The statistics announced by the head of the Ministry of Education and Science amazed many users of social networks. “211 children per year in Russia died in physical education classes. Not from terrorist attacks, not from bombing, but just at school in a physical education lesson, ”he is surprised on your Facebook page Shamil Gadisov. His reaction shares Olga Stepanenko: “211 children! For a moment, this is the normal number of one rural school. Imagine, one school died in a year. It was, it was, and suddenly it wasn’t.”

"That's all you need to know about school today," thinks doctor of one of the medical centers Anna Zlobina. - I have to watch a lot of schoolchildren and write recommendations for physical education. Many children need exercise therapy-physiotherapy exercises. Previously, it was on the basis of children's clinics. Now it’s only paid and you still need to find where to eat and still get there after school. Dull, meaningless physical education, along with its standards, takes time, health and even life. But it would be possible to organize all this for the benefit of children. And if a child attends a professional sports section, he has nothing to do in physical education at school, he spends these hours in vain.

"The news is a nightmare, - writes Martha Chuichenko. She recalls how her physical education lesson ended with an injury and many months of treatment, “I don’t understand officials who adopt uniform standards for physical education schools. I do not understand teachers who force students to complete the program. After a lesson in the ninth grade, I spent several months with a Shants collar, because I was afraid to refuse to do somersaults because of a bad grade and the already established reputation of an unsportsmanlike girl. At graduation, the only “four” (“say thank you not three”) in the diploma was physical education. After leaving school, relations with sports, for obvious reasons, did not develop for a long time. And after that they say that they are developing physical culture and sports in the country?”

Irina Anyukhina thinks that physical education lessons do not take into account the state of health of modern adolescents.

“The teacher does not have data on the health of the child, but there are standards! And the teacher is required to fulfill them! Maybe it's time to get away from the standards, which, by the way, have not changed for many years and do not take into account the state of health of modern children, and make physical education lessons really lessons of cultural activities with outdoor group games or individual physical exercises according to the abilities and interests of children? And then, after all, the TRP will soon be obliged to hand over pensioners .. ".

Daniil Alexandrov sure that the cause of deaths in the classroom is not in the protection of the personal data of children, but in the fact that "physical teachers are not interested in their health, and there are no doctors in schools, and there is even no one to help."

“When I was in the third grade, there was no protection of personal data. I was not a very athletic boy, primarily because of the complete indifference to physical pleasures. I ran to C grade so as not to be touched. But one day the fizruk, together with classmates, somehow insulted me, and I ran 2 km around the Opochininsky kindergarten to the top five. And ran. At the finish line, I threw up. I was sent to the medical room, and I passed out there. Fortunately, then there was not only personal data, but also unnecessary alarmism. The nurse brought me to my senses and sent me home. It seems that the story ends there. My parents didn’t find out anything, the physical education teacher didn’t tease me anymore, and I didn’t run to the top five. And now I'm alive and well."

The reason may also be the overcrowding of classes in schools, thinks Julia Kishkovich. “There are still enough classrooms to shove children in, but there are no gyms. Plus, they also did three physical exercises a week. Therefore, two classes are engaged in the hall, and sometimes three. And these are not always equal-aged children. For example, we had second-graders and high school, 9th or 10th grade. And how did they do it? Yes, they played dodgeball, for example.

“Claims should not be about physical education, but about how the examination is carried out and the admission of children to it,” and not about teachers, notes Artem Patrikeev.

“One guy died on kickboxing - sorry, but what kind of physical education is kickboxing? This death clearly does not apply to physical education. Another died after a basketball competition. Usually competitions are held not in the classroom, but outside of it. That is, again, this death is then difficult to fasten to physical education. And now we are looking at why the children died - from the fact that they had diagnoses that either no one noticed, or that no one reported about.

Anton Rodionov. Photo by Anna Danilova

Doctor-cardiologist, Associate Professor of the Medical Faculty of the First Moscow State Medical University named after I.M. Sechenov Anton Rodionov

They die not from physical education, but from an unrecognized disease

“Yes, man is mortal, but that would be half the trouble.

The bad thing is that he sometimes suddenly dies, that's the trick!

