prescription of emergency kits with AAI, adrenaline remains underused. In 2019, a national policy stated that all high schools must have a provision of spare AAI in case of anaphylaxis and the promotion of school staff training about food allergy and anaphylaxis was encouraged. These recommendations should be assessed widely and allergy training should be widespread. Pharmacists play an important role to take care of food-allergic children: provision of AAI prescribed for the most at-risk food allergic patients, advice and information on AAI. The pharmacist is therefore a key player in the therapeutic education of the patient to reinforce the key messages on the efficacy and safety of adrenaline used for anaphylaxis.

["I have observed anxious children who hurt themselves to avoid school."] / « J'ai observé des enfants anxieux qui se blessaient pour éviter l'école ¼.

Christine Baveux is a classics teacher. After having worked in various schools, she joined the team of the Maison de Solenn - Maison des adolescents of the Cochin Hospital as a schooling manager in 2005. Her career, rich in experience, has enabled her to appreciate the suffering that some adolescents may experience at school, a suffering often expressed on the physical level.

[When school meets health prevention, collaboration and confrontation co-occur]. / Quand l'école rencontre la prévention sanitaire, collaborations professionnelles et appropriations différenciées.

BACKGROUND: The French social security system has initiated a nutritional education program in nursery schools. On the basis of empirical data and a nursery school model compelling the application of specific standards, we analyze the conditions under which the program is implemented. METHODS: A socio-ethnographic study was conducted during the 2012-2017 period in 16 classrooms in 6 nursery schools that implemented the nutritional program. This article presents the results of a monographic analysis drawn from data collected through interviews and the observation of nutritional sessions at school. RESULTS: The pedagogical tools and the rationalization of tasks involving teachers and dietitians furthered adaptation to the constraints of nursery school functioning in accordance with the dietitians' vision of the school. With the teachers' feedback in mind, the nutritional program is called upon to evolve, but its evolution will not stand in the way of program rationalization and uniformization. Teachers will nevertheless implement the program in different ways, according to the realities of their classrooms. CONCLUSION: We studied and analyzed the conditions favorable to collaboration between nursery schools and the French social security system. Results showed how the "sanitarization" of nursery schools requires anticipation of the constraints imposed by the nursery school model. Conditions for organizing collaborative work necessitated both transformation of the health program and satisfactory coordination at school between the protagonists, thereby highlighting reciprocal influence and adjustment between two (dietitians and teachers) work cultures.

[How do children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) experience lockdown during the COVID-19 outbreak?] / Comment les enfants et adolescents avec le trouble déficit d'attention/hyperactivité (TDAH) vivent-ils le confinement durant la pandémie COVID-19 ?

