Kids Health: Back to School Health Issues (cont.)

MEMBER QUESTION:
At what age do kids slow down on infecting each other in the classroom like a bunch of Typhoid Marys? Since she was in preschool, my daughter ends up sick at least two or three times a fall while the bugs go around. She's going into fourth grade this year and I hope things will be better now that she's older.

PARKER:
Good question! Unfortunately, I don't have a good answer. It is certainly true that the greatest risk for transmitting bugs from one child to another is in the first three or four years when children are all over each other. Don't worry about coughing and spewing germs and salivating all over their peers during play. By the time children enter school and are isolated sitting at a desk rather than spending most of the time in communal play, the transmission of germs is much less frequent.

Additionally, the immune system over time becomes better and better at fighting off germs as the child gets older. In fact, it is believed that the more infections a child contracts in the first few years of life, the better their immune system may be later on in fighting off these infections.

MEMBER QUESTION:
My daughter has 5th disease; she broke out with the rash on Monday. Her pediatrician told me to keep her home until the rash disappears. Yet I read online that it's not contagious when the rash appears; it was contagious before it appeared. Should she be in the house only?

PARKER:
I wonder if you are confusing roseola with 5th disease. In roseola, the child has a high fever and is infectious. When the fever goes down, the rash emerges and the child is no longer infectious. A different virus causes 5th disease and the child is, indeed, infectious when he or she has the rash.

Nobody knows how long this infectious period persists, so it is hard to say exactly when the child is no longer a risk for giving it to other kids. My general rule is no fever for 24 to 48 hours, but I don't necessarily wait for the rash to completely disappear before saying a child may go back to school. You might ask the school's policy in this area. Some require a note from the pediatric provider, saying if and when the child is safe to go back to school.

Since it is somewhat arbitrary, your pediatric provider may use a different standard than the one I have just given you.

MEMBER QUESTION:
Dr. Parker, my 3-year-old is switching to afternoons next year and longer days. I'm going to need the school to give asthma meds. Last year I was able to be there to see that he was given them properly. Can I ask for a signed document from the school nurse to make sure he's getting it? I'm going to ask to talk to the nurse beforehand to ask too; I just wanted to know what commonly happens with kids take medicines at school.

PARKER:
The first order of business is always for the pediatrician to write the prescription and to specifically fill out the school form as to what is to be given, how it is to be given, when it is to be given, and what potential side effects to watch for.

After that, it's always helpful for parents to discuss with the school nurse their policy in this area. Usually, a consensus is reached and most don't feel it necessary for the nurse to confirm that she has given the medication each day. A more reasonable request, I believe, is to be sure the nurse will inform you of any problems in giving the medication or any time a medication might have been missed. But, at least in my experience, school nurses do a very good job of keeping medications up to date, especially with asthma, which is so common that there are undoubtedly many children in the school that will be receiving similar treatment.

"In my experience, school nurses do a very good job of keeping medications up to date, especially with asthma, which is so common that there are undoubtedly many children in the school that will be receiving similar treatment."

MEMBER QUESTION:
My 5-year-old son complains of stomach pains three to four times every day. How much of it is psychological. Does he really have some pain from anxiety of starting school and from trying to get attention since he has a new baby sister?

PARKER:
That's a good question, and one that is often very difficult for us to decide. It is certainly not an answer I can provide from out here in cyberspace. However, this is what I usually do in such cases:

The first order of business, I believe, is to look for a medical reason for the pain. This could be something like an intolerance to certain foods (for example, milk, wheat protein, or some other unusual intolerance). If it is such a problem, we often see a change in the pattern of the stools. So sometimes I elect to do an analysis of the stools to look for evidence of a food intolerance or an infection of some sort.

Having said that, it is fairly unusual to come up with a possible medical reason. I was taught in medical school that "the GI tract is a playground of the emotions." For some reason, some children, when they are stressed or anxious, do experience pain in their bellies. Often it can be easy to tell, because the stressful experience or emotion directly precedes the pain. Other times it's not exactly clear and we can only guess.

Clearly, in this case, the "treatment" is to help the child talk about and cope with whatever seems to be bugging him. The abdominal pain, since it is not a real medical concern, can be put more on the back burner and the potential stress on the front burner. As his parents, you are in the best position to talk to him and decide what the stress might be (baby sister? child care?).

The good news is this usually resolves. If it does go longer than six months or so, I'll usually revisit the question of a medical problem again, just to be sure I haven't missed anything. Good luck. Let me know how things go.

MEMBER QUESTION:
Our son is much smaller than most of the boys in his class. He gets picked on a lot because of this. He isn't small for our family (everyone is on the short side and has a slight frame), but this is no consolation to him. Is there anything we can do to help his development move along?

