HealthHints

Back to School!
Preparing for a New School Year:
Getting a healthy start/Keeping your kids healthy

August 2007 – Vol. 11, No. 8

Editors: Janet M. Pollard, MPH; and Carol A. Rice, Ph.D., R.N.

School supplies, athletic gear, backpacks, and lunch boxes…Preparing for a new school year often comes with a lot of anticipation and requires some planning on the part of parents and their kids. With a new school year come new challenges, some of which involve how to keep our kids healthy throughout the school year. Healthy children learn better, and no curriculum can compensate for deficiencies in a student’s health status.1 This issue of HealthHints will focus on some of the ways we can physically prepare for school that can help our kids start off healthy and stay that way.

Physical Preparation: Building up the body & brain

For your child to perform his/her best both academically and in recreation or sports, his/her body needs to be in good physical shape. To get or stay in good health for the school year usually requires:

  • physical examinations,
  • illness prevention,
  • injury reduction, and
  • proper rest (sleep).

Physical Examinations: The “not so routine” physical examination

Your child’s entrance into a new school year is usually preceded by an annual physical examination, but what we often consider a “routine” physical can be geared to further planning and discussion as well. Each year, doctors “come across children who have questions about their bodies or lifestyles that can have a deeply profound outcome on their long-term health. And although less common, routine checkups sometimes uncover ‘silent’ diseases or conditions,”2 such as high blood pressure or growth problems, which can indicate other underlying health conditions. So, when you schedule this year’s physical, you can expect routine measures and plan to discuss age-appropriate topics that might give you and your child the opportunity to discuss difficult issues and how they may affect their health. Here’s what you can expect at a routine physical:

  • a medical history (questions about the child’s past and current health as well as that of his/her family);
  • check of the heart and lungs;
  • check of the eyes, ears, nose, and throat;
  • examination of the back, joints, and extremities;
  • assessment for genital abnormalities or hernias;
  • inspection of the skin3;
  • measurements of height and weight;
  • blood pressure check;
  • any immunizations that are due (see recommendations); and
  • vision and hearing screening (every few years).2

Other tests that may be included are:

  • scoliosis screening,
  • blood count (to check for anemia),
  • urine analysis (to check for an undetected infection or protein).2

Difficult topics to discuss include:

  • safety around strangers,
  • driving issues,
  • body image, and
  • nutrition.2

Talking with a physician can be a positive way to facilitate conversation with your child about his/her health and some of the challenges that he/she may face during the school year.

Illness Prevention: Keeping kids well

Unfortunately, along with the start of school often comes the onset of contagious illnesses. Childhood illness may not affect a family until a child starts child care or school. After that, it may seem to the family that the child is sick all the time. “This pattern is normal as [the] child builds a robust immune system. Resistance to infection develops only after exposure to a multitude of germs.”4 “A child’s immunity improves with time. School-age children gradually become less prone to common illnesses and recover more quickly from the diseases they do catch.”4 Currently, the top five contagious diseases are:

  • colds,
  • stomach flu (gastroenteritis),
  • ear infection (otitis media),
  • pink eye (conjunctivitis), and
  • sore throat.4

Other common contagious conditions include:

  • chicken pox,
  • ringworm,
  • head lice, and
  • impetigo.5

More serious contagious conditions include:

  • meningitis,
  • hepatitis, and
  • HIV/AIDS.5

To learn more about these illnesses, see the handout, Types of Contagious Illness (PDF).

The number one thing you and your children can do to prevent contagious diseases is to wash your hands. Proper handwashing is a skill that you can teach your children and family members, which can go a long way in preventing illness. Germs multiply rapidly in warm, moist places. When objects or hands touch places where there are a lot of germs (like at school), they pick up the germs, which then enter the body through the nose, eyes, mouth, and/or broken skin.”5 For this reason, the hands are a primary avenue for the transport of germs into the body. In fact, handwashing is the number one way to prevent the spread of contagious disease. This message cannot be emphasized enough to teachers, staff, parents, and children. Simply running hands under water for a couple of seconds and drying them on a towel, however, is not enough. Share and emphasize the following handout, Guidelines for Handwashing (PDF).6


For those times when your child does show signs of illness, one of the hardest things for a parent to decide is if or when a child can return to school. Here’s a “cheat sheet on common symptoms” from Dr. Nancy Dickey11 that may help:

