Dr. Kevin Most: School health- from back packs to depression


Dr. Kevin Most

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This month is a big month for students returning to school across the country. Let’s take a couple of minutes to discuss some health concerns. For many of the concerns it does not matter whether you are going to college or going to 5th grade, for some concerns it is specific.

How about something simple, anyone want to guess the weight of their child’s back pack? I am afraid that many of you may be surprised. For starters just having an idea on how much a back pack should weigh based on the size of the child is key. Instead we just load them up and watch the child lean forward as they struggle. The new days of children having a lap top computer has not helped in many cases. The computer is not taking the place of books in many cases, it is taking the place of paper. The average lap top weighs about 5 lbs. with many manufactures providing a more expensive 2 lb. lightweight computer. So how much should a child carry in their back pack? Orthopedic surgeons feel the back pack should never be more than 10% of the students body weight. Going beyond this can cause back pain and back problems. Parents should look for a light back pack with 2 padded straps. Eliminate the excess weight as much as one can.

Let’s discuss generic first before jumping into specifics. Our big concerns are physical as well as mental for any student. We are seeing an increase in mental health issues with students across the board. We are seeing stress being put on students for getting good grades, we are seeing stress be placed on students from social media postings, we are seeing a big increase in the diagnosis of ADHD in students.

For each of these stressors, the ability for outsiders to identify and help manage is key. It may be a teacher noting the signs of ADHD, it may be a parent with the insight on themselves with the pressure they are putting on their children for grades. It may be a friend who notes some cruel posting on Facebook. It takes a team to identify and treat or minimize the stress on the students. For college students we can’t overlook the anxiety many have with being away from home and some new independence given to them. If you think college students don’t feel the stress of making good grades you are mistaken as the cost of college education is so prevalent in the news.

A recent study out of the University of Iowa, it looked at the responses of 18,000 adults discussing their children’s health. Almost 2,000 shared that their child had been diagnosed with ADHD, this jump to over 10% and been closer to 6% a few years earlier. There are a few reasons, Doctors are better at diagnosing it, teachers and parents will note and report it sooner to have the child screened. So this “rise” to over 10 % may really be just an awareness and diagnosis versus an increase in the number of cases.

Treatment for ADHD may include a medication like Ritalin or Adderall, we have discussed in the past the skyrocketing abuse of the misuse of these medications sometimes known as a “study drug”. A study of 10,000 college students found that more than half of the students who were prescribed one of these meds were asked to sell them to other students. This is an additional stress, stopping the medication you need and potentially selling it illegally to others. Parents with students on medications for ADHD need to be aware of medication consumption and dispensing patterns.

When we look at statistics they are quite startling, mental health issues are much more common than we think. Now take a young adult and place them in a stressful situation and these conditions my expand and worsen.

Studies have shown that close to 80% of students feel overwhelmed with their new responsibilities, 50% report that they have felt so anxious that they struggled in school. The most concerning stat is that a large percentage will not seek help or stop the treatment that had been started while in High School when left to live independently at school.

As individuals transition to a new school, be it High School or College life, they are exposed to new friends, new environment and they have lost the support system they once relied on. This often may trigger a worsening or an extension of an issue that was minor while in the comfortable environment they are used to.

What are the greatest psychological concerns we have as we transition these young adults? What can we do to help them and hopefully identify and line up treatment options if needed.

The first and most obvious is the student who is already being treated for a mental illness. The peer pressure in all schools can be intense and the need to continue medication and treatment can be difficult for the student patient. Support from family and friends is needed as sometimes the path of least resistance is to stop the medication and counseling. The student with a good grasp of the illness will actually share the information with their new friends or roommates initially to remove that anxiety and to explain their need to continue medication. The ability to build a support system is key to the success.

The conditions we are most concerned about include, Depression, anxiety, addiction, eating disorders and suicide. It is important to understand each of these and that students are at higher risk and what we can do to identify and treat these concerns.

Depression is much more common than we think. In students this illness is found in many forms and varying intensity. A large study showed that close to 40% of all students experience some level of depressive symptoms. It is the number one reason students, don’t finish high school or drop out of college. Depression in the student may have symptoms that include difficulty studying, difficulty sleeping and eating disorders. Depression in the student is caused by a combination of genetics, biological, psychological and probably most importantly in these situations the new environment. Depression in these students is important to identify early as its impact can be substantial.

The symptoms for depression vary from person to person, the way a student exhibits symptoms of depression can vary from their previous educational or home settings. Things to look for include….
1.) Change in sleeping patterns, this may be excessive sleeping or difficulty sleeping
2.) Appetite changes from over eating to a loss of appetite
3.) Feeling of sadness, overwhelmed, hopelessness
4.) Difficulty concentrating, paying attention or completing tasks including school work

Having these symptoms does not make a diagnosis. We know life is complicated and the transition from middle school to high school and from high school to college is as well. However if these symptoms continue or worsen it is wise to seek help. Students will often down play the symptoms or not want to share with their parents how they are actually feeling. The need to identify these issues cannot be minimized, as friends need to look for these signs, and bring them up if noted.

