Feature Archive

Back-to-School Health Checklist

Experts say how to keep your child on the right track to health this school year.

By Jean Lawrence
WebMD Feature

Reviewed By Brunilda Nazario

Shuffling your child back to school these days takes more than a new wardrobe and a shiny apple. What about the dizzying array of immunizations? Hearing and vision tests? Special instructions for the school nurse? And tips for buying and loading a backpack that won't turn your precious offspring into an achy, whiny pack mule?

Those Dreaded Shots

"We won't enroll any student without an immunization record," says Candy Mac Donald, RN, PHN, MSN, school nurse for eight schools in the Marysville Joint United School District in Marysville, Calif., north of Sacramento. "There are more and more shots now, too," she adds, including hepatitis B, chickenpox, and a booster of the MMR in junior high (flu shots also may be recommended).

The American Academy of Pediatrics (AAP) web site fully explains childhood vaccinations, advising you what is needed at what age. Your school district or local health department will also make this clear, and you can consult your pediatrician as well.

In California, Mac Donald says a first grade physical is recommended and will probably hold true if performed before kindergarten.

"We had to have the shots, period," says Jennifer Santesteban, who has a 10-year-old son in a Phoenix school district. Many health departments also offer free immunizations to children for some families without insurance. If you are in doubt, ask the school secretary for guidance.

Can Your Child See Clearly?

As many as one in 20 children can't see out of one of their eyes, according to Pamela F. Gallin, MD, director of pediatric ophthalmology at Morgan Stanley Children's Hospital of New York Presbyterian Hospital in New York City. "This is a difficult observation [for a parent] to make."

Gallin recommends vision testing by your pediatrician, even though some testing is also given in school in some areas of the country. "A younger child can 'read' the chart by turning a hand in the direction the "E" is facing," she says, describing what she calls the "E" game. "School-aged children, even kindergartners, probably can identify letters or at least numbers."

The reason to have this done is simple and twofold:

  • Kids who can't see well can't perform as well in school.
  • The silent disease of "lazy eye" is only partially or completely reversible when treatment is given before the child is nearly 7 years old. "There is a window of time," Gallin says.

Gallin says she as a parent demands screening by an eye specialist. "All parents should," she says. Yet, she explains, often parents tell her, "My kid would tell me if he couldn't see." She says often this is untrue. They don't know any differently and kids with one eye not functioning will even try to fake out the doctor on the eye test, peeking around the eye blocker. "We have all been faked out," Gallin sighs.

If one eye is not working properly, what can be done to treat lazy eyes? "It's a real pain to fix," she admits. Children have to wear a patch over the strong eye and have special lenses for the weak eye. "They hate it," she says. Some improvement comes quickly but treatment takes time. The eye-patch system, however, makes the brain tune up to process visual input better. "The child achieves peripheral vision, too," she says.

Between 2% and 5% of the population is legally blind in one eye, according to Gallin. "It's a national health issue, but no one is listening."

At her schools in California, Mac Donald says, an optometrist comes in to test the kids.

Other Advice

Some important information parents should tell the school about their child includes:

  • Above all, make sure your child's emergency telephone number card is accurate and kept current. "You can't just drop the kid off at school and drive away," Mac Donald says. If you move or change a number, corrrect it the next day. At her schools, numbers are listed in order they are to be called: mother, father, grandmother, or whatever the parents designate. The child's physician and dentist also need to be listed. "I have had to take a kid with a knocked-out tooth to the dentist and have the mother meet me there," she says. "We needed all the phone numbers."
  • The school nurse and/or school secretary also needs to know what medications your child takes, Mac Donald says. Even if the child takes the medication only at home, the nurse should know. If the child is to take the drugs at school, she says, they must be in the pharmacy bottle, clearly marked (not an envelope, for instance).
  • Any health problems should be made known to the school. Allergies are a good example. "There are so many [allergies] now to foods, plants, trees, beestings, or latex. The school has to know in advance," Mac Donald says.
  • Also inform the school of physical restrictions. Does the child have asthma, a scoliosis brace, or a heart murmur? How should this affect physical activity?

Tests and Services the School May Perform

Some schools are sending home "weight report cards," advising parents how to deal with childhood obesity. Mac Donald's district does color testing, especially in boys, in the early elementary years. Hearing tests are performed in kindergarten, second grade, fifth grade, eighth grade, 10th grade, and in special education, too.

Scoliosis screens may also be given to see if your child's spine is growing according to plan. Does your child have a shoulder or hip higher than the other? This can be picked up. "The spine can curve so much it puts pressure on the heart," Mac Donald says.

Children also are worked up to see if they could benefit from special education. "Many of our children had parents who used drugs or alcohol and their nervous systems were affected," Mac Donald says. "They need special training and treatment."

The school may also give health training. "I think that would be good," Santesteban says.

What Else Can Parents Do?

"The school said to be sure the kids wore closed-toe shoes," Santesteban says. The American Academy of Pediatrics also advises that parents not strap a jumbo backback on their children -- never more than 20% of the child's body weight (those books can add up). Some children even prefer a rolling backpack like the wheeled suitcase their parents take on business trips. Make sure the backpack has wide straps and a padded back.

If children are hanging back or seem anxious about the first day, explain that their friends are waiting to see them again. Maybe another child in the neighborhood could come along the first day.

Be sure you have arrangements for after-school, too.

Parents must also be sure the child has sufficient sleep, usually eight hours for a growing child and even more for a teen. And the child should go off with a good breakfast. Sometimes kids can eat at school, too, but nutrition helps the child to focus and concentrate.

"Actually, that's something the schools could do better," Santesteban says. "Serve better food. Some of the stuff is nasty and cheap, like deep-fried pancakes on a stick. My son doesn't eat breakfast at school, but he would like to, for that very reason."

In other words, adult supervision is needed.

Star Lawrence is a medical journalist based in the Phoenix area.

Published Aug. 9, 2004.


SOURCES: Candy Mac Donald, RN, PHN, MSN, school nurse, Marysville Joint United School District, Marysville, Calif. Pamela F. Gallin, MD, director, pediatric ophthalmology, Morgan Stanley Children's Hospital, New York Presbyterian Hospital, New York City, Jennifer Santesteban, mother, Phoenix. "Back to School Tips," AARP web site. Group on Immunization Education.

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Last Editorial Review: 1/31/2005 8:30:45 AM