Sudden death of young people is a rare, but nonetheless sufficiently studied and well-known problem. The leading cause of sudden death is considered to be the so-called cardiomyopathy- diseases of the myocardium, which are based on a genetic breakdown, less often an infection. The immediate cause of the death of patients, as a rule, is ventricular tachycardia, which turns into ventricular fibrillation - a fatal arrhythmia in which the heart stops beating and the blood supply to the brain stops. An effective method of resuscitation in this situation can only be defibrillation (applying an electrical discharge).

Despite the fact that in the world sudden deaths are more often described in athletes and schoolchildren in physical education classes, it should be understood that they die not from physical education, but from an unrecognized disease. A lot of physical activity can simply at some point become the trigger that starts the arrhythmia.

If, say, we take and ban physical education at school tomorrow, then sudden death will still happen sooner or later, but it will happen while playing in the yard, during active work in the summer cottage, on a hike or during any other intense physical activity. By the way, one should not think that only weakened and untrained children who attend classes under duress and do not comply with school standards die in physical education classes. The patient with a fatal disease may well be an outwardly athletic and hardy young man or girl.

How to recognize the disease in a timely manner? Alas, this problem is still not solved all over the world. The usual examination by a doctor with listening (auscultation) of the heart and a standard electrocardiogram very often do not reveal pathology. In some people, signs of the disease can be detected during echocardiography (ultrasound examination of the heart), but, firstly, normal ultrasound does not give 100% confidence in the absence of the disease, and secondly, no country in the world can provide a mass examination of all children - there will not be enough doctors or equipment, and the cost of such a regular “medical examination” will be prohibitive. Reliable genetic markers of the disease are also lacking. Thus, it must be recognized that, to date, there are no reliable methods for screening for sudden death in young people.

However, two practical recommendations can be made in this situation:

1. If there are cases of sudden cardiac (or unexplained) death in the family, it is necessary to carefully examine blood relatives.
2. Schools (as well as other crowded places - stations and airports, airplanes and trains, museums and stadiums) must be equipped with automatic external defibrillators (AEDs). These devices, which can be used by non-specialists, are able to automatically recognize fatal rhythm disturbances and perform defibrillation.

"Get exercise!" - called Vladimir Mayakovsky in his famous slogan. And he was right.

Strong cardiovascular and respiratory systems, developed muscles, good blood circulation and metabolism, strong immunity - all these are the merits of a small set of exercises that should be performed regularly.

And the sooner you start, the more effective and beneficial for the body. It is no coincidence that in Russian schools general physical training begins from grade 1 and lasts until grade 11 - a systematic increase in the load, outdoor games, passing standards in the hall and in the fresh air. But with the wrong approach, lessons “for health” turn into lessons “from health” and have a mirror effect.

One of the latest cases that turned into a tragedy occurred on October 17 in Krasnoyarsk. An ambulance took a fourth-grader from a physical education class who became ill during running exercises. According to eyewitnesses, the child ran, then slowed down and fell. Paramedics who arrived at the scene were unable to resuscitate the student.

In Volgograd, a similar incident occurred in 2014 - a 3rd year student died in the college of the Traktorozavodsky district. The 18-year-old girl lost consciousness and literally fell dead. The teacher tried to bring her to her senses, but the pulse was not felt, the heart did not beat. Arriving doctors recorded the death.

Why the body of children and even adolescents can not withstand the load? Education Minister Olga Vasilyeva sees a problem in the protection of personal data.

Today, educational institutions do not have medical records and access to them. Because of this, teachers do not know what the child is ill with and what can threaten his life. The former director of one of the schools in the Volgograd region agrees with the head of the Ministry of Education and Science:

The doctor does not have the right to disclose the personal data of the child. Communication with polyclinics and dispensaries at schools is now very poor. Previously, schoolchildren used to go for scheduled check-ups at the physical dispensary, make a diagnosis of health, and if there were problems, they appointed a special group or issued a certificate of release. In this situation, it remains only to hope for the parents - they will fuss or not.

Only moms and dads took a strange position on this issue. Sometimes they deliberately keep silent about the ailments of the child. Our interlocutor recalls an example from his own pedagogical practice:

There was a case in my school when parents did not want to say that their son was epileptic. It turned out by accident. For a long time, adults put their own child in danger, and all in order to keep the diagnosis a secret. Parents feared that this information would harm the child in the process of studying and later, as it would end up in the medical record and personal file. But the teacher must be aware of such problems, if only in order to be prepared for the situation and be able to provide timely assistance to the student in case of emergency.

