Pennsylvania physicians examine back-to-school health, offer tips for parents and students

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Have you ever wondered how that one lucky student out of hundreds, maybe thousands, gets recognized every school year for not missing any days of school?

Could it be luck? A good plan to stay healthy? Or maybe both?

As students start heading back to classes for the upcoming academic year, Pennsylvania physicians take a close look at back-to-school health and offer some tips for parents and students who strive to stay in class and not home in bed sick.

"The school year should be an enjoyable experience, and staying healthy - both physically and mentally - is one way to help get the most out of every day of class and extracurricular activities," says Karen Rizzo, MD, president of the Pennsylvania Medical Society and a practicing physician in Lancaster.

Get vaccinated and stay up-to-date

Diseases and illnesses can race through a school quickly if left unchecked. And the best way to fight illnesses like the measles, chicken pox, and influenza is to be fully vaccinated per recommended guidelines.

In Pennsylvania, students should receive tetanus, diphtheria, polio, measles, mumps, rubella (German measles), hepatitis B, and varicella vaccinations before their first day of class. For 7th grade, they'll also need to have the meningococcal conjugate and Tdap (tetanus, diphtheria, acellular pertussis) vaccines.

However, current state regulations allow students in kindergarten through 12th grade to be admitted to school provisionally for up to eight months if evidence that at least one dose of each of the required antigen for vaccines has been given. This includes vaccinations for measles, rubella, polio, diphtheria, tetanus, varicella, and hepatitis B.

Pennsylvania Physician General Rachel Levine MD would rather see students start the school year properly vaccinated.

"Immunizations are very safe and effective," Dr. Levine says. "Allowing a 'window' in which some children are not vaccinated presents a very real and unnecessary risk for children to become infected and potentially spread preventable, communicable diseases."

Susan Kressly MD, president of the Pennsylvania Chapter, American Academy of Pediatrics, agrees with Dr. Levine and also encourages parents to immunize their children at every opportunity and especially in time for the start of school.

"Decisions parents and guardians make for children impact the health of those children as well as others around them," says Dr. Kressly. "Parents should confirm with their child's pediatrician that their vaccinations are up-to-date and complete."

PAMED's Dr. Rizzo adds that in addition to the state required vaccinations, parents should talk to their physicians about getting a flu vaccine during the school year for the student and the rest of the family. Unless there is a medical reason not to, an annual flu vaccine is recommended for everyone.

This is especially important for those who come in contact with children, where flu tends to spread quickly. School employees should be vaccinated annually in order to protect themselves and the students they serve.

"Whether you are a school bus driver, principal, teacher, coach, or student, you should contact your physician to schedule your annual flu vaccine," says Dr. Rizzo.

Cafeteria dangers

For students with food allergies, the cafeteria can be a minefield to navigate. But a new Pennsylvania law less than a year old eases some of the worry.

Previously, a student having an allergic reaction that required the use of an EpiPen would have to wait until the school nurse was on the scene to inject epinephrine, which can be a life-saving medication.

The new law allows schools to have someone other than the school nurse administer epinephrine in situations in which it is needed. In addition, it allows schools to maintain a supply of EpiPens in a safe, secure location, as well as allowing students who are having an allergic reaction to self-administer the injection.

Joel Fiedler MD, president of the Pennsylvania Allergy and Asthma Association, explains this allows for a quick response to a potentially life threatening situation.

"Unfortunately, there's no cure for food allergies," says Dr. Fiedler, who practices in Philadelphia, "and sometimes the only line of defense for a person experiencing anaphylaxis is an Epi-pen. Anaphylaxis is potentially life-threatening and can happen within seconds after being exposed to an allergen."

Dr. Fiedler continues, "Children in school settings can be vulnerable, particularly since they may not pay attention to what they are eating or touching during their lunch period and in some cases may not even know they have a food allergy."

Achy, breaky back

When is a back pack too heavy for a child? According to Thomas Muzzonigro MD, president of the Pennsylvania Orthopaedic Society, it could be too heavy after a few books depending upon the size of the child.

"As a general guideline, don't allow your child to carry a backpack that's more than 15 percent of their own body weight," says Dr. Muzzonigro, who practices in Pittsburgh. "Lugging around a ton of books and other supplies all day can eventually be problematic."

When a heavy backpack is incorrectly placed on the shoulders, the weight's force can alter the child's posture. Many children will compensate by bending forward at the hips or arch the back, which can cause the spine to compress unnaturally. It's a recipe for shoulder, neck, and back pain.

Also, says Dr. Muzzonigro, some kids will wear their backpacks over just one shoulder, and that too can present issues.

