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Faculty experts provide back-to-school tips

by UofL Today last modified Aug 02, 2013 04:00 PM

UofL faculty and University of Louisville Physicians clinicians have been making the rounds of local media to share back-to-school tips with TV viewers. Here are some of the tips they’ve provided.

What JCPS Requires

Eye Exams and Eye Safety

Sport-related Teeth and Mouth Protection

Medication Management Away from Home

School Anxieties and Phobias

Sleep Matters

Healthy Lunch Choices

What about Children with Food Allergies?

What JCPS Requires

Will your child attend a Jefferson County Public School? If so, Erica Labar, UofL Pediatrics, noted that the school system requires several exams for new and returning students.

  • Physicals: Children must get physicals for kindergarten and sixth grade.
  • Dental exams: Kentucky law requires proof of a dental screening no later than January of the first year a child is enrolled in public school.
  • Eye exams (see more below): Kindergarteners require an exam by an optometrist or ophthalmologist.
  • Sports physicals: Athletes are often required to receive comprehensive physical exams to ensure they are ready to participate in organized sports.

Your child’s doctor may do other exams based on the requirements of your child’s school and American Academy of Pediatrics’ recommendations. If your child is on medication that must be taken at school, be sure to get the proper forms during your child’s check-up. (See more below on medication management).

JCPS students also are required to have these vaccinations:

  • Haemophilus influenzae type b conjugate (Hib). Required for preschoolers under 5.
  • Measles, Mumps, Rubella (MMR). Second dose for students and preschool or Head Start children who have reached fourth birthday.
  • Hepatitis B. Three doses required for preschool, Head Start, kindergarten through sixth grade and students, born 10/1/92 or later.
  • Diphtheria, Tetanus, Pertussis (DTP, DTaP, Td, Tdap). Minimum: four doses with one dose on/after fourth birthday and at least six months between last two doses. For sixth grade entry, age 11 or 12 years old, one dose of Tdap.
  • Polio (OPV/IPV). Minimum: three doses, one dose on/after fourth birthday, and at least four weeks apart, but preferably six months between last two doses.
  • Chickenpox (Varicella). One dose, on/after age 12 months; second dose required for students and preschool or Head Start children who have reached their fourth  birthday unless physician confirms the child had chickenpox previously.
  • Pneumococcal (PCV) Vaccine. Four doses, one on/after 12 months of age.
  • Meningococcal (MCV) Vaccine. One dose at sixth grade entry, students 11 years of age.

Eye Exams and Eye Safety

Rahul Bhola, UofL Physicians director of pediatric ophthalmology, recommends that all preschool children, even those without noticeable eye problems, have at least one vision screening or comprehensive eye exam before the age of five. “After age five, every child should have an annual eye exam,” he said.

To help parents, Bhola offers eight signs that can signal a child has a vision problem:

• An eye appears to be misaligned, either crossed or drifting outward

  • Squinting, closing or covering one eye
  • Rubbing one or both eyes excessively
  • Headache, nausea or dizziness with visual tasks
  • Excessive or unusual clumsiness
  • Tilting the head to one side
  • One or both eyelids droop downward
  • A sibling or other close family member has lazy eye or other eye problems

Eye protection also is important. More than 12 million children suffer from vision impairment, and eye injuries are one of the leading causes of vision loss in children. Of the estimated 42,000 sports-related eye injuries each year, the majority happen to children.

Have your child wear protective eyewear while participating in sports or recreational activities and provide him or her only age-appropriate toys—avoid toys with sharp or protruding parts.

Sport-related Teeth and Mouth Protection

Ann Greenwell, associate professor of dentistry, and pediatric dental resident Porscha Jefferson, recommended providing protection for your child’s teeth and mouth when he or she participates in any recreational activity that could possible cause injury to their teeth or face.

A sport mouth guard cushions blows that otherwise would cause broken teeth and protects against injuries to the lips, tongue, lower jaw and the joint. Mouth guards also have been linked to providing athletes protection against concussions and to enhance athletic performance.

There are three types of mouth guards:

  • Ready-made, or stock
  • Mouth-formed or “boil and bite”
  • Custom made (by a dentist)

All properly fitted mouth guards provide some degree of protection but the most effective mouth guard should:

  • be resilient
  • be tear resistant
  • be comfortable
  • fit securely
  • be durable and easy to clean
  • not restrict speech or breathing

A child should wear a mouth guard only when involved in sport. As soon as the activity is over, the child should remove and clean the mouth guard before storing it until the next use.

Medication Management Away from Home

Schools request parents to give medications at home, but at times it may be necessary for students to take medication during the school day. For this reason schools have worked with physicians and health care providers to develop policies to ensure student safety and health.

You should work with your child’s doctor to create a medication plan before the start of school and obtain any of the necessary permission or action plan forms, Labar said. Use the forms to record the name of the drug, the dose, approximate time it is to be taken, instructions on how to take the medicine, the diagnosis or reason the medication is needed, and any adverse reactions to watch for or reasons not to give the medication.

Note that most forms require a physician or health care provider’s signature.

Older and more responsible students may be allowed to carry medicines with them and take them when needed, whereas younger children may have medicines kept in the front office or classroom.

