Note for international readers: Japan requires annual health screening for all school-age children under the School Health and Safety Act (Article 13). The checkup covers vision, hearing, dental health, cardiac auscultation, urinalysis, and other measures, and results are sent home to families each year, typically in the spring. Schools retain official records for five years; there is no institutional system for families to track longitudinal change. This article is about what families can do with that gap.
Lead
The result slip from school arrives. Under "Vision," it says: Observation recommended. Should the child see an eye doctor? Get glasses? Or wait? No one explains what to do next.
Japan's School Health and Safety Act (Article 13) mandates an annual health checkup for every student [1]. The legal record retention period for schools is five years under the implementing regulations [2]. But what is sent home is a judgment category — not a trend line, not a clinical interpretation, not an explanation of what to do. The Maternal and Child Health Handbook (boshi techo) served as a running medical record through early childhood; once school starts, the school checkup becomes the only regular structured health assessment in a child's life, and yet no mechanism exists to ensure that it accumulates as a continuous record in the family's hands.
Reading the Results: The Basics
School checkup results are commonly expressed in an A–B–C–D classification:
- A (no abnormality): No problem identified for that item
- B (observation recommended): A mild finding; not urgent enough to require immediate specialist consultation
- C (specialist evaluation recommended): A finding that warrants further investigation
- D (treatment needed): A condition requiring active treatment
An important caveat: the school checkup's classification thresholds are not the same as the diagnostic criteria used in clinical medicine.
Vision is a clear example. The school checkup uses uncorrected visual acuity below 0.7 (on the Japanese visual acuity scale) as the threshold for recommending specialist evaluation. But whether glasses are actually indicated depends on more than a single visual acuity number — it involves daily-life impact, axial length, age, and other factors [3]. A "B" result on vision does not mean glasses are immediately necessary.
Cardiac murmurs flagged by the school physician's auscultation: the clinical technique of listening to internal body sounds, typically the heart and lungs, using a stethoscope are a similar case. Giuffre and colleagues (2005) reported that 50–80% of school-age children have audible innocent (functional) murmurs [4]. The large majority represent benign findings with no structural cardiac abnormality. A notification reading "cardiac murmur — specialist evaluation recommended" is likely to alarm parents considerably; a specialist consultation is still the appropriate step, but "referred for evaluation" does not mean "serious disease is probable."
Proteinuria on urinalysis is another common source of anxiety. Orthostatic proteinuria: protein that appears in urine only in the upright position and disappears when lying down, a benign and common finding in school-age children — protein appearing in urine only when standing — is common in school-age children and benign. The Japanese Society of Nephrology's guidelines recommend using first-morning urine as the basis for renal disease screening [5]; protein detected in the school checkup's urine sample does not by itself indicate kidney disease.
If you are unsure, a call or visit to your pediatrician or a relevant specialist with "this is what the school checkup found" is more reliable than any attempt at self-interpretation.
The Trend Matters More Than a Single Result
The most valuable thing about a school health checkup is not any single year's result but the change across years.
Vision is again a useful example. Comparing a child's visual acuity in grade one with grade four allows you to see rate of change. Data from Japan's Ministry of Education's School Health Statistics Survey show that the proportion of primary school children with uncorrected acuity below 1.0 has been rising — reaching 60–70% by grade six in recent years [6]. Vision decline is happening across a large proportion of children; what carries distinct clinical meaning is rapid decline in a short period, which is different from a slow, steady decline over three years.
When you visit a specialist, bringing "the school checkup results from each year since first grade" gives the clinician a richer picture. Whether the visit is to an ophthalmologist or a pediatrician following some ongoing concern, "here is what the school checkup has shown each year" is a useful piece of context.
Neuspiel and Stubbs (2014) noted that school hearing screening: a brief standardized test to identify children who may have hearing loss and need further audiological evaluation functions as a genuine early-detection opportunity only when there is a system for continuous follow-up [7]. Processing a checkup result as a single slip of paper rather than as one entry in a time series leaves the screening function incomplete.
Designing the Home Record
What the system does not provide, the family can design for itself.
The minimum viable practice: Each spring (April–June in Japan), when the school sends home checkup results, put the slip in the same folder — one folder that runs from first grade onward. Paper folder or photo on a phone — either works. The point is: everything goes in the same place.
A personal follow-up rule for "B" results: Set your own threshold in advance. For example: "if vision stays at B for two consecutive years, we book an eye appointment." Having a self-made rule means the decision is already made before the slip arrives.
Using the record at medical appointments: When visiting an eye doctor, ENT, or pediatrician, bring the school checkup results. This gives the clinician the context of "this child's record" — especially valuable for families without a consistent primary care physician.
Recording numbers: Noting numerical values — vision in each eye, height and weight, urinalysis results — makes year-on-year comparison concrete. The arc of how a child's body changes over the primary school years is also, in its own way, a growth record.
A Side Note: Using the Checkup as a Conversation Opener
A checkup result slip can be a concrete hook for a conversation. "What did you think of the vision test this year — do you remember doing it?" is a specific, answerable question. "How was school today?" is hard for most children to answer. "What tests did you have?" is much easier.
Fivush and colleagues (2006) found that when parents use open questions and elaboration to revisit past events with their children — what they called elaborative reminiscing — children develop more coherent autobiographical narratives [8]. Using a school checkup as the prompt for a conversation about what school is like is a small, practical version of that.
Summary
Changing how you handle a school health checkup result slip — from "read it and discard it" to "file it with all the others from first grade" — changes the value of what it contains. A row of annual checkup results tells you something that a single slip cannot. Making that longitudinal record, on the family side, fills the gap that the current institutional design leaves open — and in doing so, provides something that picks up where the Maternal and Child Health Handbook left off.
References
- School Health and Safety Act (Japan), Article 13 (Act No. 56 of 1958). Available from: https://elaws.e-gov.go.jp/
- School Health and Safety Act Implementing Regulations, Article 8 (retention of health checkup records). Available from: https://elaws.e-gov.go.jp/
- Japan Ophthalmological Society; Japan Association of Ophthalmologists. Statement on Vision Testing and Correction Guidance in Schools. Tokyo; 2021.
- Giuffre RM, Gupta S, Dipchand A. Innocent heart murmurs in school children: risk of over-referral. Paediatr Child Health. 2005;10(5):289–292. doi:10.1093/pch/10.5.289. PMID: 16278701
- Japanese Society of Nephrology. Pediatric Renal Disease Clinical Practice Guidelines. Tokyo: JSN; 2023.
- Ministry of Education, Culture, Sports, Science and Technology (Japan). School Health Statistics Survey, FY2022 (Final). Tokyo: MEXT; 2023. Available from: https://www.mext.go.jp/b_menu/toukei/chousa05/hoken/kekka/k_detail/1411711_00006.htm
- Neuspiel DR, Stubbs KG. Screening for hearing loss in children: approach in the office. Pediatr Rev. 2014;35(4):155–163. doi:10.1542/pir.35-4-155. PMID: 24686947
- Fivush R, Haden CA, Reese E. Elaborating on elaborations: role of maternal reminiscing style in cognitive and socioemotional development. Child Dev. 2006;77(6):1568–1588. doi:10.1111/j.1467-8624.2006.00960.x. PMID: 17107449