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Glenn D. Braunstein, M.D.

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How to Get Youngsters Off to a Healthy School Year

Posted: 08/22/2011 6:06 pm

Admit it, Mom and Dad: You've gotten lax over the summer. Bedtime for the kids has gotten later as has the call to rise and shine. Maybe you've said "yes" too often to sweet snacks, video games and sleepovers. But now the youngsters are going back to school, and it's time to get the whole family back into a healthy routine (especially since the oldest siblings, as I've written about recently, have gone off to college). This means seeing that your youngsters eat well, sleep well and get required medical check-ups.

It also may mean new worries: Are your kids learning up to their potential? Are they making good friends? Are they behaving themselves when out of earshot? Are they getting into trouble?

The good news is that emerging problems are rarely as serious as you can imagine. So first, ensure the back-to-school basics get covered: Are your youngsters eating a nutritious diet, beginning with a good breakfast and including a healthy lunch to refuel their energy and a relaxing dinner, preferably with the whole family? Families who share meals have kids who are less likely to become overweight and more likely to do well in school. (I've explained why here.)

Dinner, bath, a story and bed. That was the kids' routine in the good old days when they were toddlers. Now that they're older, be sure you see they get enough sleep. The National Sleep Foundation offers some rules of thumb. On average, children ages 5 to 12 need 10 to 11 hours of sleep, and older children, ages 13 to 17, need 8.5 to 9.25 hours of sleep.

Importance of Sleep
People forget that adequate sleep is as key to good health as a nutritious diet and daily exercise. Yet up to 15 million American children trudge off to kindergarten through high school in a sleep deprived state. Things get tricky with teens turn into "night people," and insist on staying up late. That's normal. What's abnormal for teens is an early rising time, yet that's what schools require. Teens really do need to pay back that debt by sleeping in on the weekend, so grit your teeth and let them. And for health's sake, tell the kids that all electronic devices must be shut off and down long before bed time, as increasing information suggests gizmos -- Ding, ding, ding! -- interrupt or disrupt a good night's rest.

If things go wrong at school -- dropping grades, reluctance to go to class, or too many notes from teachers or calls from the principal's office, take a deep breath and look for simple causes first. Maybe your kid just isn't seeing or hearing right. Make an appointment and have her eyes checked. Bad grades can result from poor vision. Maybe she's not seeing the board well. Maybe the words he sees on the page are blurry. A vision specialist also may pick up on learning issues like dyslexia.

Then have your kids' hearing checked. Recent animal research is spurring scientists to look deeper into hearing development in infants and young children. While animal research, does not always translate to similar findings in humans, it can form the basis for further research into humans. Scientists found that when newborn lab rats were deprived of hearing in one ear, the loss interfered with the brain's initial wiring of its hearing centers.

Ear infections are common in children, and while the brain is good at making up for lost time when hearing is clear, an infant with a history of short-term hearing blockages from infections might become a child who has trouble hearing in, say, crowded rooms or rooms with a lot of background noise.

Get Those Vaccinations
Your school has no doubt notified you of immunization requirements. California requires up-to-date vaccinations and booster shots as described here before entering kindergarten and at points in grades K through 12. I've written about the importance of vaccinations and their protective value both for individuals and the community. I urge everyone to follow the vaccination recommendations to protect their kids and those around them.

Getting the kids to the pediatrician for required shots is a good reason, too, to get them a general check-up; the American Academy of Pediatrics recommends annual physical exams through the school years. Toddlers before entering kindergarten or the first grade in California must undergo a health exam or their parents must sign a waiver about it; local government agencies, including the Los Angeles Country Health Department, can provide help to families who meet certain income standards and need assistance to get their kids vaccinated and examined. There are other community outreach programs to help with kids' health care, including Cedars-Sinai's own Coach for Kids and Their Families™ program. Meantime, a sports exam for a child for football or soccer, say, may not include an electrocardiogram. But a recent study found that adding that ECG improved the detection of underlying heart disease that can cause sudden death. Every year, two in every 100,000 young athletes succumb to sudden cardiac death.