The son of Anna from Volgograd (at the request of the girl, the name was changed) is a primary school student. Since childhood, he has been involved in sports, goes to the section of martial arts and shows good results. Recently, during the next examination, the doctor warned about the risk of asthma, wrote out a conclusion.

This certificate is now in my house, in the documents. I didn't take it anywhere. We are monitored and tested regularly. And to enter this diagnosis right away into a personal file like this - why spoil the boy's future? We have a military father, we plan that our son will follow in his footsteps. And this “probability of asthma” is a stain for life.

Sometimes such actions "for good" cause irreparable harm. Even a common cold carried on the legs is fraught with serious complications, and it is difficult to predict which vital organ will be hit.

The virus weakens the body - the child has a temperature or just a runny nose and cough. During this period, serious changes occur in the body, therefore, in no case, at the first signs of infections, serious physical activity should not be given to the child. I note that the timing of each disease is different, so children who have recovered from physical education are exempted from physical education for a period of 2 weeks to several months.

He can send the student to a preparatory, special physical education group, or even write an exemption and forbid him to study. Doctors advise to examine the child once a year to monitor the dynamics of the disease.

Diagnostics of the cardiovascular system, checking the pulse, pressure, taking an ECG, visiting an ophthalmologist, several blood tests is a minimum. With it, you can understand how a growing organism feels, whether everything is in order, whether there are any deviations. If something confuses the pediatrician, he continues to look for the cause, referring to other doctors.Olga Guro, Chief Physician, Volgograd Regional Clinical Center for Medical Rehabilitation

Many people think that children are simply overloaded in physical education classes, they say, go - don’t go to the doctors, and even a healthy body can’t stand this. Teachers in response deny - the standards are the same as before. At the same time, today a child is groomed and cherished at sports classes - who needs extra scandals and problems at work? Here, for example, is what Ekaterina, a young teacher, told us physical culture of one of the Volgograd schools:

A student accidentally dislocated his finger from hitting a soccer ball - such investigations begin. The prosecutor's office, checks ... Also, parents cheat, write complaints, demand compensation. From the degree of injury and the situation in which it was received, it can reach up to criminal liability, and, of course, dismissal. As a result, teachers are afraid of everything. No technical means are used in the lessons - a rope, a goat, bars, etc. Although almost all schools today have new sports equipment. Some children play with a rubber ball, it is almost weightless and safe.

Educators say out loud that the current generation of children and adolescents is weaker than the previous ones. Many hours of sitting at the computer, unlimited TV viewing, attachment to gadgets, and a sedentary lifestyle have an effect.

Doctors urge: children should walk, spend time in nature, in the fresh air, run, play. The child should receive a norm of physiological activity, only then he will get sick less and study well.

Sports are not to be feared. We must remember the formula: the interest of doctors plus the interest of parents plus the interest of teachers equals "sport for good."Olga Guro, Chief Physician, Volgograd Regional Clinical Center for Medical Rehabilitation

According to scientists, teachers should promptly respond to children's health complaints, and schools themselves should be equipped with publicly available resuscitation devices.

"Give it up, Seryoga!" - the ball flies to the most athletic guy in the class. Eighth graders play basketball on the playground in the school yard. Seryoga's team has already scored three points, one of them is his. “Super, we’ll tear them!” he rejoices.

And then, instead of throwing the ball, he falls to the ground - and no longer breathes. Classmates are trying to somehow help, but the pulse is gone.

When such tragic incidents hit the news, they seem exceptional. But this is not so: recently, the Minister of Education Olga Vasilyeva, that 211 schoolchildren died during the last academic year in physical education classes.

Life collected information from studies by Russian scientists - it says how and why schoolchildren die in physical education.

In 2017, scientists from the Samara State Technical University published the work "Problems of sudden deaths of schoolchildren and students during physical education and sports." At the beginning, they list 22 cases where students died right in the classroom. Here are some tragic examples:

An eighth-grader died in one of the schools in New Moscow. The incident happened during a gym class. The schoolgirl didn't even have time to start the lesson. When the teacher called the students to warm up, the eighth grader got up from the bench, walked two steps and fell unconscious. The teachers immediately called an ambulance and, before the arrival of the doctors, carried out resuscitation measures on their own, but they failed to save the girl.

In Novosibirsk, a 13-year-old schoolgirl died at a sports dance lesson. During the check, it was found that she had no serious health problems.

