Prevention of poor posture in children and youth in public schools

Spinal deformity as well as defects of feet and knees are the most common health problem of children and youth, even more common than allergies, eye disorders of refraction and accommodation, obesity, or other diseases. According to various sources, 50-60 percent of students suffer from postural defects. These problems develop during the so-called growth spurts (ages 6-7 and 12-16) when the development of the muscular system does not keep up with the fast growth of bones.

Types of postural defects in children:kyphosis,lordosis,kyphosis-lordosis,flat back,scoliosis

The main causes, apart from congenital lesions, include bad habits (e.g. not accommodating the student’s workplace to his or her needs and/ or resting in a bad position, too little physical effort) and excessive body burden (e.g. too heavy and incorrectly carried a backpack, obesity). Postural defects may result in serious diseases in adult life, such as e.g. cardiorespiratory disorders, physical performance impairment, back pains, gynecological issues in women.

Correct and incorrect student behaviours causing postural defects: body posture while resting and moving, way of carrying school bag, way of sitting in school bench

Prophylaxis of bad posture in children requires knowledge about prevention itself and the role of correct body posture as well as motivation, abilities, and prophylaxis implementation. It is also important to undergo screening and prophylactic medical examination for early diagnosis. Schools should provide conditions fostering healthy development which also covers preventive healthcare.

Close cooperation with families and education workers is essential here. Even more so since nowadays young people spend more and more of their free time in front of computer screens or with phones in their hands. This is the collaboration of all entities responsible for children’s development - parents/ caregivers, education workers, healthcare - that determines the effectiveness of the prevention of postural defects in students.

Responsibilities of various entities in terms of prevention of postural defects •	Municipality o	identifies health needs and health condition of inhabitants  o	develops and implements health policy programmes  o	ensures safe and hygienic conditions for learning, education and care in schools o	supervises school’s activity in administrative and financial terms •	Principal o	provides health prevention office o	cooperates with the healthcare entity providing services of the school nurse o	provides a place where students can leave their school books and school accessories o	provides ergonomic learning conditions  o	provides conditions to conduct physical education classes  o	cooperates with the school nurse and the doctor who take medical care of students  o	cooperates with parents for their children’s development  o	cooperates with the municipality and other entities supporting students’ physical activity and bad posture prevention •	Teacher/  Class teacher o	makes sure students have proper body posture during classes o	cares about ergonomic working conditions for students during classes o	cooperates with parents, other teachers and the school nurse in implementing  prevention measures •	Physical education teacher o	adjusts working methods and forms of PE classes to children’s abilities and needs, level of their physical efficiency and stamina  o	passes knowledge to students essential to maintain physical activity and healthy lifestyle habits  o	motivates students to participate in PE classes and after-school physical activities o	applies physical activity of different kinds to foster students’ harmonious development •	School nurse  o	conducts physical activity screening tests  o	leads the post-screening process in students who had positive results in screening tests  o	provides health education to students o	cooperates with parents and teachers in planning and performing activities for students qualified by the doctor into individual groups of physical education classes and remedial exercises  •	State Sanitary Inspection  o	supervises sanitary conditions of classes and requirements with regard to the equipment used in schools, including organisation of students’ workplaces, accommodation of education furniture to ergonomics principles

Bad posture prevention measures taken so far in the audited municipalities and the schools managed by them were insufficient, and thus ineffective. The municipalities fail to identify their inhabitants’ needs in that regard, they do not realise how important the issue is and they do not ensure close cooperation among schools, healthcare workers, and the students’ parents to implement comprehensive prophylaxis of postural defects. The identification of inhabitants’ health needs - if any - rarely covers diseases of the locomotor system, including the spine, and even less often ends in planning or implementation of any prophylactic measures.

Only part of the municipalities covered by the audit diagnosed their inhabitants’ health condition. Only in one municipality, the bad posture prevention measures were planned. In other audited municipalities, the planning and execution of tasks in that area were left to schools.

The municipalities rarely informed about the possibility of bad posture prevention, although the care of students’ healthcare is their own task. Despite the fact that regional healthcare programmes were up and running in various provinces, none of the audited municipalities made sure the students took part in them.

The municipalities do not develop or implement healthcare programmes related to bad posture prevention in children and youth. Neither do they pay for such healthcare programmes implemented by other entities. They only secure funds for the functioning and equipment of schools.

Nevertheless, students participate in prevention programmes which more or less directly are related to bad posture prophylaxis.

