Her frizzy hair bouncing and her hands busy dispensing medications, Alexandria school nurse Karen Meehan chuckled inside her office yesterday at the memory of how her high school nurse spent her days in the 1960s: looping thread through a needle as she stitched her personal crochet patterns.

That was before little people had adult-sized health problems, said Meehan, who is the nurse for 550 students at Patrick Henry Elementary. That was before food allergies and asthma, seizures and hyperactivity, diabetes and tube feedings became as common as the schoolyard scrape.

"It's true, she literally had so much time that she would sit and do crochet," said Meehan, who took a deep breath and patted her black curls into a neat bundle. "It's nothing like that now. Some days I am so under pressure that I have to remind myself that I am only one person."

With school budgets swelling and more money being spent on classroom technology and reductions in class size, the school nurse somehow has been left out of the expanding pot, said Judy Robinson, executive director of the National Association of School Nurses.

"School nurses are now called upon for what used to be institutional care. Children are more medicated than ever before. There are more disabled education students in schools," Robinson said.

In some districts, one nurse is shared by several schools. Some schools are so understaffed that office secretaries are forced to dole out medications, and teachers with little medical experience must change colostomy bags or suction tracheotomy tubes.

Patrick Henry and other schools in Alexandria and Arlington are the lucky ones. Each school has one nurse. But even here the new challenges are felt every day.

Meehan, who has worked at Patrick Henry for nine years and knows the first name of almost every child, feels the pressures when she doesn't have enough time to get through vision or hearing test screenings. Or when she has to cancel a health chat with a class because the line of students waiting outside her door was longer than she expected. Or when she doesn't get the chance to talk with overweight students because there are more pressing problems.

"The kids just come off the bus and come straight here to the nurse's office," said Patrick Henry Principal Marcia Baldanza. Meehan said she sees 30 students on a typical day but sometimes as many as 50.

Inside her office yesterday, she scrunched fifth-grader David Yanes's jeans over his swollen left leg. At the bus stop, he had decided to "jump off a cliff," or a small pile of bricks, and had bruised his leg.

He sat quietly on a long light blue recliner as she cleaned his wound and pressed a plastic bandage over the red scratch. "I know that hurts," she said, as his face tightened with pain.

"It's okay," David said, looking up at her. "This will make it better."

While he was there, others strolled in. Some claimed their daily medicines and others complained of everything from a swollen mouth and tongue to a stomachache. The age-old fakers arrived as well, complaining of stomach pains even as they munched on snack food.

Meehan dismisses nothing. The child who hides out in the nurse's office to avoid going to class might have a learning disability that teachers have not detected. The youngster who looks fine but reports feeling tired could be suffering a reaction to a medication.

"There is an awful lot of stuff being given to kids who haven't developed emotionally or physically," Meehan said. "Sometimes you have to look at what they are taking and what is happening and put them together."

She also sees students who have recently emigrated from countries around the world and whose parents don't speak English.

"Sometimes you have to have the children translate," said Meehan, who speaks some Spanish and knows the country each student is from. "There aren't a lot of nurses who know Urdu or Arabic yet, but that may happen soon."

About 11 a.m. yesterday, Meehan spotted volunteer Teresa Reilly, a retired nurse, who shuffled in from the snow. Meehan cheered. Reilly, a graying woman with a gentle manner, said she comes because she knows how understaffed school nurses are.

"Sometimes there could be lines of students waiting for one Karen," Reilly said. "Even if I'm just here to listen to problems, it helps."