Dr. Kevin Most: Back To School? We Just Got Out…

Dr. Kevin Most

Back to school sales used to make me cringe, it was the sign that summer break was coming to a rapid end. We used to worry about new binders, folders and school supplies, it often meant a new pair of gym shoes for gym class as well. Certainly some of this still applies however it has changed dramatically over the years, binders have been replaced with computers, in some schools gym class is almost nonexistent but the health related concerns have continued and in some cases increased.

What should we be doing to get our children ready to hit the books again after this nice break they have had? Some of the health changes that need to occur are totally in control of the parents, others in control of the doctors and in some cases a combo of Parent, Doctor and school nurse. It does take a little planning to jump back into school and it is our opportunity to use this yearly event to reinforce some health issues and use the opportunity for education.

First let’s discuss what a parent should be doing as we approach the school year. Summer break is usually a time to break most of the sleep rules we have, children are out playing late or up late with activities and parents have no concerns as kids will sleep in the next day. It is not unusual to hear that high school students will sleep past noon as they have been awake late into the night. Children are often not awoken by an alarm clock in the summer, they often wake up whenever their body tells them to. With school right around the corner it is important to get students back into their school sleep patterns a week or so before school actually starts. This is important as they have convinced their bodies over the past 2 months of a new pattern. Sleep experts tell us we should shoot for 10 hours of sleep in teens and children. It is also important to get their bodies to a point where they are ready to fall asleep at the correct time. This is by no means easy and in fact it is probably one of the tougher aspects of back to school that parents face.

The second is nutrition, one would think that during the summer children would eat a better diet than during the school year as parents have control. Studies actually show the opposite. Across the country 22 million children receive free or reduced priced meals thru the National School Lunch program, however during the summer these children do not have that benefit and thus do not receive a well-balanced nutritional meal. This lack of access to these meals results in poor nutritional meals that often result in obesity. The school based meals are not only nutritional but they also teach children balance and portion control going forward in life.

When we discuss food we cannot forget the ever increasing issue with food allergies in children. These allergies can run the spectrum from an intolerance to a food group all the way to life threatening reactions. There are few important areas here. One is awareness for the teachers as exposures can come from many sources. Having the teacher aware can help decrease the chance of any exposure as well as have them aware of what to look for if there were to be an exposure. From the parent side making sure the teacher and school nurse understand the extent of the allergy and provide the staff with the recommendations and orders from the physician. Having an Epi pen can be lifesaving and making sure it is not expired and available is key to it working as expected and needed.

Many parents feel that the annual sports physical is a waste of time, they know their child is healthy, I mean they are an athlete, right?? Wrong, the sports physical is the opportunity for a professional to review your child’s records, get them up to date for their vaccines, and most importantly, exam their back and joints, listen to their heart and lungs, listening for breathing changes, murmurs or irregular heartbeats. The exam allows for the doctor to measure and discuss weight issues and body changes as well. 99.9% of kids are healthy but identifying the one that is not can save a life. What parents don’t understand is that the physician is also going to be the individual that talks to them about peer pressure, drug use, sexual activity, depression identification, cyber bullying all of the topics a parent does not want to discuss or won’t discuss with their child. Asking the doctor beforehand to touch on these subjects and stepping out of the room as they do is an opportunity for the physician to educate and the child to ask questions they may not ask you.

It almost takes an athlete to carry books these days, the ritual of buying a back pack should be much more important than picking out their favorite color. Backpacks should have no more than 15-20% of a child’s weight and should be fitted so that both straps can be used. The child who weighs 80 pounds, the backpack should weigh no more than 12-16 pounds, yet we know that often these will weigh close to 30 lbs. as books and a laptop computer weight adds up quickly. For the younger child who is still growing and developing a back pack that weighs too much can impact muscle and skeletal issues and can cause low back pain, shoulder pain and arm pain. Many parents are looking at the new rolling backpacks which prevent any back or arm issues. Please check with your school if you are thinking about a rolling backpack for your child as some schools are blocking them as they are seen as tripping hazards in the busy hallways.