Stress and anxiety are quite common in college students. The stress to deliver good grades is highlighted even more as you commonly hear about student loan debt. Stress can manifest itself in many ways including anger, substance abuse, eating disorders and depression. We have taken young adults from a somewhat stress free environment (living at home, senior year, free education …..) and placed them in a potentially very stressful environment. Living on their own, new roommates, cost of college, new peer pressure, each of these alone can impact their personal health as well as their academic success.

Things to consider, check in with face time as well as simple calls, face time will show facial expressions. Often text and voice calls do not tell the true story. Watch for signs of disengagement with other friends or family members. Watch for disengagement from activities they used to like. Listen for apathy, or lack of interest in school. Signs of drug or alcohol use, missing classes, frequent use of ATM at unusual hours.

Listen for signs of anxiety, fear of failure academically, lack of concentration, signs of guilt.

“College is the best 4 years of your life!!” but do we understand that this is not without some incredible stress. The stress of making new friends, living with a stranger, choosing courses that will shape the rest of your life and being away from family and lifelong friends. These stressors can be complex and can lead to other medical issues or conditions. Watching for signs of stress in college students is difficult, being away from family often eliminates that close personal identification of concerns. If you run across one their friends, checking in with those friends on your new college child is not snooping, a simple question to a friend of your child may be helpful. “Have you talked with XXX, How do you think they are doing?

We have discussed in the past the outbreaks of Influenza, Whooping cough, mumps and meningitis in the school setting. The increase in other common illness must also be considered as students interact so much and college students will be in close quarters. We have seen the spread of mono as well as MRSA skin infections in the school setting as well.

Making sure that your simple vaccines are up to date is important. The meningococcal vaccine will protect the student from a common illness that can cause meningitis. Having your Pertussis and Mumps vaccines up to date can protect you from any exposure or out breaks of Whooping Cough or Mumps. It is also important to make sure your student receives the flu vaccine when it is available. These vaccines can help keep your child healthy and protect them from some devastating illnesses.

Students with physical ailments will run the entire range from, “nothing is wrong” to “I think this rash is cancer” Balancing when to go to a doctor maybe easier in younger years as often there is a school nurse, a convenient care or your doctor right around the corner. For the college student they are now making that decision without the opinion of their parent. Student health is often the brunt of many jokes, but I assure you the physician working in this setting have focused their practice on the narrow age group of a college student and are quite good. Letting your children know that you are available for a health discussion is important. Parents will often have insight into their children’s health and can give good advice over the phone or with facetime. A parent saying go to student health may be the push the child needs to be seen in a timely fashion.

We all have hear of the “Freshman 15”, is this real or just a myth? Well it is real, more than a handful of studies have shown that the weight gain in freshman in their first college semester is quite common. We also know there is a growing concern in the US with childhood obesity. For college students, the new independence in their diet, coupled with less physical activity and dorm cafeteria all you can eat dining leads to this. This increase in many cases does not take the entire freshman year in fact it is often noted in the first 3 months. We know many universities are looking at offering healthier food options, they continue to offer options of not so healthy food and often with no limits on how much one can eat. Grade school and High School kids are also not eating healthy, fast foods and lack of activity will impact the weight of many.

That being said, we cannot overlook or minimize the number of students who develop eating disorders during their adolescents and young adult life. Eating disorders are very common and unfortunately they have a high mortality rate. Red flags for individuals who may have eating disorders include having a sense of poor body image, excessive exercise, fear of eating in public, constantly making excuses for eating habits. So although we all talk about the freshman 15, we rarely hear anyone discussing this much more serious issue with eating disorders. Students who live away from home may be noted to be purchasing clothes due to weight changes and that may be the only sign a parent notices between visits or trips home.

Dealing with eating disorders takes more than a simple” You need to eat better” or “ you look too heavy or skinny” weight changes need to be identified and reviewed and addressed. It may be signs of depression, inactivity or eating disorder to just name a few, so any notable changes should be evaluated.

Depression is much more common than we think. In college students this illness is found in many forms and varying intensity. A large study showed that close to 40% of all students experience some level of depressive symptoms. It is the number one reason students drop out of college. Depression in the college student may have symptoms that include difficulty studying, difficulty sleeping and eating disorders. Depression in the college student is caused by a combination of genetics, biological, psychological and probably most importantly in these situations the new environment. Depression in these students is important to identify early as its impact can be substantial.

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