OBJECTIVES: During the COVID-19 pandemic, the French government has decided a general lockdown. This unprecedented situation has raised concerns about children's and adolescent's mental health. Children and adolescents diagnosed with attention deficit hyperactivity disorder (ADHD) may find this context of restrained activity particularly tricky. The objectives of our study are to gather information about the well-being and global life conditions of children and adolescents with ADHD during the COVID-19 outbreak in France. METHODS: We designed a survey including both open-ended questions and questionnaire items for parents of children and adolescents with ADHD. Parents responded to the following open-ended questions: 1) "How is your child doing since the lockdown?" 2) "How is life at home since the lockdown?" 3) "If you had a remote service provision with a mental health professional (e.g. by telephone or video technology), please share your thoughts and any suggestions with us" 4) "Please share any other items that you think are important about ADHD symptoms of your child and the lockdown situation". This survey was posted on social media on the 6th of April and disseminated by French ADHD-parent and patient organizations. The present article reports the descriptive, qualitative and textometrical analyses of the survey. RESULTS: Between day 20 and 30 of lockdown, 538 parents responded to the survey, and we included 533 responses in the final analysis. The vast majority of responders were women 95 % (95 % CI 93,50; 97,18) with children whose mean age was 10,5 (95 % CI 7.58; 13.44). Since the lockdown, 34.71 % (95 % CI 30.70; 38.94) of children experienced a worsening in well-being, 34.33 % (95 % CI 30.34; 38.56) showed no significant changes and 30.96 % (95 % CI 27.09; 35.10) were doing better according to their parents. The thematic analysis showed that an improvement of their children's anxiety was one of the main topics addressed by parents. This improvement related to less school-related strain and flexible schedules that respected their children's rhythm. Improved self-esteem was another topic that parents linked with a lesser exposure of their children to negative feed-back. Parents repeatedly reported both inattention and hyperactivity/impulsivity. However, optimal lockdown life conditions seemed to compensate for the impact of ADHD symptoms (e.g. sufficient space at home, presence of a garden). Some parents reported worsening of general well-being in their children, and this manifested as oppositional/defiant attitudes and emotional outbursts. Parents also cited sleep problems and anxiety in this context. As regards everyday life during lock-down, at-home schooling was another major topic-parents described that their children struggled to complete school-related tasks and that teachers seemed to have forgotten about academic accommodations. The lockdown situation seems to have raised parents' awareness of the role of inattention and ADHD symptoms in their children's learning difficulties. Due to potential selection biases, the results of our survey may not be generalizable to all children and adolescents with ADHD. The main strengths of this rapid survey-based study lies in the reactivity of the participants and the quality and diversity of their responses to the open-ended questions. CONCLUSIONS: According to their parents, most children and adolescents with ADHD experience stability or improvement of their well-being. An improvement in school-related anxiety and the flexible adjustment to the children's' rhythms as well as parents' increased awareness of the difficulties their children experience are among the key topics in parents' descriptions.

[The "Creation of History" workshop: a clinical device for migrant children in Brazil]. / L'atelier "création d'histoire" : un dispositif clinique auprès des enfants migrants au Brésil.

A clinical research device, the "Creation of History" workshop was set up in schools in São Paulo, Brazil, with migrant children aged 6 to 10. This workshop allows these children to retrace their migratory history with the help of a family album, based on the construction of the space-time dimension present in their interpretation of their drawings.

The dissemination of the French School of Psychiatry and its impact in the world.

The French School of Psychiatry has characteristics which are proper to it, and it conveys many notions related to health care, in addition to the accompaniment and the comprehension of mentally ill people and mental illness. These notions are specific to the French culture. Thus, famous French psychiatrists have described many syndromes and discovered the first neuroleptic, chlorpromazine. Among these psychiatrists: Pinel, Esquirol, Janet, Ey, Delay and Deniker. Furthermore, the first World Psychiatry Congress was held in Paris in 1950. It was a major congress for many specialists from all the world have participated and strongly influenced the future of psychiatry in the world. We will be describing the French School of Psychiatry's impact in the world (South America) and mainly in the French-speaking world (Romania, Africa, Lebanon and Quebec). We will also be discussing the tools, associations and publications which participate in the dissemination of this school of thought's knowledge.

[Mental health educational programs in schools: Experiences, needs and expectations expressed by students in France]. / L'éducation à la santé mentale à l'école : vécu, besoins et attentes exprimés par les étudiants en France.

AIMS: This study explores the experiences and expectations of young adults concerning mental health educational programs in schools. The scarcity of these programs leads us to deepen students' perspective in order to boost the establishment of such sessions. Indeed, this type of prevention plan can improve the access to care and reduce the impact of such disorders. METHODOLOGY: We have developed a standardized questionnaire to be filled online by students between the ages of 18 and 25 years, reached using Facebook pages of student associations of universities from different regions of France. RESULTS: From the 3rd to the 20th of July 2017, 1852 students filled in the questionnaire. In total, 1672 (90%) of the young adults had not experienced mental health educational programs in their school career. However, 1652 (90%) requested that these programs be a part of their academic career. The majority of the young adults (n=590, 56%) would have chosen a psychologist as leader for these programs, preferably (>80%) in a discussion around a difficult imaginary situation, using role-playing or a board game. Furthermore, 1067 (57%) young adults reported having felt the need to talk to someone about mental health during their school career. CONCLUSION: This exploratory study highlights the lack of mental health educational programs in schools and the need expressed by students themselves. It suggests directions to think about how to develop these mental health preventive programs, evoking their limits and advantages.

