She is a principal, but Sharman Rowe often found herself checking students' heads for lice, deciding whether a sick child should be sent home, and helping dole out medicine to a line of squirming children with attention deficit disorder.

"It was like a madhouse," Rowe says.

But now, as part of a push by the Baltimore City Health Department to put health staff in every school full time, Hampstead Hill Elementary in Canton and 87 other schools have their own nurse and health aide, and principals like Rowe no longer have to worry about syringes and inhalers, about doing things they're not trained to do.

Across the country, as schools grapple with sicker, poorer students, the trend is the same.

In Maryland, the number of school nurses has tripled to more than 1,400 since 1990. And these professionals are bringing in far more than Band-Aids.

Today's school nurses give out medicine and hugs, serve as sounding boards for psychologists, steer parents through complicated insurance forms, and watch over children with chronic health conditions such as asthma and diabetes.

These nurses teach students about hygiene and work with such complex medical needs as feeding tubes and tracheotomies.

"Fifteen years ago, we did very little," says registered nurse Marge Reider, who used to split her time among six schools and now has just two, including Hampstead Hill. She spends 2 1/2 days at each school. "Now, we do much, much more."

This summer, about 35 city schools had no health staff and 80 had part-time coverage, some as little as a day a week.

But as of this fall, the Baltimore City Health Department is about two-thirds of the way to its goal of hiring 150 nurses and health aides, says Bernadette Greene, assistant commissioner for nursing, adult and community services.

The number of city schools with full-time nursing staff has more than doubled, and by the time students return from Christmas break, officials expect to have health staff in place in every city school.

It's welcome news for teachers and students.

"Thank God the nurse is here," says Sara Schmerling, Hampstead's social worker.

"She [Reider] is warm. She's nurturing. She cares. I think the kids really feel that."

In the Canton school, Reider and the health aide, Deanetrice Fleming -- who is at Hampstead Hill full time -- have set up an efficient system in which the 22 children who need daily medication show up at designated times, quietly picking up their color-coordinated cups and downing their pills.

Other children are triaged, especially during the recess rush.

A girl has hit her head against the fence. John Fay, a first-grader, has a bloody nose. Justin Thomas, a fourth-grader who recently was diagnosed with asthma, shows up at the door.

"I feel it starting," Justin whispers.

Reider kneels next to him, making sure he executes each step correctly: shaking the inhaler, putting it in his mouth, then holding his breath.

Reider puts her hand out, counting to five with her fingers, then telling him to let the air out.

"I can't see how we can do without them anymore. We just need them here," says Evangeline Nadolny, an attendance monitor and parent liaison.

"Before, she was here like one day a week, and it was always like, 'Where's Marge? Where's Marge?' "

Last month, Reider and Fleming handled 238 first-aid incidents, 197 parent conferences on the phone or in person and 90 talks with teachers. They dealt with 13 other health agencies.

Reider makes home visits to parents who don't have telephones, to talk to them about lice or the glasses a child needs.

She has also put together cards for every child with health information, emergency contacts and health insurance.

She has coordinated the visit of a representative from the local muscular dystrophy group. Classmates of a boy with the condition have been making fun of his wobbly walk, and staffers want them to better understand it.

Reider also dresses up on the holidays as Santa Claus or Dracula, giving out toothbrushes. On one recent day, she stands in front of a class of kindergartners, telling them they need to get a good night's sleep and use an umbrella in the rain.

Then she flips on a music tape, encouraging the children to sing along, "Brush a-way tooth de-cay," as they all pretend to brush their teeth with their index fingers.

Baltimore County has had nurses full time in every school since 1944. But nationwide, since the concept started in the early 1900s, health services have been fragmented and inadequate, often with different goals.

When school budgets had to be cut, experts say, nurses were often the first to go.

But the changing, more vulnerable student population makes health staff more valuable than ever.

Thousands of disabled children have been moved into public schools. National figures show that as many as a quarter of students are in poverty.

Carol Costante, immediate past president of the National Association of School Nurses, says there is an increase in children with chronic illnesses. Nurses also have to deal with emotional problems, family issues and mental health conditions.

"More and more families are depending on the school nurse to identify problems," Costante said.

"They've done it for years, but people didn't realize it or take it seriously. Now people are taking it seriously."

In Maryland, a 1991 law requiring health services has sparked the increase in school nurses.

During the 1996-1997 school year, figures show there were about 6 million visits to school nurses.

Of those children, 85 percent to 92 percent returned to their classrooms, an increase from the days when principals and secretaries erred on the cautious side and often sent children home.

Some of the city's new aides are women getting off welfare; they are trained and certified in first aid, CPR and administering medications.

The additional health staff costs the city about $1.8 million, federal dollars Baltimore got from aggressively billing for health services it was already providing to special education students, according to Dr. Peter L. Beilenson, the city health commissioner. Some of the extra money has been used to place 76 mental health professionals in schools.

Together, these new staffers are creating places where students TC can find compassion.

"They'll be having a rough day. They find this as a security blanket," Fleming says. "Some just want a hug."

One first-grader, Douglas Canes, shows up at the health office because he had been pushed down on the playground. Fleming gets down on the floor next to him.

"I know you're having problems with these boys. If they bother you, go tell the person in charge, or you come back and tell me," Fleming says to him, zipping up his coat and snapping it tight at the top.

"OK, you go have fun," she urges him.

The boy looks at her for a long moment and smiles. "OK!"

Pub Date: 11/28/98