28.1 Health Literacy, Wellness, Nutrition & Disease Prevention

Overview & Exam Relevance

Competency 003 of the TExES Core Subjects EC-6 (391) examination evaluates your understanding of personal health, nutrition, mental and emotional wellness, disease prevention, safety practices, and statutory legal obligations in elementary school settings. Within Subtest 905 (Fine Arts, Health, and Physical Education), health education items test your capacity to translate public health science into age-appropriate classroom instruction that empowers young learners to make responsible lifestyle choices. In early childhood through grade 6, students develop foundational habits regarding diet, hygiene, emotional regulation, and safety that persist throughout their lives.

On the TExES 391 exam, health questions test your ability to interpret dietary guidance (such as the Dietary Guidelines for Americans and Nutrition Facts labels), implement evidence-based conflict resolution and anti-bullying strategies, design disease prevention routines, execute first aid and emergency response protocols (including RICE, epistaxis management, and anaphylaxis response), and fulfill your mandatory legal reporting duties under Texas Family Code §261.101. This guide covers health in three sections: wellness, nutrition, and disease prevention here, then mental and social health, and then safety and abuse reporting.

---

Multidimensional Health & The Wellness Continuum

Health is not merely the absence of disease or infirmity; it is a holistic state of well-being across multiple interconnected dimensions.

The Health Triangle

The Health Triangle conceptualizes wellness as an equilateral triangle composed of three essential, interdependent domains:

1. Physical Health: The biological condition of the physical body. It encompasses cardiovascular fitness, muscular strength, nutrition, proper hydration, adequate sleep (9–12 hours a night for children ages 6–12, per the American Academy of Sleep Medicine), oral hygiene, and the avoidance of harmful substances.
2. Mental and Emotional Health: Cognitive and affective well-being. It includes a child's self-concept, self-esteem, emotional regulation, stress resilience, coping mechanisms, and ability to express feelings constructively.
3. Social Health: The quality of interpersonal relationships. It involves effective communication, empathy, cooperative teamwork, conflict resolution, active listening, and building supportive relationships with family, peers, and teachers.

When one side of the triangle receives inadequate attention—such as chronic sleep deprivation damaging physical health—the other two sides suffer, as fatigue impairs emotional patience and strains social friendships. Optimal wellness requires continuous balance among all three dimensions.

The Wellness Continuum

Health is dynamic rather than static. The Wellness Continuum illustrates health as an ongoing spectrum ranging from premature death (characterized by chronic illness, disabling symptoms, and low energy) on one extreme, through a neutral midpoint (absence of overt disease but lacking vitality), to optimal, high-level wellness (characterized by peak physical vigor, emotional zest, and meaningful social connections) on the other. Educational interventions aim to guide elementary students past neutral health toward proactive, high-level wellness.

Health Literacy & Responsible Decision-Making

Health literacy represents the capacity of an individual to obtain, process, understand, and apply basic health information and services to make informed health-related decisions. In the elementary classroom, health literacy progresses through three developmental tiers:

• Functional Health Literacy: Basic reading and comprehension of factual health information (e.g., recognizing warning labels, following handwashing steps).
• Interactive Health Literacy: Applying social and cognitive skills to participate actively in healthy routines and communicate needs (e.g., asking for help when anxious, discussing food choices).
• Critical Health Literacy: Analyzing information critically to exert greater control over life events and resist unhealthy social pressures (e.g., evaluating food marketing claims, resisting peer pressure).

To foster critical health literacy, educators teach systematic decision-making models. A widely tested framework is the DECIDE Model:

• D — Define the problem: Identify the core issue or dilemma requiring a decision.
• E — Explore the alternatives: Brainstorm multiple possible courses of action.
• C — Consider the consequences: Weigh the positive and negative short-term and long-term outcomes of each alternative.
• I — Identify your values: Align potential choices with personal, family, and cultural values, ethical standards, and school rules.
• D — Decide and act: Select the most responsible alternative and carry out the plan with confidence.
• E — Evaluate the results: Reflect on the outcome, examine what worked well, and adjust future decisions accordingly.

Nutritional Science & Dietary Guidelines

Nutrition provides the chemical fuel and structural substrates necessary for pediatric growth, cognitive performance, and metabolic health.

Federal Dietary Guidelines: From MyPlate to the 2025–2030 Guidelines

The Dietary Guidelines for Americans are updated every five years by USDA and HHS. From 2011 until early 2026, their visual symbol was MyPlate. Older curricula and many practice items still use it: half the plate fruits and vegetables, at least half of grains whole grains, a protein portion, and a dairy serving. On January 7, 2026, USDA and HHS released the Dietary Guidelines for Americans, 2025–2030, built around the message "eat real food" and an inverted-pyramid graphic that replaces MyPlate as the headline image. Key points for teaching children:

1. Prioritize whole, nutrient-dense foods: protein foods, dairy, vegetables, fruits, healthy fats, and whole grains, with general serving goals of about 3 servings of vegetables, 2 of fruit, 3 of dairy, and 2–4 of whole grains on a 2,000-calorie pattern.
2. Protein at every meal: both animal sources (eggs, poultry, seafood, meat) and plant sources (beans, peas, lentils, nuts, seeds, soy).
3. Dairy: the Guidelines say full-fat dairy products are important for children to help meet energy needs and support brain development, and they recommend dairy with no added sugars.
4. Whole fruits and vegetables are preferred over juice; 100% juice should be limited or diluted.
5. Limit highly processed foods, sugar-sweetened beverages, and added sugars: for middle childhood (ages 5–10), no amount of added sugars is recommended, and children should avoid caffeinated beverages.
6. Sodium limits for children: less than 1,500 mg a day for ages 4–8 and less than 1,800 mg for ages 9–13. Saturated fat should stay at or below 10% of calories.