Comparing the behavioural impact of a nudge-based handwashing intervention to high-intensity hygiene education: a cluster-randomised trial in rural Bangladesh.

OBJECTIVE: To determine the impact of environmental nudges on handwashing behaviours among primary school children as compared to a high-intensity hygiene education intervention. METHODS: In a cluster-randomised trial (CRT), we compared the rates of handwashing with soap (HWWS) after a toileting event among primary school students in rural Bangladesh. Eligible schools (government run, on-site sanitation and water, no hygiene interventions in last year, fewer than 450 students) were identified, and 20 schools were randomly selected and allocated without blinding to one of four interventions, five schools per group: simultaneous handwashing infrastructure and nudge construction, sequential infrastructure then nudge construction, simultaneous infrastructure and high-intensity hygiene education (HE) and sequential handwashing infrastructure and HE. The primary outcome, incidence of HWWS after a toileting event, was compared between the intervention groups at different data collection points with robust-Poisson regression analysis with generalised estimating equations, adjusting for school-level clustering of outcomes. RESULTS: The nudge intervention and the HE intervention were found to be equally effective at sustained impact over 5 months post-intervention (adjusted IRR 0.81, 95% CI 0.61-1.09). When comparing intervention delivery timing, the simultaneous delivery of the HE intervention significantly outperformed the sequential HE delivery (adjusted IRR 1.58 CI 1.20-2.08), whereas no significant difference was observed between sequential and simultaneous nudge intervention delivery (adjusted IRR 0.75, 95% CI 0.48-1.17). CONCLUSION: Our trial demonstrates sustained improved handwashing behaviour 5 months after the nudge intervention. The nudge intervention's comparable performance to a high-intensity hygiene education intervention is encouraging.

[Supporting the linguistic plurality of the children of migrants from nursery school]. / Valoriser la pluralité linguistique des enfants de migrants dès l'école maternelle.

Teaching professionals have available tools to promote the wellbeing and success of young pupils in a situation of bilingualism, as well as those of all the other pupils. For this, they can use in particular activities inspired by language awareness programmes and the Avicenne language assessment of non-French-speaking children and first-time immigrants (ELAL).

[Educational project for raising awareness of food hygiene in infant schools]. / Séquence éducative pour une sensibilisation à l'hygiène alimentaire.

Five students from a nursing training institute designed an educational initiative aimed at infant school pupils. The objective of this primary prevention intervention was to raise children's awareness of food hygiene.

OIE twinning programme for veterinary education.

Building capacity is synonymous with sustaining development. Both are required to fuel progress and propel efforts towards heightening health and security. The urgency to build capacity has been catalysed by an increasing number of sanitary crises, threats, and disease outbreaks that have spanned countries, regions and continents. Education has often bridged the gaps in learning, but it has also divided the ways in which learning is practised. Differing cultural, religious and political beliefs, together with alternate economic priorities, have meant that countries have been advocating for education to meet their own specific needs, and not necessarily those of the international community. The varying contents of veterinary curricula around the world do not always demonstrate that the initial education of veterinary students provides them with the necessary skill sets to fulfil their responsibilities as key actors in the private and public sectors of national Veterinary Services. This has resulted in discrepancies in the competencies acquired by veterinarians and their capacities to uphold good veterinary governance and practices. To address this educational imbalance, the World Organisation for Animal Health (OIE) has drafted recommendations and guidelines to assist Veterinary Education Establishments worldwide with improving the breadth and depth of their veterinary curricula in order to strengthen their national Veterinary Services. The OIE has, furthermore, developed a twinning programme for Veterinary Education Establishments, under which learning opportunities for teaching staff and students are created and shared. Twinning has, to date, proved to be an effective and powerful mechanism through which developments in veterinary education through mutual capacity and confidence-building can be sustained.