  • Running nose — If a runny nose is your child’s only symptom (and your child does not act ill or have a fever over 101 °F), it is okay to send him to class.
  • Ear infection — Unless the pain from the infection or a temporary loss of hearing keeps your child from participating in class, it is fine for him to go to school. Ear infections are not contagious.
  • Cough — If your child’s cough is not productive (a dry cough, not coughing up phlegm), and she does not have a fever over 101 °F, there is no need to keep her home.
  • Vomiting, Diarrhea — If your child has had either symptom more than once within 24 hours, it is best to keep him home. Since dehydration is often a complication after bouts of either symptom, make sure to take precautions.11 For more information, see Sick Kids – When to Keep Your Child Home.

Remember, these are simply guidelines. Each child is different and has different needs. Schools may also have policies that differ from these guidelines.

Injury Reduction: Strategies for safety

The beginning of school also means the beginning of physical education (PE), athletics, and other outdoor recreation. Primary health concerns in this area are about injuries, including heat-related injuries for southern states.

“Nearly 4 million children and adolescents are injured at school each year.”12 “Approximately 715,000 sports- or recreation-related injuries occur in an around schools each year,”13 and “approximately 13,000 playground equipment-related injuries occur on school playgrounds during school hours.”13
Emphasize the following general rules around playground equipment to reduce injuries:

  • Always make sure there is an adult supervisor present before playing on the playground equipment.
  • Never push or roughhouse while on jungle gyms, slides, seesaws, swings, and other equipment.
  • Use equipment properly – slide feet first, don’t climb outside guardrails, no standing on swings, etc.
  • If you jump off equipment, make sure that you check that there are no other children in the way. When you jump, land on both feet, with knees slightly bent.
  • Leave bikes, backpacks, and bags away from the equipment and the area where you’re playing so that no one trips over them and falls. (See the handout, Oh, My Aching Back [PDF].)
  • Playground equipment should never be used if it is wet because moisture causes the surface to be slippery.
  • During the warmer months, playground equipment can become uncomfortably or even dangerously hot, especially metal slides. So use good judgment – if the equipment feels hot to the touch, it’s probably not safe or fun to play on.
  • Don’t wear clothes with drawstrings or other strings at the playground. Drawstrings, purses, and necklaces can get caught on equipment, causing accidental strangulation.
  • Wear sunscreen when playing outside, even on cloudy days, so you don’t get sunburned.14

Emphasize the following guidelines3 to minimize injury risks during athletics (sports or PE):

  • Get a preseason physical examination.
  • Be in the proper physical condition to play the sport.
  • Know and abide by the rules of the sport.
  • Wear the appropriate protective gear for the sport.
  • Know how to use athletic equipment properly.
  • Warm up before playing, and cool down afterwards.
  • Avoid playing when very tired or in pain.3
  • Have adequate water or other liquid available for maintaining proper hydration.15

For further information, see the following handouts: Tips for Reducing Risk of Injury (PDF) and Resources (PDF).

Proper Rest: Getting enough sleep

Proper rest is essential for good performance physically and academically. Recently, “researchers surveyed 280 students at a suburban high school outside of Philadelphia. The students start their school day at 7:30 a.m. and finish at 2:25 p.m. The survey found that:

  • 78 percent of the students said they found it difficult to get up in the morning.
  • Only 16 percent said they felt they got enough sleep.
  • 70 percent said they believed their grades would improve if they had more sleep.
  • 90 percent felt their academic performance would improve if school started later in the morning.
  • Many students said they did not feel alert taking tests during early morning classes and don’t think they’re at the peak of their academic ability at that time.
  • Most of the teens said the best time to take tests would be from 11 a.m. to 1 p.m.

“Teenagers need more sleep than adults [8–9 hours vs. 7–8], and their circadian rhythms are phase shifted so that their ideal bedtime is midnight to 1 a.m.; yet they have to get up at 6:30 or earlier for high school,” study author Dr. Richard Schwab, of the University of Pennsylvania, said in a prepared statement.18

Though working with school systems to shift the start time may be helpful, working with your child to be sure he/she gets enough sleep is essential. Try to have a regular routine to help relax your child and help him or her get to sleep and stay asleep for enough hours to feel well rested. Use the general guidelines below to be sure your child gets enough sleep.