The underlying food groups remain useful for classroom sorting activities:

• Fruits and vegetables supply vitamins (especially vitamin C), potassium, fiber, and phytochemicals.
• Grains: whole grains keep all three parts of the kernel, the fiber-rich bran, the nutrient-rich germ, and the starchy endosperm. Refined grains keep only the endosperm. Examples of whole grains are brown rice, oatmeal, and whole-wheat bread.
• Protein foods provide the amino acids needed for growth and tissue repair.
• Dairy supplies calcium, protein, and (when fortified) vitamin D for bone growth during childhood.

Macronutrients and Micronutrients

Nutrients divide chemically into energy-yielding macronutrients and catalytic micronutrients:

• Carbohydrates (4 calories per gram): The body's primary energy substrate, broken down into glucose. Simple carbohydrates (monosaccharides and disaccharides found in refined sugars, candy, and fruit juice) provide rapid energy spikes followed by reactive hypoglycemia. Complex carbohydrates (polysaccharides and starches found in whole grains, legumes, and tubers) break down slowly, supplying sustained glycemic release. Dietary fiber (indigestible plant cellulose) regulates bowel motility, blunts blood sugar spikes, and reduces cholesterol.
• Proteins (4 calories per gram): Chains of amino acids required for cellular repair, enzyme synthesis, muscle hypertrophy, and antibody creation. Complete proteins contain all nine essential amino acids that the human body cannot synthesize internally (found in animal sources, quinoa, and soy). Incomplete proteins lack one or more essential amino acids (most plant sources, which can be combined complementarily, such as rice and beans).
• Fats / Lipids (9 calories per gram): Concentrated energy reserves necessary for nerve myelination, cellular membrane structure, insulation, and the absorption of fat-soluble vitamins (A, D, E, K).
  • Unsaturated Fats: Liquid at room temperature, considered heart-healthy. Includes monounsaturated fats (olive oil, avocados) and polyunsaturated fats (omega-3 and omega-6 fatty acids found in fatty fish, walnuts, and flaxseeds).
  • Saturated Fats: Solid at room temperature, primarily derived from animal products (butter, lard, high-fat meats) and tropical oils (coconut, palm). Excessive intake elevates low-density lipoprotein (LDL) cholesterol.
  • Trans Fats: Partially hydrogenated industrial oils designed for shelf stability. Trans fats aggressively elevate LDL ("bad") cholesterol while depressing high-density lipoprotein (HDL, "good") cholesterol. The FDA has removed partially hydrogenated oils, the main source of artificial trans fat, from the U.S. food supply.
• Micronutrients:
  • Vitamins: Organic compounds regulating metabolic pathways. Water-soluble vitamins (Vitamin C and the B-complex vitamins: thiamine, riboflavin, niacin, B6, folate, B12) dissolve in water, cannot be stored in large quantities, and excess amounts are excreted through urine, requiring daily replenishment. Fat-soluble vitamins (Vitamins A, D, E, and K) dissolve in lipids, are stored in adipose tissue and the liver, and can accumulate to toxic levels if taken in massive supplemental overdoses.
  • Minerals: Inorganic elemental compounds. Critical pediatric minerals include calcium (bone mineralization and neuromuscular contraction), iron (constituent of hemoglobin responsible for oxygen transport in red blood cells; pediatric deficiency leads to iron-deficiency anemia, causing fatigue and cognitive lag), potassium (fluid balance and cardiac conduction), and sodium (fluid regulation; excessive dietary sodium promotes arterial hypertension).
  • Water: The universal physiological solvent. Children require frequent hydration throughout the school day. Water regulates core temperature through evaporative sweating, cushions joints, lubricates mucous membranes, and transports nutrients.

Reading Nutrition Facts Labels

Elementary health curricula train students to interpret standard FDA Nutrition Facts labels:

• Serving Size & Servings Per Container: All nutrient values printed on the label reflect a single serving. If a package contains 2.5 servings and a child consumes the entire package, all caloric and nutrient values must be multiplied by 2.5.
• Percent Daily Value (%DV): Indicates how much a nutrient in a serving contributes to a total daily diet based on a 2,000-calorie reference intake.
  • The 5/20 Rule: A %DV of 5% or less is considered LOW for that nutrient. A %DV of 20% or more is considered HIGH. Students should aim for high values (20%+) in dietary fiber, Vitamin D, calcium, iron, and potassium, while targeting low values (5% or less) in saturated fat, sodium, and added sugars.
• Added Sugars vs. Total Sugars: Total sugars include naturally occurring sugars (such as lactose in milk and fructose in fruit) alongside added sugars (syrups, cane sugar, high-fructose corn syrup). The 2020–2025 Dietary Guidelines capped added sugars at 10% of daily calories. The 2025–2030 Guidelines go further: no amount of added sugars is recommended (none at all for children in middle childhood), and a single meal should contain no more than 10 grams. The Nutrition Facts label still uses a Daily Value of 50 grams of added sugars when it calculates %DV.