In the Kemerovo region, a 13-year-old girl died during a warm-up before a basketball practice. Sports classes were held in the premises of one of the schools in Novokuznetsk. Despite the efforts of doctors, the girl died on the way to the hospital. The regional Investigative Committee of the ICR noted that during her lifetime, the 13-year-old schoolgirl did not suffer from any chronic diseases.

According to the study, there are two main causes of such sudden death: it's heart disease and injuries received in the classroom.

As for injuries, these can be injuries to the head, neck, chest and abdomen.

But "heart" cases happen more often. They are divided into two types. The first is a concussion (a sudden disruption in the heart rate due to a blow to the chest, such as a fall or a ball).

The second is sudden damage to the myocardium (the main heart muscle) due to existing heart problems (even if they were not previously identified).

With any physical activity, the heart works at an accelerated pace, and if overexerted, the consequences can be fatal.

This topic was also studied by Moscow doctors from the Federal Medical and Biological Agency and the Russian National Research University. N.I. Pirogov. In 2016, they published the study "Prevalence of sudden cardiac death in young adults in a large metropolitan area".

Scientists for four years, from 2005 to 2009, analyzed such cases. As a result, coverage amounted to two and a half million deaths of young people (under 45).

It turned out that in 9% of cases people died from sudden cardiac arrest. The main causes are congenital heart disease and cardiomyopathy (damage to the heart muscle).

Moreover, in half of the cases, people died not at home, but during a walk or in the classroom at school and college, at work, etc. Men die from sudden heart failure four times more often than women. scientists came to the conclusion.

As stated in a study by scientists from the Mordovian State University. N.P. Ogaryov, about 1 in 50,000 young athletes die while playing sports. Mostly due to heart problems. In this case, the cause of sudden cardiac death often remains unclear.

"The first signs of illness, such as chest pain or increased fatigue, precede sudden cardiac death," the Samara study says. "If these symptoms are present, you should immediately stop physical activity and seek medical help."

Every student should know this. And parents should explain it to him. Teachers do not have the right to ignore the complaints of students. Ideally, they should be prepared to provide first aid to the child.

In the works of scientists it is said that schools should be equipped with defibrillators - devices that, with the help of a discharge of electricity, can start a stopped heart. Moreover, you can install very easy-to-use devices. In order to save the life of a child who has fallen due to cardiac arrest in class, special medical knowledge is not even required.

Like Life, for several years the government, at the suggestion of the Ministry of Industry and Trade, has been discussing the idea of ​​allowing such publicly available defibrillators, but the process is slow. To date, a corresponding bill has been developed.

Technologies have changed a lot,” said Vladimir Gutenev, First Deputy Chairman of the State Duma Committee on Economic Policy. - If earlier people who provided assistance with defibrillators had to have special knowledge and qualifications, now everything is completely different.

As he explained, "you just need to fix two stickers with wires on the body of a person whose heart has stopped - the instructions indicate exactly where to attach them."

Further, the device "reads" the state of a person and determines whether he really needs a discharge, - said Vladimir Gutenev. - Further, exactly the force of the discharge, which is necessary, will be given on command from the central point. And if there is no need for a discharge, then it will not be. That is, no one can be harmed by such a device.

According to him, presumably, the bill will be submitted to the State Duma within the next two to three weeks.

And its passage in all three readings can take place no earlier than February-March 2018, the deputy said.

The list of places where it will be possible to place publicly available defibrillators will be determined by the government - after the adoption of the bill. Probably schools will be among them. It remains to wait.

When the bill is adopted, the use of such equipment, according to experts, will save 15-18 thousand lives of Russian citizens annually, said Vladimir Gutenev.

Tells doctor of the highest category, pediatric cardiologist Anna Vereshchagina.

In each case, the conclusion is given by a special commission investigating the fact of death. From a medical point of view, sudden death in children can be due to various reasons - both cardiological (congenital malformations, tumors, rhythm disturbances, carditis, cardiomyopathies, pulmonary hypertension crises) with the development of acute heart failure, and diseases of the central nervous system (epilepsy, tumors brain). Unfortunately, parents may not be aware of the existence of such a problem in a child. However, everything can be diagnosed with timely access to specialists.