The amount of sleep we need depends on many factors, including age, and varies from person to person. Generally, however, sleep requirements can be approximated as follows:

  • Children aged 6–9 need between 10–12 hours of sleep.
  • Children aged 10–12 need about 10 hours of sleep.
  • Teenagers need approximately 8–9½ hours of sleep.19

“It can be tempting for teens to sacrifice sleep to squeeze studying and other activities into an already full day. But less sleep does not equal more time. Research shows that sleep deprivation in teens—even if they are consistently getting just a few hours less than they need each night—can impair their ability to learn and hurt their overall performance.

Research shows that sleep deprivation impairs:

  • ability to pay attention;
  • verbal creativity and effective communication;
  • abstract thinking;
  • creative problem-solving and innovation;
  • mental sharpness (the sleep-deprived person is more vulnerable to misleading remarks and has more difficulty with complex, ambiguous material);
  • decision-making involving the unexpected;
  • adaptive learning that involves retrieving knowledge from long-term memory, adding to that knowledge, and using it to solve problems; and
  • overall mood and motivation.

Studies also show that when learning certain types of tasks, those who get a good night’s sleep afterward perform better when tested the next day than those who get insufficient sleep. In fact, researchers have found that after a person learns new information, there is activity in the same area of the brain during sleep, and there is improvement in memory performance when the person is tested the next day. So getting a good night’s sleep after learning something new is a crucial step in organizing new information and strengthening recent memories.”20

For more information on sleep, see HealthHints: Sleep (PDF).

Keeping Kids Healthy…throughout the year

Remember, starting our kids out with a thorough physical examination, information on preventing illness and reducing injuries, and helping them get proper rest can go a long way in preparing them for the physical and mental challenges of a new school year. Read the next issue of HealthHints for more back-to-school ideas, including mental preparation, food preparation, and transportation preparation.

2007 Immunization Recommendations

Handwashing & Hand Sanitizers

Hands should be washed with liquid soap and water when possible, but an alcohol-based hand sanitizer can be helpful as a supplement or substitute when soap and water are not available. Look for a hand sanitizer with at least 60 percent alcohol in it.7 Follow the manufacturer’s directions. Generally, directions for hand sanitizers require placing enough hand sanitizer (usually a small amount) in the palm of your hand to thoroughly cover your entire hand and rubbing your hands together until dry.8

Recently, through e-mail, the use of hand sanitizers, which typically contain ethyl alcohol as their prime ingredient to kill germs, have come under scrutiny when it was claimed that the ingestion of such a sanitizer caused a 4-year-old girl to become intoxicated or poisoned to some degree. The little girl had gotten a bottle of sanitizer and swallowed a small amount (amount not determined in the report). According to comments from a physician, 1 tablespoon of sanitizer could cause a child to show signs of intoxication or poisoning, such as sleepiness, drowsiness, depressed respiration, nausea, or vomiting. The physician also stated, however, that hand sanitizers are still safe to use on small children, but they should be administered by teachers and parents with care—making sure the child does not put it in his or her mouth. Hand sanitizers should be treated like any medicine or cleanser and kept out of the reach of children.9

Note: Plain, liquid soap and water are best. Liquid soap is more sanitary than bar soap where multiple people will be using the soap. Antibacterial soaps are NOT needed. Antibacterial soaps may contain triclosan, a chemical that kills both bad and good bacteria. While bad bacteria can make you sick or cause infection, good bacteria can help you. The triclosan in antibacterial soaps may change the balance of bacteria on your skin and may even make bacteria harder to kill.10

This document is meant for educational purposes only and is not intended to replace the advice of your doctor or other health care provider.