Keep a heads up around school buses

Just because a school bus lights are flashing and nearby cars are supposed to stop doesn't mean those cars will stop. All it takes is one distracted or impatient driver to cause a serious risk to students.

"The one thing no person at any age wants to mess around with is getting hit by a car," says Todd Fijewski, president of the Pennsylvania College of Emergency Physicians who practices in Pittsburgh. "You can't win that fight and the trauma can be devastating if not deadly."

Dr. Fijewski encourages students to not dart in, out, or around any bus. Similarly, he suggests not texting and walking when getting on or off a bus. Instead, he encourages students to pay attention for the sake of their safety.

According to Mike Berk, executive director of the Pennsylvania School Bus Association, on any given school day there are more than 1.5 million students riding a school bus in the Keystone State. Fortunately, he says statistics show school buses are the safest way for students to get to school, but he recognizes dangers outside the bus exist.

"During the school year, it's not unusual for a commuter to come upon a school bus picking up or dropping off students," he says. "Stop as required by the law, be patient, and wait until the red lights of the bus have stopped flashing and the stop arm has been withdrawn before moving. "

Friday Night Lights Safer

Many students decide to play a sport - either interscholastic or intramural. Athletics can provide a great way for a student to exercise while developing socially.

While the majority of student-athletes remain healthy through a season, a few may experience a serious injury. In Pennsylvania, state laws - strongly supported by physicians - are in place to address concussions and cardiac issues.

State law requires all high school coaches pass tests related to concussion management and sudden cardiac arrest. And leading up to each season—fall, winter, and spring—coaches across Pennsylvania prepare themselves for the worst through mandatory online education on these subjects.

The state concussion law has several parts. The most important section of the law is likely the mandatory online training course that each coach must complete every year. The course, titled "Concussion in Sports—What You Need To Know" and provided by the National Federation of State High School Associations, walks a coach through the science behind concussions and trains them to recognize the symptoms. Coaches are taught "when in doubt, sit them out."

But the state law goes beyond just education. The law also provides guidance on the steps that must be taken for a student-athlete to return to competition. In a nutshell, the coach is not permitted to return a player to participation until the athlete is evaluated and cleared for return in writing by an appropriate medical professional. Coaches who do not comply face harsh penalties including suspensions.

Like the concussion law, the Sudden Cardiac Arrest Prevention Act requires coaches, parents and athletes to receive education on SCA on a yearly basis. It also establishes protocol for removal from play as well as return to play after being cleared by a licensed physician or certified nurse practitioner. And, penalties exist to address coaches who do not follow these protocols.

"Every student-athlete wants to have fond memories of their playing days," says Srinivas Murali MD, president of the Pennsylvania Chapter, American College of Cardiology and a practicing cardiologist in Pittsburgh. "These laws are in place to protect student-athletes and reduce the risk of injuries that can be life altering."

Stressed out students

Most children have some apprehension on the first day or school, and around significant events that may occur throughout the school year. When this becomes excessive, problems can occur.

The job of family members, teachers, and those who regularly interact with students is to create an environment that makes children feel safe, secure, and emotionally well-protected. For those students who experience additional stress or anxiety, resources should be available both at school and at home to assist with any uncomfortable transitions.

"Growing up can present many situations that are stressful to children," says Robert E. Wilson, MD, PhD, president of the Pennsylvania Psychiatric Society and PAMED member. "There is pressure on students to succeed or adapt to new situations."

Dr. Wilson, who practices in Erie, says that often events beyond the student's control occur, such as bullying and unrealistic expectations for performance. These can create undue stress and anxiety. The key is to create an environment where children can ask questions, initiate a dialogue that addresses their anxiety and concerns, and feel safe to interact with their peers, teachers, parents, and the community in which they reside.

So what can a parent do to contribute to their child's personal and academic success?

•Look for negative changes in the student's health, behavior, thoughts, or feelings
•Be aware of how your student may interact with others
•Watch for overloading
•Help the student learn stress management skills
•Be supportive and encourage involvement in sports and other pro-social activities

"One of our greatest concerns is when stress leads to anxiety, depression, or even suicidal thoughts," says Dr. Wilson. "When stress becomes dangerous, it's really important for parents, teachers, counselors, and their peers to pay close attention, and seek help for the student."

Dr. Wilson offers these tips for students to help manage stress:

•Get organized and take better control of the way your time and energy is spent.
•Control who you surround yourself with and what you are surrounded by.
•Give yourself positive feedback.
•Reward yourself by planning leisure activities.
•Get the right amount of rest.
•Eat right.

When stress gets beyond normal levels or beyond parental comfort level, contact your school counselor or seek assistance from a child and adolescent psychiatrist in your local area.


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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