PARKER:
You haven't given me his age, and there are certainly different concerns that children have based on their developmental level. In answer to your question, however, there really is nothing you can do to make him taller unless at some point you feel this is such a significant problem that you might consider growth hormone shots. This is a very controversial subject.

There is no question that children who are short because of an inborn deficiency in growth hormone do well in getting the growth hormone from shots. What is now being questioned is whether or not children with normal growth hormone (as I suspect your child has, since this seems to be familial) should, in some cases, also receive growth hormone, which tends to increase ultimate height by somewhere between 1 and 3 inches.

I don't have time to really get into the debate, but this is something that I usually do not recommend, but offer up for your consideration and knowledge, should you feel your child's self-esteem and emotional health is being severely hurt by being so short.

Usually, parents can help children overcome this by talking about it with them, pointing out role models of shorter people who are doing very well, and emphasizing values outside the appearance in judging the person.

MEMBER QUESTION:
My daughter gets headaches and my son, the jock, gets injuries. Sometimes the kids need Tylenol to get past the pain and get through the day. I can send some Tylenol to school, but there isn't a nurse to dispense it, just a secretary. I wonder how you feel about the trend to not having school nurses. And at what age do you think kids should be deciding for themselves that they need something like Tylenol? If I sign a release form the secretary will give it to them whenever they say they need it.

PARKER:
Hmm ... The age at which children should decide for themselves, in large part, needs to be individualized and decided by his or her parents. Some older children, the parent may know, use complaints of pain to get out of class and avoid work. In such cases, I wouldn't want to encourage them to take medication during school, except under rare circumstances. Most younger children, I would say up to age 8 or 9 or so, I wouldn't especially trust to always take the right dose, and I certainly would want adult supervision when they needed it.

Personally, I think the dispensation of simple and safe medication, like Tylenol, by non-nurses is fine. Most schools provide such lay people with training in giving the medication, and the risk of harm is minimal. However, I do believe that only nurses should be giving more heavy-duty medications, such as those for asthma or ADHD.

I'm not sure if I've answered your question, but those are some free-floating thoughts from Dr. P. on the subject.

"I think the dispensation of simple and safe medication, like Tylenol, by non-nurses is fine. Most schools provide such lay people with training in giving the medication, and the risk of harm is minimal."

MEMBER QUESTION:
My kid thinks I'm turning him into a "wuss" by making him take sunscreen to school to put on for gym class and sports after school. I'm trying not to turn him into a skin cancer victim! I have a strong feeling he doesn't use the stuff. If I put some on him in the morning, will it last until 4 or 5 o'clock? And is there any brand you know of that doesn't smell like a swimming pool so he can wear it discretely?

PARKER:
I am very pro sunscreen and applaud your efforts. Being mindful of children feeling stigmatized by the littlest things in school, you certainly can apply sunscreen before he goes. Since he won't be swimming and hopefully won't be rubbing at it, the sunscreen should last until he goes outside into the sun. I don't know any specific brand, but through trial and error, you can find many which have no smell at all and which are easy to apply.

I would suggest having a "planned discussion" with your guy. Tell him that you want to protect his skin, but you understand his concerns, and see if he will agree to the compromise of applying the sunscreen in the morning and leaving it alone during school, so that both of your agendas are met. If you don't get his endorsement of whatever plan you use, he's likely to undermine your efforts. So I would go the extra mile in finding a solution you both can live with.

MEMBER QUESTION:
How do I decide when it is OK to send my child to school with a cold and when to keep her home? I go to work with a cold, but don't necessarily want to push my child as hard as I push myself. She is a child after all.

PARKER:
There are really two sides to this question. First, is it in your child's best interest to stay home with a cold? I think the answer is yes, for any child with a fever. However, there's no evidence that with a simple cold, and no other real symptoms or fever, staying home is of any benefit.

The second question is the protection of other children from catching the cold. Of course, your child probably picked it up from daycare in the first place, and it's really impossible to prevent the germs from bouncing from one child to another. In this case, you usually have to go by the school's rules in this area. It can be quite different. Some will not allow a snot-nosed child back to class until things are pretty much cleared. Others are quite tolerant of simple colds and, hopefully, use good hand washing and washing of toys in an effort to cut down on giving it to other children. So you'll need to see your school's specific rules to decide when they will allow your child to return.

MODERATOR:
Dr. P, before we wrap things up, do you have any final words on getting fit for us?

PARKER:
This was a lot of fun. There's no question that for most parents, as much as they love their kids, they're a whole lot happier once school has started again. All the best. Dr. P.

MODERATOR:
Our thanks to WebMD's own pediatrics and child development expert, Steven Parker, MD, for sharing his expertise with us.

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