Also make plans for field trips, camps and other out-of-school or afterschool activities.

Discuss with your child’s school how any treatment given will be documented and how the school will contact you should the need arise.

It is your responsibility to supply the school with prescribed medications, provide labeled containers, keep medications current and supply any medical devices needed (such as nebulizers, insulin pumps, oxygen).

School Anxiety and Phobias

Starting school is a child’s first major transition and it is completely normal for 6- to 7-year-old children to experience separation anxiety caused by being away from their parents, said Allan Josephson, chief executive officer, UofL Bingham Clinic and child psychiatrist, UofL Physicians-Pediatrics.

Josephson and Labar offer several things parents can do before school starts to help alleviate that anxiety.

  • Focus on being excited about your child’s new adventure and don’t share your worries and concerns about school with him or her.
  • Remind your child of a previous new beginning that caused anxiety but worked out well.
  • Visit school to walk around the building and play on the playground. If the child’s anxiety is very strong, you may want to contact the school to see if there is a way the child can meet their teacher and see their room.
  • Distract a particularly anxious child in the days leading up to starting school so they don’t focus on their worries.

And when the time comes, send them to school with age-appropriate comfort items to help ease the transition.

Josephson noted that school anxiety in older children is a cause for concern and may stem from a child feeling different from others or not fitting in, being a victim of bullying or feeling pressure to succeed in academics or athletics.

If your child cries; is visibly anxious; has nightmares, headaches, stomach pains or problems eating or sleeping; or refuses to go to school, it may be that he or she has a school phobia, said Labar.

In that case:

  • Talk with your child, asking open-ended questions about school. Let them tell you what’s bothering them when they are ready.
  • Talk to their teacher/ guidance counselor.
  • Talk to your child’s doctor. Some children need extra help during difficult transition times or extreme circumstances.

Sleep Matters

Insufficient sleep is a problem for kids all year long, said pediatric sleep medicine specialist Egambaram Senthilvel with UofL Physicians-Pediatrics. Children between the ages of 6 and 12 need 10 to 11 hours of sleep each night. Adolescents need 9 hours.

Getting an adequate amount of sleep is important because insufficient sleep can adversely affect academic performance and mood. In teens, it impairs decision-making and driving ability.

Chronic sleep deprivation has been linked to mental illness, learning and attention problems, driving accidents and weight gain.

But, Senthilvel said, changing bedtimes can make sleep problems worse. When the school year starts, children may not be tired at their school bedtime. Putting them to bed before they are tired can cause sleep problems, increase bedtime anxiety and lead to bedtime behavior problems.

To make the transition easier, you can:

  • Set a sleep schedule to allow your child sufficient sleep.
  • Transition gradually, at a rate of 15 to 30 minutes per day.
  • Start by waking your child earlier and earlier each day and adjusting the bedtime accordingly.
  • Upon awakening, have your child sit in a sunny part of the house for 30 minutes.
  • Keep a regular routine (vary by only one hour on weekends).
  • Avoid electronics within an hour of bedtime.
  • Limit caffeine six hours before bed.

Healthy Lunch Choices

Help your child eat well during the school day by providing them healthy lunch options. Megan LaFollette, registered dietician, UofL Pediatrics Healthy for Life!, Pediatric Weight Management Clinic, made these recommendations:

Involve your child

  • Let children help pack their lunch as early age as possible.
  • Pack lunch the night before to save time in the morning.
  • Spend extra time on the weekend shopping for food and prepping in advance.  Vegetables and fruits can be washed and cut up in advance and put in baggies, kids can choose which baggies to add to lunch when they are packing the night before.

Think lunch through

  • Lunch should contain a starch, protein, fruit and/or vegetable
  • Fruit cups should be packaged in 100 percent fruit juice, not syrup or light syrup.
  • If the school is peanut free, use a nut butter like almond butter
  • Limit treats in lunches to 1-2 days per week. Pack a granola bar or low-fat pudding cup on Fridays.

Variety can work for you or against you

  • Don’t send your child to school with the same food every day, every week. Vary daily or weekly.
  • Don’t send a new food to lunch with your child. Make sure he or she has eaten the food at home first.

Save and be safe

  • Save dollars by not buying pre-packaged convenience items or pre-washed fruits and vegetables.
  • Keep your child’s food safe by freezing a lunch box ice pack each night.

What about children with food allergies?

Gerald Lee, allergist, UofL Physicians, offers these tips:

  • Know your school’s policies and procedures regarding food-allergic children.
  • Inform the teacher and staff about your child’s allergies.
  • Meet your pediatrician or allergist before school begins to make sure the proper forms are completed and prescriptions are up to date.
  • Educate your child about his or her allergies.
  • Be aware of social issues. Children with food allergies are at high risk of bullying and should not be singled out

These pediatric practices welcome the children of UofL faculty, staff and students:

Gerry Lee (Cardinal Station and Gray Street Medical Building)
Allan Josephson, Bingham Clinic
Erica Labar (at Sam Swope Kosair Charities Centre)
School of Dentistry
Healthy for Life
UofL Physicians Pediatric Eye Specialists

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