Texas School Health Screening Requirements by Grade Level (2025-2026)

Texas school health screening requirements for the 2025-2026 year specify which DSHS-mandated screenings your school must conduct at each grade level. These requirements are set by the Texas Department of State Health Services (DSHS) under Texas Health and Safety Code, Chapter 36 and 25 Texas Administrative Code, Chapter 37. The goal is early detection of vision, hearing, spinal, and metabolic conditions that can affect a child's ability to learn.

For the 2025-2026 school year, DSHS mandates four categories of screening: vision, hearing, acanthosis nigricans (a marker for insulin resistance and type 2 diabetes risk), and scoliosis (spinal screening). Each screening type applies to specific grade levels, and schools are responsible for ensuring compliance.

Screening Requirements by Grade Level

The table below shows which screenings are required at each grade level. Schools must screen students in these grades each year.

Note: "New students" at any grade level have additional requirements — see below.

The "New Student" Rule

Texas requires that any student enrolling in a Texas school for the first time — regardless of grade level — must receive vision and hearing screenings within 120 days of enrollment. This applies to students transferring from out of state, students entering from home school, and any student who does not have a screening record on file in Texas.

This means even students in grades that don't normally require screening (like 2nd, 4th, 6th, or high school) must be screened if they are new to the Texas school system. Schools should have a process in place to identify new enrollees and ensure they are included in the next available screening event.

Why Scoliosis Screening Is Gender- and Grade-Specific

Scoliosis screening in Texas is required for girls in 5th and 7th grade and boys in 8th grade. The reason for this split comes down to growth patterns and the age at which scoliosis is most likely to develop or progress.

Girls typically enter puberty and experience growth spurts earlier than boys. Since scoliosis curves are most likely to worsen during rapid growth, screening girls earlier (5th and 7th grade) increases the chance of catching a curve before it progresses. Boys tend to hit their major growth spurt later, so 8th grade is the targeted screening year for them.

By aligning screening with peak growth periods for each sex, DSHS aims to maximize the window for early intervention, which can include bracing or monitoring to prevent the need for surgery.

Pre-K Age Cutoff: Turned 4 by September 1

For Pre-K students, vision and hearing screenings are only required for children who have turned 4 years old on or before September 1 of the current school year. Children younger than 4 are not required to be screened under DSHS rules, though schools may choose to screen them voluntarily.

This cutoff exists because reliable screening results depend on a child's ability to understand and follow instructions during the test. Most standardized screening protocols used in Texas schools are validated for children age 4 and older. Screening younger children can produce unreliable results and unnecessary referrals.

If your Pre-K program includes 3-year-olds, those students are exempt from the state mandate but should still be monitored by parents and pediatricians.