School nurses conduct screening tests, however, it happens that schools do not have access to the data about the scale of identified postural defects, which significantly limits the selection and thus the effectiveness of implemented prophylaxis. The health prevention offices meet essential requirements and have the obligatory equipment to make screening tests of the locomotor system. 

Principals cooperate with medical care entities providing preventive healthcare for students, particularly with school nurses. This cooperation is not formalised, though, and actions they take are not always documented.

In a big part of audited municipalities, the schools conducted not only screening tests but also additional tests to identify postural defects. In 20% of schools, those were free tests, made by the school nurse, physical therapist, or an external entity as part of a contract concluded with the municipality. In one municipality such tests were made on the initiative of a private entity and their costs were born by the students’ parents.

The identification of postural defects in students is often not followed by planning and organisation of remedial exercises and PE teachers are rarely qualified to conduct classes of this kind. Only 7.4% of funds earmarked for poor posture prevention at schools was spent on remedial exercises. None of the audited municipalities used the subsidy from the Ministry of Sport and Tourism for sports classes for students with some elements of remedial exercises.  


PE classes take into account the poor posture issue. Only in two audited schools, the students were given the option to choose the type of PE classes: sport, recreation and health, dance, or active tourism. That is where the participation frequency in PE classes was the highest.

The schools measure students’ height and accommodate school furniture accordingly. In most schools, though, the students’ workplaces did not meet the ergonomics standards (and so NIK identified irregularities in that area). Municipalities invest in providing conditions to prevent poor body posture. The investments include first of all: sports infrastructure, organisation of PE classes at the swimming pool, after-school sports classes and remedial exercises. Schools also receive money from municipalities for ergonomic school furniture accommodated to students’ anthropometric conditions as well as for places where students can leave their schoolbags or school accessories. The places, though, are not organised in a way that would encourage students to use them. 

More than half of students of the majority of schools have much too heavy schoolbags. This is confirmed by the Sanitary Inspection. In one-third of audited schools, class teachers or school nurses organised the weighing of school bags. That is where the cases of exceeding the schoolbag weight were the least frequent. Such measures were part of pedagogical supervision plans. There were also competitions organised in that area. Sporadically - to reduce the weight of students’ backpacks - some schools use e-schoolbooks.

Information and education measures related to poor posture prevention are implemented by all the audited schools but only by 40% of audited municipalities. This education is ineffective, though. Teachers lack knowledge about postural defects in students and their parents are not aware of the type and scope of tests their children undergo at schools. The schools cooperate with parents in the area of poor posture prevention but this cooperation is also ineffective. This is confirmed by the results of the control of the Sanitary Inspection concerning the load of school bags or the fact that in some schools the great majority of students covered by screening tests do not use medical examinations.

A good practice is the parents’ participation in remedial exercises. This is where they learn how the child should properly work out at home. Another good practice is related to meetings with the Sanitary Inspection representatives concerning the weight of school bags.

NIK’s recommendations

Local governments and schools

  • close cooperation of the municipality governing bodies with schools, medical care entities and parents/ caregivers for more effective prophylaxis by the organised and systematic performance of tasks by persons responsible for comprehensive development of children and youth,
  • Municipalities

should perform their mandatory tasks, such as identification of their inhabitants’ health needs but also shape healthcare policy in their area by taking the following actions:


  • developing healthcare programmes for inhabitants, covering also - depending on identified needs - prophylaxis of postural defects in students,
  • collaborating in health promotion and protection with other public administration units, at the district- and province levels in particular, including participation in regional healthcare policy programmes,
  • providing active education to eliminate bad posture risk in children and youth, addressed to principals, teachers, parents/ caregivers, and students.


  • providing ergonomic school equipment, accommodated to students’ anthropometric conditions,
  • eliminating the issue of students’ overloaded schoolbags by providing lockers and other places to store schoolbooks and school accessories,
  • providing education addressed to students and their parents and caregivers,
  • broadening the scope of bad posture prevention by providing additional remedial exercises,
  • ensuring systematic cooperation and exchange of information about students’ health and recommendations about health prevention classes among the principal, teachers, school nurse, and parents.

Article informations

Date of creation:
30 July 2020 10:11
Date of publication:
30 July 2020 10:11
Published by:
Marta Połczyńska
Date of last change:
30 July 2020 13:28
Last modified by:
Marta Połczyńska
On the left: a child's back with an adult's hand on its shoulder, presumably during medical examination.On the right:drawn images of children carrying a school bag and sitting in a school bench in a correct and incorrect way (with their back straight or c

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