Aim: To explore the association between positive self-reported health (SRH) in pre-school and 4th grade SRH in a long–term prospective population-based study in Sweden. Methods: Data originated from the Health Dialogue (HD) a structured instrument used by school nurses. 1084 children participated. Odds ratios were analyzed. Results: In 10-year-old children’s SRH, comfort in school, normal BMI and absence of headaches were shown to be significantly important health indicators. Normal BMI showed to have a potentially causal effect on 10-year-old girls and absence of headaches showed a potentially causal effect among 10-year-old boys. Conclusion: Schools should be designed to meet the children’s needs so that they are perceived as comfortable, safe and secure places. Schools should advocate physical activity and play, serve healthy nutritious food in order to motivate, support and promote a healthy lifestyle. Schools are a unique arena for health promotion as they reach practically all school-age children.