Reason #1 Missed Congenital Heart Diseases

Theoretically, this should not happen. According to the medical examination plan, at 1 year, then at 3 years (before kindergarten) and 6-7 years (before school), children must pass a medical commission without fail, which includes a cardiologist who is obliged to refer the child for standard studies - echocardiography (EchoCG) and electrocardiography (ECG). EchoCG (or ultrasound of the heart) allows you to evaluate the work of the heart, its anatomical structure, contractility of the ventricles, measure the pressure in the cavities, which is necessary to exclude congenital and acquired anomalies of the heart and lungs. An ECG analyzes the work of the conduction system of the heart, reveals its violations, including life-threatening ones. If you suspect a rhythm disorder in a child, the doctor sends him for additional examination - daily ECG monitoring and consultation with a pediatric arrhythmologist.

This should ideally be the case, but the reality is often different. Free studies are carried out by appointment, the queue for them is on average 3-5 weeks, and parents often come at the last moment before submitting documents to the school.

In such a situation, the doctor can either offer the parents to undergo a study for a fee (which often ends with a complaint to the head doctor about “extortion by the doctor”), or refuse to issue a conclusion (which also ends with a complaint). There is another option - to take an honest word from the parents to undergo an ultrasound of the heart in the near future and issue a conclusion solely on the basis of the ECG results. But this is unacceptable, since a single ECG, and even “on a short film”, in order to save paper, does not provide complete information about the work of the heart.

With some undiagnosed malformations of the heart, tragedy can occur even with moderate physical exertion. But it is even more dangerous when underexamined children, in an effort to earn points before admission, decide to pass the TRP standards, which require absolute health and serious preparedness. Therefore, doctors insist that before passing the TRP standards and competitions, children undergo a full cardiological examination (echocardiography, stress ECG, daily ECG monitoring) to exclude life-threatening disorders in the work of the heart.

Reason number 2. Transferred viral diseases

Often, after suffering viral diseases, myocarditis (inflammation of the heart muscle), inflammation of the heart vessels (aortitis, coronaritis) develop. This leads to a decrease in myocardial contractility, disruption of its blood supply (including the conduction system of the heart), to the development of heart failure and life-threatening arrhythmias. There are different forms of these diseases (acute, subacute, chronic), which can go unnoticed. Therefore, after recovering from a viral infection (especially a severe one), the child should be released for two weeks from physical education and be sure to undergo an ECG.

Reason number 3. Fainting

The cause of fainting can be associated with both a violation of the heart (cardiac arrest, vegetovascular dystonia), and pathology of the central nervous system (tumors, epilepsy), diseases of the endocrine system (hypoglycemia, diabetes mellitus), abnormal development of the spine (Kimmerle anomaly), etc. .d.

The cardiovascular system of a rapidly growing child's body is extremely vulnerable. In adolescence, many children develop vegetative-vascular dystonia of the vagotonic type - a condition in which there is a tendency to hypotension. A sharp drop in blood pressure can lead to fainting, in which unsuccessful falls are fraught with fatal brain damage.

Therefore, if a child complains of dizziness, headache, periodically loses consciousness, be sure to contact a specialist and undergo the necessary examination.

Reason number 4. Smoking and "fashionable" food

Many teenagers smoke and drink energy drinks. It is dangerous if this happens immediately before a physical education lesson. Nicotine causes spasm of the coronary arteries and against the background of physical activity, when the heart rate increases and the time for its blood supply decreases, a situation arises similar to myocardial ischemia, which is fraught with the development of acute heart failure.

Another problem is the special nutrition system chosen by teenagers who are concerned about their figure. They exclude fats from the diet and replace meals with protein shakes. However, the exclusion of one food component provokes the early and rapid development of atherosclerosis of the coronary arteries, leading to myocardial ischemia, the development of acute heart failure and sudden cardiac arrest.

The other side of the problem

There are many children who have undergone heart surgery at an early age. But they lead a normal life. They are engaged in sports sections, as they say, without fanaticism, for health. But for them, like other children, you need to get a certificate from a cardiologist. And doctors, frightened by terrible statistics, refuse to issue such a certificate.

This is wrong - a child's heart can develop normally only if there is adequate physical activity. To show that for children who have undergone heart surgery, sports are possible and safe, the Scientific Center for Cardiovascular Surgery named after. Bakuleva and the "League of Health of the Nation" held a football friendly match between a team of guys who underwent open heart surgery, professional football players and famous artists.