Children with special needs, of course, need not only everything we've discussed, but they also have the protection of two powerful federal laws, both passed in the 1970s and revised over the years. The Individuals with Disabilities Act and the Rehabilitation Act ensure that all children, including those with autism, ADHD, or any physical or mental disability receive a free, appropriate public education in the least restrictive environment. Education itself is often the best treatment for many children with special needs. The law, in these austere times, bumps up against strapped school budgets, so parents, unfortunately, should prepare themselves to battle for their children's rights.

If the problem isn't a long-standing special need but rather the roller coaster of childhood social life -- being "popular" one month, exiled the next -- parents are kids' best advocates. They need you to listen, to take these ups and downs seriously. If the problem is as serious as bullying, you must take a strong stand. Bullying mostly occurs in elementary grades, declining as kids get older; one study estimates that 19 percent of elementary school children were bullied. They need your help learning to cope, finding protective friendships and drawing on that inner "sticks and stones may break my bones" mentality that has bolstered kids for generations. As youngsters make technology part of their lives, parents also should exert control and set boundaries for video games, computers and social media. I'm not a Luddite, but common sense demands robust parental oversight to avert cyber bullying, cyber stalking, sexting and other youthful mischief and to ward off online pedophiles and criminal perverts.

And if your child is shy, that's not a bad thing. Maybe you've wanted a social butterfly, but you got a kid who likes being alone. Science is discovering that there are several reasons that some kids end up outside the big circle of fun. By the time your child is school age, you've had years to observe and you know your child simply delights in his own imagination. He likes to play alone, building ever higher towers. Or she holds one-character plays with an appreciative audience of dolls. More troubling is a child who is reticent, passively watching others have fun. Then, it's time to step in with encouragement, play dates and your own exploration of what might be holding them back.

Dealing With Sexual Issues
When puberty hits, there are frequent concerns about providing the right reproductive health information at the right time. Be alert to a child who might be confused or troubled by issues of sexual identity. School teasing on this topic is an urgent call for you to listen and to talk about how your child is feeling about sexuality. Teenage sexual identity and youthful bullying can collide in horrendous ways. The legal system still is working through the tangle involving Lawrence King, 15, who was shot to death in his Oxnard high school weeks after announcing he was gay. Whatever the sexual identity issues that arise, your children need your wise counsel and unstinting support.

And in Los Angeles, parents need to keep in check body image concerns -- the stereotype that everyone is young, beautiful, mostly blonde and has a perfectly sculpted body. The Southland's standards for a certain kind of beauty can make perfectly wonderful looking youngsters feel inadequate. Keep telling them they're beautiful, even if they won't believe you. When the poet Maya Angelou went to Africa for the first time, she told a reporter that she loved being surrounded by black faces and people whose ample, high-riding rear-ends were like hers. Others come back from trips to their family homelands and feel a new pride in the physical features they were born with. If you can't physically get the kids out of our appearance-obsessed community, let them see other worlds and people through international movies or by your taking note of an unconventionally attractive person in a magazine.

Help Make Annual Check-Ups a Lifelong Habit
Here's one final potential fight I can help you with: Your middle or high school kids may balk at seeing a pediatrician. You can't blame them for feeling uncomfortable in a room full of coloring books and tiny tables and chairs. You know it's not yet time to let go, but it may be time to begin preparing them for a future of adult medical care. Recently, three physician organizations whose members work with children and families, recommended a transition schedule for patients from pediatrics to adult medicine. When your children are ages 12 or 13, start talking to their doctors about the transition. When they're 15 or 16, ask the physician to put recommendations in writing, along with your child's health history. At 17, an exploratory visit to a new doctor and "medical home" might be timely, so when the adolescents are 18, they're comfortable making their own appointments and having their own adult relationship with a physician.

 
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