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Tips from a pediatrician at each age

By: Jessica Meszaros


For parents and kids, going back to school is a time to reexamine more than just what’s inside their backpack. From immunizations to athletic physicals and even mental health evaluations, there are questions and discussions for parents to have with both their child and their child’s physician.

Medical conversations about physical and cognitive development are important at every age, especially prior to the stress of returning to school.

Dr. Jamie Kondis, Washington University emergency department pediatrician at St. Louis Children’s Hospital, has provided tips and topics for families to discuss at various ages and stages.

Kindergarten and elementary school students

According to Dr. Kondis, the best tip for parents and kids at this level is to, “Start thinking about going back to school as soon as possible, and have parents think about any sort of accommodations kids might need for the year.”

• After talking with your child’s pediatrician, contact the school weeks in advance to discuss unique accommodations your child may need, including medication.

“Do they need to have an epinephrine pen at school? Or do they need to have Benadryl at school? Things like that,” Dr. Kondis said. “Just making sure that parents kind of square that away before the first day of school with their doctors so that they’re not just showing up with medications in incorrect forms.”

• Many mandatory immunizations are required before entering kindergarten, so plan ahead. The American Academy of Pediatrics [AAP] recommends parents try to schedule yearly wellness visits around the time of back to school. Parents can review lists of required vaccinations at healthychildren.org, which is supported by the AAP.

• Develop a good sleep routine before school starts. According to Dr. Kondis, an optimal amount of sleep for young kids is 10 to 12 hours.

“We see a lot of problems with kids having a hard time concentrating because they don’t get enough sleep,” Dr. Kondis noted. 

Middle school students

Middle school is a time where students likely will see a larger boost in schoolwork. It’s important for pre-teens to learn healthy study habits early, as well as healthy ways to diffuse stress like exercise or other extracurricular activities.

• Develop healthy study and homework habits. Creating a designated study space inside the home is necessary for students. Discuss time-management skills to accommodate for the increased assignment load.

• Discuss how to avoid overuse of electronics. Symptoms of electronic overuse can include fatigue, insomnia, eye strain and bad posture. Pediatricians can offer tips for combating this. 

“[Kids] need to let parents know when they need breaks, or if they have to take a few moments to stretch and walk around so that they’re not getting these vision problems and other issues,” Dr. Kondis said.

• Be aware of where your kids are before and after school, as they become involved in more extracurricular activities inside and outside of school.

“I think this is an age where parents start to let kids walk alone before and after school, and also take part in more extracurricular activities,” Dr. Kondis said. “Our recommendation is that, unless they are incredibly mature 11- and 12-year-olds, we really don’t recommend them being home alone until they’re around 13 or more into their teenage years.”

As kids begin to explore more hobbies through recreational activities, it’s important that parents also be aware of the training and identity of all program staff members.

“It’s important for parents to know who is in charge of those programs and what training the staff members have,” Dr. Kondis said. “We don’t recommend that they be one-on-one with adults, because child abuse is a concern at this age. They’re still at that pre-adolescent age, so they can be talked into things by not-so-good grown-ups. That’s something parents need to be talking to their children about.”

High school students

High school is an age where students and parents should have discussions about “tough topics” while also keeping an eye on possible flags regarding mental health.

• Have discussions about topics like sexual activity and drug abuse. 

“A big thing that we’re seeing right now with teens is not necessarily drug use, but the alternate products like the e-cigarettes and things that teenagers might not think of as dangerous, but they definitely are.”

• Watch for signs of over-scheduled students, especially with competitive athletic programs. High school athletes should have a sports physical at least six weeks prior to the start of school or athletics to determine overall health and risk of injury.

“If you’re a swimmer, you should be looking for shoulder pain from over-use, or whatever particular injuries might occur in a particular sport,” Dr. Kondis said. “We’re definitely seeing a lot more over-use injuries, like shin splints, that we didn’t used to see in teens. There are so many teenagers now who are in these regionalized athletics that are so much more high-impact than they used to be.”

• Talk about health scares teenagers can face.

Discuss mental health issues such as depression or suicidal thoughts. Teenagers can be prone to eating disorders or self-harm. Talking to a pediatrician can help parents narrow down signs for specific concerns.

While signs vary from teen to teen, parents should be on the lookout for signs like excessive sleeping or insomnia, lost interest in hobbies, a sudden decline in academic performance, a sudden change in appetite, weight loss or severe changes in personality.

“All of a sudden if they’re really angry or really aggressive, or maybe they’re snapping at people they didn’t used to snap at,” Kondis said, of some things to look for. “Or anything that would indicate a change in self-esteem. Maybe they just seem down on themselves all the time.”

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