Le renforcement des capacités est synonyme de développement durable. L'un comme l'autre sont indispensables pour alimenter le progrès et canaliser les efforts vers un niveau optimal de santé et de sécurité. Le renforcement des capacités est devenu une nécessité urgente du fait du nombre croissant de crises sanitaires, de menaces et de foyers de maladies qui se propagent dans différents pays, régions et continents. L'offre éducative permet souvent de remédier à des savoirs lacunaires mais elle peut aussi créer des fractures quant aux manières d'apprendre. Les différentes croyances culturelles, religieuses et politiques mais aussi les priorités économiques successives ont souvent induit des politiques éducatives qui visent à répondre aux besoins spécifiques d'un pays plutôt qu'à satisfaire ceux de la communauté internationale. Les variations de contenu des programmes d'enseignement de la médecine vétérinaire dans le monde ne permettent pas toujours de garantir que la formation initiale des jeunes diplômés les dote des compétences requises pour exercer pleinement leurs responsabilités en tant qu'acteurs essentiels des composantes tant privées que publiques des Services vétérinaires. Cela se traduit par un écart entre les compétences acquises par les vétérinaires et les capacités requises pour soutenir une bonne gouvernance et des bonnes pratiques vétérinaires. Afin de remédier à cette disparité des contenus d'enseignement, l'Organisation mondiale de la santé animale (OIE) a préparé des projets de recommandations et de lignes directrices visant à aider les établissements d'enseignement de la médecine vétérinaire dans le monde à dispenser une formation plus étendue et approfondie, dans le but de renforcer les Services vétérinaires nationaux. En outre, le programme de jumelages entre établissements d'enseignement de la médecine vétérinaire mis en place par l'OIE offre de nouvelles perspectives pédagogiques, tant aux enseignants qu'aux étudiants. Le jumelage s'est révélé jusqu'à présent un mécanisme efficace et performant : par le renforcement mutuel des capacités et de la confiance qu'il induit, il pérennise dans les pays participants les effets de la modernisation de l'enseignement vétérinaire.

Refuerzo de capacidades es sinónimo de desarrollo sostenible. Ambos elementos son necesarios para alimentar el progreso e impulsar una labor que permita mejorar los niveles de salud y seguridad. El creciente número de crisis o amenazas sanitarias y de brotes infecciosos que se han extendido por países, regiones y continentes ha puesto de manifiesto que urge dotarse de más sólidos medios de acción. La enseñanza ha servido a menudo para aportar al alumno conocimientos que le faltaban, pero a la vez ha consagrado diferentes maneras de aprender. El distinto bagaje cultural, religioso y político y las dispares prioridades económicas de los países han llevado a una situación en que cada país apuesta por un tipo de enseñanza adaptado a sus propias necesidades específicas, y no necesariamente a las de la comunidad internacional. Los heterogéneos programas de estudios veterinarios que se siguen en el mundo no siempre sirven para que el estudiante de veterinaria salga de la facultad provisto del conjunto de aptitudes necesarias para cumplir la función que le incumbe como pieza básica de los Servicios Veterinarios nacionales, ya sea desde el sector privado o desde el público. Ello da lugar a una gran disparidad en cuanto a las competencias que adquieren los veterinarios y a su capacidad para secundar las buenas prácticas y el buen gobierno veterinarios. Con el objetivo de resolver estas discordancias en la enseñanza, la Organización Mundial de Sanidad Animal (OIE) ha elaborado recomendaciones y directrices que ayudan a establecimientos de formación veterinaria de todo el mundo a conferir más amplitud y profundidad a sus programas de estudios y, con ello, a fortalecer los Servicios Veterinarios de su país. La OIE, además, tiene formulado un programa de hermanamiento dirigido a dichos establecimientos, que ofrecen así a profesores y alumnos la posibilidad de formarse o de hacer intercambios. Por lo observado hasta la fecha, el hermanamiento constituye un potente y eficaz mecanismo con el que respaldar el desarrollo de la formación veterinaria, gracias a la creación de lazos de confianza y al refuerzo recíproco de capacidades.

[Mother tongue and protection of children, the role of school]. / Langue maternelle et protection des enfants, le rôle de l'école.

The question of mother tongues in the socio-educational context of school was the subject of a memorandum of 2016. Moreover, research in psychology and linguistics shows the extent to which the family language and culture are important elements in the construction of the child. These must be taken into account at school as well as in any support and care environment.