Energy Balance, Childhood Obesity, Type 2 Diabetes & Dental Health

• Energy Balance: The relationship between energy intake (calories consumed through food and beverages) and energy expenditure (calories burned through basal metabolic rate, thermogenesis, and physical activity). A chronic positive energy balance (caloric intake exceeding expenditure) results in weight gain.
• Childhood Obesity Prevention: Pedagogy emphasizes active lifestyle habits rather than restrictive dieting. Schools help children reach the recommended 60 minutes of daily moderate-to-vigorous physical activity (MVPA) through PE, recess, and active lessons. They also limit sedentary screen time, offer water instead of sweetened beverages, and promote nutrient-dense whole foods.
• Type 2 Diabetes: Characterized by progressive insulin resistance, where body cells fail to respond effectively to insulin produced by the pancreas, leading to chronic hyperglycemia. While Type 1 Diabetes is an autoimmune condition where pancreatic beta cells are destroyed (requiring lifelong exogenous insulin administration), pediatric Type 2 diabetes is strongly correlated with sedentary lifestyles, excess adiposity, and poor nutrition.
• Pediatric Dental Health: Dental caries (tooth decay) is the most common chronic childhood disease. Bacterial plaque metabolizes dietary sugars into lactic acid that demineralizes tooth enamel. Instruction emphasizes: brushing teeth twice daily for two full minutes with fluoride toothpaste, flossing daily to disrupt interdental plaque, limiting sticky sugars and acidic drinks, and visiting a dentist regularly (commonly every six months).

---

Disease Prevention & Infection Control

Educators must understand pathogen transmission mechanics to break chains of infection and accommodate students with chronic health conditions.

Communicable Diseases

Communicable diseases are infectious illnesses caused by microscopic biological pathogens transmitted from an infected host, reservoir, or vector to a susceptible individual.

Infection Control Protocols

• Hand Hygiene: Handwashing is the single most effective intervention to prevent the transmission of communicable disease. Proper handwashing requires wetting hands with warm running water, applying soap, and scrubbing vigorously with friction for at least 20 seconds (covering palms, backs of hands, between fingers, and under fingernails—equivalent to singing "Happy Birthday" twice), rinsing thoroughly, and drying with a clean disposable towel.
• Universal Precautions: Standard infection control practices assuming all human blood and bodily fluids are potentially infectious. Teachers must wear disposable non-latex (for example, nitrile) gloves whenever rendering first aid involving blood, vomit, or bodily secretions, followed by proper glove removal and immediate handwashing.
• Immunizations: Vaccines stimulate active acquired immunity through the introduction of weakened or inactivated antigens, establishing immunological memory cells. High community vaccination rates confer herd immunity, protecting medically fragile students who cannot be vaccinated.

Non-Communicable Chronic Diseases

Non-communicable diseases are non-infectious, long-term conditions driven by genetic, environmental, or physiological factors:

• Asthma: A chronic inflammatory disorder of the bronchial airways characterized by episodic airway obstruction, mucosal edema, and bronchial hyperresponsiveness. Common classroom triggers include chalk dust, mold, cold air, strong perfumes, animal dander, and physical exertion. Teachers must maintain access to the student's Asthma Action Plan and ensure quick-relief bronchodilator inhalers (albuterol) are immediately accessible. During an acute asthma attack (wheezing, persistent coughing, chest tightness, retractions), seat the student upright, assist with prescribed rescue inhaler medication, remain calm, and contact the school nurse or 911 if distress persists.
• Severe Allergies & Anaphylaxis: An acute, potentially life-threatening systemic hypersensitivity reaction triggered by allergens (peanuts, tree nuts, dairy, wheat, soy, eggs, fish, shellfish, insect venom, or latex). Histamine release causes vasodilation, airway bronchospasm, and capillary leakage.
  • Symptoms: Urticaria (hives), facial and periorbital angioedema (swelling of lips, tongue, and throat), stridor, wheezing, dyspnea, nausea, vomiting, dizziness, and hypotension.
  • Emergency Action: Immediately administer an epinephrine auto-injector (EpiPen) into the anterolateral aspect of the middle-to-outer thigh (vastus lateralis). Epinephrine reverses bronchoconstriction and raises blood pressure. Hold firmly in place for 3 seconds (or manufacturer directions), massage the injection site for 10 seconds, and call 911 immediately. Never leave the student unattended, and prepare to administer a second dose after 5–15 minutes if emergency medical services have not arrived and symptoms continue.