Back to School Health Primer

Back to School Health Primer

The start of a new school year is always exciting with new challenges and new expectations. Everything that occurs during the school year from September through June will impact our children’s health – mostly in positive ways but there are always a few speed bumps along the way at unexpected times. Here’s a snapshot of the most important issues nuts and bolts to consider as you march through a new school year with your kids.



The Annual Well Child Examination

Most public school systems require an official physical examination, or well child examination, on record entering Kindergarten, Middle School and High School, and for sports participation. The American Academy of Pediatrics, however, actually advises a checkup annually from 3 to 21 years of age. This is really the only way to be sure your child’s health and well being is stable year to year and to catch subtle issues that need attention. During those visits, the entire child’s health is looked at, not just the physical exam. A year’s overview of a child’s emotional, developmental and academic ups and downs is what gives ups a picture of a child’s health. We can tell you a great deal about your child based on what has changed, or not changed, from one year to the next and help you prepare for what changes are anticipated next.

Finally, keep in mind that since the point of the visit is to get a sense of your child’s health, it is important for your child to weigh in on issues. Most pediatricians and nurse practitioners work hard to help a child learn to talk about themselves during these visits as they get older. What helps is if the child is given an opportunity to answer the questions first with you filling in the blanks later. In some offices, the parent talks with the pediatrician separately and during the actual physical is more of a fly on the wall.

When A Child Is Sick

Kids can and do get sick during the school year. During cold and flu season, many illnesses are hard to avoid. Given that kids get 6-12 illnesses a year, it is not surprising that most of these illnesses occur during the school year when kids are in close proximity of one another. Luckily, most illnesses are minor and self-limited but that doesn’t mean they won’t impact your child’s school attendance and your ability to go to work. What can create great peace of mind is having some basic information, including return to school guidelines. Your school will have specific guidelines in place created by your public health department but these are the general rules of thumb we follow in pediatrics:

Most illnesses are viral and take time to resolve.

A simple cold last 3-5 days but a stronger virus up to 2 weeks. That can seem like forever sometimes!

Fever and even a rash can be part of many viral illnesses but some due require medical attention so you’d want to notify your doctor if sick symptoms develop with BOTH a fever and a rash.

Fever alone is not a concern if your child looks well and is acting well.

More important than the height of the fever is how your child looks with any degree of fever.

Your child is contagious with fever needs to stay home from school until fever free for a full 24 hours.

It is important to remember that even minor illnesses take time to recover from. Kids don’t learn well when they are worn down. It is lousy enough to be sick and get behind in school, it is even more upsetting for a child to be back in school before the illness has cleared enough to really function well. Time really does cure most ails so be patient and don’t push your child back to school until you are sure your child is really ready. Your pediatrician can help guide you if you are uncertain.

Common School Year Illnesses

Your child will likely not get all of these but here’s a list of the typical sick and urgent complaints kids in general are prone to each September to June:

Mono

Strep Throat

sniffles: common cold or allergy

injuries

chicken pox – even if having had the shot

vomiting and/or diarrhea

headaches

“not feeling well”

starting an antibiotic: no school for 24 hours or until fever free for 24 hour

needing medications at school

asthma

rash

fever

flu symptoms

Your school nurse’s office usually sends around notices if any of these illnesses are in your child’s school or building. What is important is to be sure your child is diagnosed properly and not to push your child back to school until your child is ready. Your pediatrician is the best guide for both of these important decisions.

Medication Use In School

With the school year starting, take a minute to think about the types of medications your child may need at school, both prescription and nonprescription. This is particularly important for conditions that could be live threatening, such as allergies to food or stings and asthma. Make sure the school has necessary inhalers, benadryl and epipens. If your child has an asthma action plan, the school should have a copy.

For acute illnesses, usually all you need is a note from the doctor and the prescription medication. Luckily many antibiotics can now be given only once or twice a day but there are still a few that are 3-4 times a day so will need to be given during the school day.

Just in case medications are sometimes needed at school. Migraines are a great example of this. So, make sure your school has what your child needs should a headache begin.

Finally, if your child gets diagnosed with a major condition, talk to the school nurse so she is aware of the treatment plan and medications.

Immunizations

School is a special situation for health care because of the group setting created by the close proximity of teachers and students. For this reason, all States have State mandated immunization laws in place for school entry that are based on the current CDC 2010 Childhood Immunization Schedules.

In most states, parents must provide proof of immunizations when kids are entering Kindergarten, when moving into the school system, and in middle school or high school, depending on the district. Typical immunization requirements for those grades include:

By Kindergarten, students must have proof of:

3 doses of Hep B
5 doses of DTaP/DTP
4 doses of Polio
2 doses of MMR
1 dose of Varicella

By 7th Grade, students must have proof of:

3 doses of Hep B
1 booster dose of Td
3 doses of Polio
2 doses of MMR
1 dose of Varicella if under 13 years of age; 2 doses if over 13 years of age

You can find the school entry immunization requirements for your State here.

Special Vaccines for Special Situations

There are two times special vaccines are needed: travel to other countries and during the flu season. If you are planning a trip over seas, check the CDC.Gov website to see if your family will need pre-travel vaccinations.

For the upcoming flu season, all kids now need an annual flu shot. The risk to kids from the flu is just too high and anti-flu medications ineffective and dangerous. Annual vaccination against the flu is the only way to protect kids from the flu.

If you have an infant under 6 months at home, it is crucial that both parents and all siblings over 6months get the flu shot. This is the only way to protect that very vulnerable infant.

Here's some valuable new information from the CDC on the seasonal flu, including H1N1.

Unexpected Problems

Finally, just like with a check-up on your car, the annual physical examination only is a touch point at that time. And, while your pediatrician can talk to you about issues expected for each age, that doesn’t mean those issues will come up for your child or others won’t occur. Just be open to whatever comes your way and call your pediatrician at the first sign of concern, in you or your child. Better to call and have something be nothing than to find out an issue is brewing your pediatrician can help with. A child’s body is very dynamic and changing all the time. And, a school year has a way to molt our children in new an unexpected ways. While most of those changes are wonderful, some can be a bit rough and we don’t want you to face those alone.

August 2010 by Dr Gwenn