References:

  1. Symons CW, Cinelli B, James TC, and Groff P. Bridging student health risks and academic achievement through comprehensive school health programs. Journal of School Health 67(6):220-7, 1997.
  2. Dickey, W. (2001). The yearly physical – more than just a trip to the doctor [on-line]. Retrieved June 11, 2007. From http://www.medem.com/msphs/msphs_drdickeycolumns_detail.cfm?
    article_ID=ZZZ37RN2K9D.
  3. Mayo Clinic (1998). Pre-participation physicals: Making sure a young athlete can play safely [on-line]. Available: http://www.mayoclinic.com/findinformation/conditioncenters/
    invoke.cfm?objectid=2237B71A-8AA6-4132-BC97F02D6982CE1D.
  4. Mayo Clinic (2006). Children’s illness: Top 5 causes of missed school [on-line]. Retrieved June 11, 2007. From http://mayoclinic.com/health/childrens-conditions/CC00059.
  5. ARCH National Resource Center for Respite and Crisis Care Services (1996). Preventing the spread of disease: Tips for providers [on-line]. Retrieved November 10, 2006. From http://www.archrespite.org/archfs42.htm.
  6. National Resource Center for Health and Safety in Child Care (2006). Handwashing [on-line]. Retrieved November 20, 2006. From http://www.healthykids.us/chapters/handwashing_pf.htm.
  7. GroupHealth Cooperative, Tacoma-Pierce County Health Department, & Washington State Department of Health (2006). Living with MRSA [on-line]. Retrieved October 6, 2006. From http://www.tpchd.org/files/library/3550750db4a81b14.pdf.
  8. Texas Department of State Health Services (2006). Information on staphylococcal infections for day care administrators and care givers [on-line]. Retrieved October 5, 2006. From http://www.dshs.state.tx.us/idcu/health/antibiotic_resistance/
    mrsa/mrsa_daycareadmin.pdf.
  9. Pope, P. (2007). Killing germs with hand sanitizers could harm children [on-line]. Retrieved June 12, 2007. From http://www.kbtx.com/news/headlines/7929372.html.
  10. Tacoma-Pierce County Health Department (2006). What should I use to wash my hands? [on-line]. Retrieved October 6, 2005. From http://www.tpchd.org/files/library/12b59c64cf77a8a0.pdf.
  11. Dickey, W. (2004). Sick kids – when to keep them home from school [on-line]. Retrieved June 11, 2007. From http://www.medem.com/search/article_display.cfm?path=
    \\TANQUERAY\M_ContentItem&mstr=/M_ContentItem/ZZZ8OM05CKE.
    html&soc=Medem&srch_typ=NAV_SERCH.
  12. Centers for Disease Control (2006). How the School Health Index works [on-line]. Retrieved June 11, 2007. From http://www.cdc.gov/HealthyYouth/SHI/brochure.htm.
  13. Safe Kids USA (2004). Injury facts: School injuries [on-line]. Retrieved June 11, 2007. From http://www.usa.safekids.org/tier3_cd.cfm?folder_id=
    540&content_item_id=1170.
  14. Nemours Foundation (2005). Playground safety [on-line]. Retrieved June 11, 2007. From http://www.kidshealth.org/parent/firstaid_safe/outdoor/playground.html.
  15. Clark, N. (1997). Nancy Clark’s Sports Nutrition Guidebook, (2nd edition). Brookline, MA: Human Kinetics.
  16. American Academy of Orthopaedic Surgeons (2004). Backpack safety [on-line]. Retrieved June 11, 2007. From http://www.orthoinfo.org/fact/thr_report.cfm?
    Thread_ID=105&topcategory=Children
  17. American Academy of Pediatrics (2003). News from AAP: Acute backpack injuries in children [on-line]. Retrieved June 11, 2007. From http://www.medem.com/search/article_display.cfm?path=
    \\TANQUERAY\M_ContentItem&mstr=/M_ContentItem/ZZZR8OG5BBD.
    html&soc=AAP&srch_typ=NAV_SERCH.
  18. Preidt, P. (2007). Most teens want a later start to school days [on-line]. Retrieved June 11, 2007. From http://www.nlm.nih.gov/medlineplus/news/fullstory_49441.html.
  19. Nemours Foundation (2007). All about sleep [on-line]. Retrieved June 15, 2007. From http://www.kidshealth.org/parent/general/sleep/sleep.html.
  20. National Sleep Foundation (2007). From zzz’s to a’s: Sleep and learning [on-line]. Retrieved June 15, 2007. From http://www.sleepfoundation.org/site/c.huIXKjM0IxF/b.2419137/
    k.3DB8/From_ZZZs_to_As_Sleep_and_Learning.htm.

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Last updated: 26 July, 2010

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