What is the normal blood pressure in children?

Pressure should be measured in a calm environment one hour after eating and physical exertion.

What should parents be concerned about?

1. The blueness of the nasolabial triangle and the area around the eyes is a sign of a deterioration in venous outflow and insufficient blood oxygen saturation.
2. Pain in the region of the heart, shoulder blades, in the left arm.
3. Persistent hypothermia - low body temperature.
4. Shortness of breath, which occurs due to stagnation of blood and oxygen starvation.
5. Cold hands and feet.
6. Fatigue after exercise - the child sits down, sighs, complains of palpitations.
7. Fainting.

Says Professor, Doctor of Medical Sciences, Head of the Department of Pediatric Cardiology of the Children's City Clinical Hospital. Bashlyaeva Inna Trunina:

Every year there are more and more children with hypertension. At risk are adolescents whose parents suffer from arterial hypertension, and children with kidney disease and endocrine diseases, in which adrenaline is released, which increases blood pressure. High blood pressure is also more common in anxious, responsible children. Other risk factors include alcohol and smoking (40% of boys and 7% of girls in Russia smoke).

It must be remembered that hypertension is rarely asymptomatic. Children complain of headaches, dizziness, weakness, fatigue, veil or flies before their eyes. In hypertensive children, vision is often sharply reduced. It is very important not to attribute these complaints to overwork, but to consult a doctor in time. The initial forms of childhood hypertension are corrected non-pharmacologically. Results can be achieved if the weight of the child, the daily routine are normalized (the student needs to get enough sleep, he should not get tired, overexcited) and nutrition. It is very important to choose the right physical activity. The best results are given by cardio training (brisk walking - daily 30-40 minutes, swimming, flat skiing, cycling).

But strength training for children with hypertension is absolutely contraindicated. If these measures do not give results, drugs are prescribed, the doses of which are selected individually, and canceled only by a doctor.

Most often, an increase in blood pressure worries children in adolescence (13-16 years). The norms of pressure in children vary depending on age, weight (overweight children have higher blood pressure), height (lower blood pressure in short children) and gender (boys have higher blood pressure than girls). In children under 14 years of age, the average pressure should not exceed 120/80 mm Hg. Art., in the older ones - 135/85 mm Hg. Art.

Physical education lessons in schools are becoming deadly for our children. A shocking statement was made today by the Minister of Education. Over the past academic year in Russia, more than two hundred students died in school gyms. The percentage of accidents in these statistics is negligible - children die due to health problems and with the full connivance of adults.

The basketball game for school teams was very important. The fight, the heat, everything was grown-up - judges, teachers, fans. Who would have thought that death would stop this game. The 16-year-old teenager died immediately after the game. And there are hundreds of such tragedies. Education Minister Olga Vasilyeva today announced terrible figures: 211 children died in physical education classes during the year, and not from physical injuries, but from chronic diseases.

In fact, including school holidays, boys and girls died every day on a subject that should improve their health, and not vice versa. Why so many child deaths in physical education classes? Apparently, this is the criminal negligence of parents, teachers and doctors. For some parents, it is sometimes more important to simply get a medical certificate without an examination, and in order not to waste time in line for a medical examination, they simply buy a certificate. A mass case of violations, when sick children were diagnosed as "healthy", was discovered by investigators in the Kurgan region.

Such negligence sooner or later leads to tragedy. In Vladimir, a 15-year-old schoolboy died at a boxing tournament, despite the fact that he had a serious injury, with which boxing should have been banned for him, but the doctors either did not notice the problem, or the athlete himself hid it. Teachers say there is no single base where everything about the health of schoolchildren is written in black and white. Then it would be possible to distribute them into groups and give the corresponding loads.

In addition, the absence of medical workers in schools leads to the fact that in an emergency, first aid is provided unprofessionally, or doctors simply do not have time. Physical education teachers, who are responsible for everything that happens in their lessons, find themselves in a difficult position, because without a certificate of diagnosis, a sick child performs the same exercises as healthy children, and the child's heart cannot withstand excessive stress.

According to doctors, today's children and adolescents often suffer from chronic diseases, but often hide their illnesses themselves. After all, it is fashionable to be healthy and wear the TRP badge. In a school environment with exemption from physical activity, it is easy to become an outcast. So unhealthy children have to hide their problems, and as statistics show, this is deadly.