A second-grader wearing a bright yellow top and matching hairbow stands at Suzanne Mahaffey's office door. Tears wet her face.

"Did you throw up?" Mahaffey asks.

An affirmative nod is followed by a fresh flood of tears.

"It's all right," Mahaffey reassures her. "Let's get you cleaned up, and I'll call your mom."

It's 10 a.m. and Mahaffey, the Peeples Elementary School nurse, is receiving a steady stream of students through her clinic doors.

Already she has tended to 16 students with ailments including nausea, headaches, asthma and cold symptoms, not to mention one change of clothes.

Two students, in addition to the second-grader, wait in the clinic for a parent to pick them up. A third is lying on a bench in a holding pattern - trash can nearby.

"It's actually been pretty slow today," Mahaffey says.

Slow? Considering Mahaffey logged 3,422 student visits to the clinic in the first 3½ months of school, anything less than 40 students per day seems less frenetic, she says.

But ah, the day is young.

Mahaffey, in her fourth year at Peeples, is one of 32 nurses employed in 27 Fayette County elementary, middle and high school clinics.

Debbie King directs the nurses. She's a longtime registered nurse the Fayette County Board of Education hired in 2000 to launch and coordinate the county's school nurse program.

The school system created King's position to comply with the state's Education Reform Act of 2000, which specified that each Board of Education establish a school-nurse program staffed by licensed health care professionals, King said.

"Prior to that, we mostly had volunteers in schools," she said.

While it was no small task to get licensed nurses in operational clinics in each school, King said now it would be hard to imagine the school system without them. In 2005-06, Fayette school nurses recorded 166,997 student health visits, or an average 7.5 visits per student systemwide.

King said she's confident the Board of Education recognizes the value of school nurses, too.

In the 2005-06 school year, the system spent $755,115.78 on the school health services program.

About half of that total, $395,299, came from the state's tobacco settlement program.

"I think this is really a necessity as far as support services for the school system," King said. "Really, the kids can't stay in school unless they are healthy."

To that end, school nurses are charged with prevention through screenings and monitoring of health records; health maintenance through daily first aid and administering of medication; and health education through communication with parents and staff about health and safety issues.

Though each nurse reports to her school principal, King, who keeps an office at the Lafayette Educational Center, serves as their health care resource.

"I've never had a job that impacts so many people, most of it anonymously," King said. "My nurses are making less than half of what they could make in a hospital setting. . . . They are the most dedicated group."

To ensure consistency among the school clinics, King created for the nurses a 3-inch-thick manual - updated annually - containing policies, first-aid procedures, basic guidelines and immunization information, among other things.

Each nurse also has special health care plans on file for students with severe allergies, asthma, diabetes and other student-specific chronic health conditions, such as muscular dystrophy, sickle cell anemia and cerebral palsy.

"In some cases, these are kids who wouldn't have been going to school 15 years ago," Mahaffey said. "We can troubleshoot now, whereas there used to be more 911 calls years ago."

At about 11 a.m., bubbly kindergartner Katie Kojali waltzes in for a blood sugar check before going to recess, pricking her own finger like a pro.

"She comes in six times a day, and I give her insulin at lunchtime," Mahaffey said.

Katie is one of 54 diabetic students in the Fayette school system monitored by school nurses.

Mahaffey provides daily updates on the girl's health to her parents through a log book that goes between clinic and home.

"When we relocated here a few years ago, one of the big reasons we chose this school district was because they had full-time nursing," said Katie's mother, Kelly Kojali.

"She [Katie] had just started learning to check her blood sugar. I can't imagine her [Mahaffey] not being there. She's helped us tremendously.

Soon after, a fifth-grader appears. The palm of her hand is pressed against her forehead.

"I have a headache," she says.

Mahaffey opens a cabinet behind her desk to see if the student has over-the-counter medication approved and provided by her parents.

Sure enough, she has chewable tablets.

"Ew," the girl says.

"They're flavored," encourages Mahaffey.

Next.

A doe-eyed kindergartner arrives, looking forlorn.

"She threw up on the playground," says her teacher escort. "But she managed to finish recess."

By the end of the school day, Mahaffey had tended to 59 children. The following day, it was 71.

"It [the school nurses' office] is no longer just a place for unseen ouchies and tummy aches, but it is where kids receive breathing treatments, insulin calibration and administration and are fed through assisted technologies," Mahaffey said.

"I like to think of it as my very own mini-emergency room . . . you never know what is going to come walking through that door."

- This article is a reprint from The Atlanta Journal-Constitution.