Everyone has heard about the importance of vaccinations, this is probably most important in the school setting where children are in close contact with each other and spreading a communicable disease is very easy. It is not surprising that August is National immunization Month. Promoting vaccines their safety and effectiveness is important in keeping our children safe.

Recent years have shown us the importance of vaccines as measles outbreaks have shown us what happens when a portion of the population decides to not get vaccinated. Unfortunately there are still portions of the US who feel that vaccines are dangerous and add risk to their children’s health. This could not be further from the truth and in fact it not only puts their children at risk but it also puts all other children at risk. The non-medical exemptions have been tightening in many states. Individuals can claim religious exemptions but most religions are not taking an anti-vaccine stand. In Illinois one can claim a religious exemption but they must provide a signed certificate from a provider saying that the vaccine information has been provided to them. The thoughts of philosophical objections are now on shaky legal ground, and pediatricians are able to remove a patient from their practice if the parent refuses vaccinations. The CDC is recommending that all schools post vaccination rates on line. Overall Illinois schools do well with vaccination rates close to 95% which falls into the range that historically provides good herd immunity. Herd immunity is the concept that with enough vaccinated individuals in a herd a single case of an illness will not spread and the infection will be controlled and not spread to individuals who cannot receive the vaccine yet. The concept of herd immunity is important in illness where the vaccination period does not start until a later age.

Back to school vision screening is very important. Children are resilient and can learn to cope with many handicaps. One they should not have to deal with is poor vision. From and educational and safety view, vision accuracy is important. The ability to read a screen, a chalkboard or even a book will impact the learning of a young child. The importance of setting a good educational foundation is key as we know learning is based on growth of the foundation. The child that falls behind early in life due to vision problems may be playing catch up for a long time, and in some cases not catch up. A simple eye exam and correction may make a huge impact in the education of a child.

Growing up we all knew who the Bully was, he was often one of the biggest kids in the class and he often used his size to be a physical bully. Times have certainly changed as the bully in cases today does not need physical size, they just need a computer. Cyberbullying is a very big issue now and the impact of social media on children has led to record number of suicides and depression rates in teens and adolescents. The big bully would often be put in his place by a large group of individuals or by peer pressure from a few key individuals, today that is often not the case as the bullying can happen anonymously and with reaches far beyond the playground.

We have seen the power of a mentor when fighting bullying. The professional athlete who responds to an individual who is being bullied captures the attention of the media and will stop the bullying episode in its tracks. I recommend all parents of children discuss this with their children, empower them to do the same. Show them that the individual who protects the vulnerable individual will be rewarded forever as that attitude will continue with them for the rest of their lives. Any coward can make fun of an individual they see as weak or vulnerable, it takes a champion to be the one to stand up and take that vulnerable individual under their wing, protect them, include them. This will allow for both individuals to grow and prosper and will actually place the bully where they need to be placed, minimized and in the shadows, perhaps with a lesson that being a bully is not a good idea.

Children often will not share with their parents about the bullying as it may be embarrassing or imply some family dynamics that they do not want to expose. As a parent monitoring of social media is key, as a teacher sharing the social media concerns with parents is key and as a child sharing inappropriate posts with an adult is key. All three are needed to minimize or eliminate the impact of this on children. Law enforcement professionals are recommending pressing charges or getting the police involved when needed as this may often protect not only the individual but also will send a message to the individual placing the posts that this type of activity will not be tolerated going forward.

Depression and anxiety are two of the outcomes often associated with cyberbullying, but we have to understand that these conditions can occur without any impact on social media. Parents, friends and doctors all need to be aware of the mental health issues that children are faced with and identifying a mental health issue is important. Seeing a child who has a large change in social activity, a decrease in the grades suddenly, a rapid change in weight, these are a few of the signs a parent or friend may notice and having that individual seek help is what may be needed to identify and threat the issue.

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